Precision Medicine and Digital Health's Role in ALD Care: Elliot Tapper, MD

Alcohol-associated liver disease (ALD) and metabolic and alcohol-associated liver disease (MetALD) account for a growing share of the chronic liver disease burden. In these conditions, mental health is rarely incidental, and missed interventions carry steep consequences. Depression, anxiety, and alcohol use disorder travel alongside these diagnoses, driving nonadherence, relapse, and poor post-transplant outcomes, yet behavioral health care remains siloed from hepatology practice.

Digital health tools are increasingly being looked to as a bridge: prescription digital therapeutics and mobile health apps have shown promise in expanding access to mental health support, particularly for patients in provider shortage areas where psychiatric care is scarce.¹ But without a clear road map for language and cultural access built in from the outset, these tools risk exacerbating the very disparities they aim to close.²

The tension between digital health's promise and its pitfalls extends across chronic disease care broadly. A persistent digital divide affects underserved groups, including low-income, uninsured, and limited English proficient patients who already carry a disproportionate burden of chronic disease.³ The expansion of health technology has, in some cases, widened that divide, with those who already have access and digital fluency benefiting the most. A 2026 analysis of more than 250,000 adults with chronic conditions found that older patients, Black patients, and non-English speakers showed significantly lower odds of patient portal use compared with their younger, White, and English-speaking counterparts, underscoring how digital health equity gaps can persist even within integrated health systems.⁴

At the 2026 European Association for the Study of the Liver (EASL) Congress, Elliot Tapper, MD, associate professor in the Division of Gastroenterology and Hepatology and academic chief of hepatology at the University of Michigan Medical School, took up both challenges. He discussed how precision medicine and digital health can work in concert to reduce morbidity and mortality in ALD and MetALD.

This interview has been lightly edited for clarity.

The American Journal of Managed Care^® (AJMC^®): ALD and MetALD represent a growing share of chronic liver disease burden. How are precision medicine approaches beginning to change how we stratify risk for these patients?

Tapper: Right now, the key is identifying the alcohol use and addressing that. There are no metabolic risk factors that are as risky for disease progression as alcohol.

AJMC: What does the evidence show about digital health tools like mobile health apps or digital adherence support in terms of improving outcomes for patients with liver disease? Where is the signal strongest?

Tapper: At EASL Congress, I discussed the innovative use of ambient mobile phone sensors to predict alcohol consumption, which could enable just-in-time interventions to reach patients when they are most vulnerable. I also highlighted the MyWayUp app developed by a group in Barcelona. This is a unique and powerful tool to enhance self-management skills and improve abstinence.

AJMC: Mental health assessment is often siloed. Why is it important for hepatologists specifically to take ownership of this issue in their chronic liver disease patients?

Tapper: Mental health conditions are not incidental in chronic liver disease. They drive nonadherence, alcohol relapse, and poor post-transplant outcomes, making them directly within the hepatologist's therapeutic purview. Waiting for a referral that may never be completed means the window for intervention closes, often at the most consequential moment in a patient's disease course.

AJMC: What screening tools do you find most useful in identifying mental health problems in a busy hepatology clinic, and are any of them validated specifically for the chronic liver disease population?

Tapper: I like the Hospital Anxiety and Depression Scale. It has the advantage of de-emphasizing somatic symptoms that overlap with liver disease itself, making it arguably more specific. It was recently validated in cirrhosis by Nneka Ufere, MD, in Hepatology Communications.⁵

AJMC: When a hepatologist identifies a patient with depression, anxiety, or another mental health condition, what are the realistic options for what they can actually do about it, especially in practices that don't have embedded behavioral health staff?

Tapper: Hepatologists can initiate selective serotonin reuptake inhibitors for depression and anxiety. We should feel empowered to do so rather than deferring indefinitely.

References

1. Brezing CA, Brixner DI. The rise of prescription digital therapeutics in behavioral health. Adv Ther. 2022;39(12):5301-5306. doi:10.1007/s12325-022-02320-0
2. Payer perspectives on prescription digital therapeutics for psychiatric disorders. AJMC. October 2, 2025. Accessed May 22, 2206. https://www.ajmc.com/view/payer-perspectives-on-prescription-digital-therapeutics-for-psychiatric-disorders
3. Wang K, Hernandez AM, Penate V, Abhat A, Casillas A. Digital health implementation among older adults: health technology navigators' perspectives. Am J Manag Care. 2025;31(5):e125-e131. doi:10.37765/ajmc.2025.89736
4. Adler-Milstein J, DeMasi O, Soleimani H, et al. Insights into patient portal engagement leveraging observational electronic health data. Am J Manag Care. 2026;31(1):42-48.
5. Zeng C, Donlan J, Indriolo T, et al. Validation of the Hospital Anxiety and Depression Scale in patients with decompensated cirrhosis. Hepatol Commun. 2024;8(12):e0588. doi:10.1097/HC9.0000000000000588