Incentivized Collaborative Care to Desseminate Contingency Management

ABSTRACT Contingency management, an incentive-based intervention, boasts a massive research base and has been demonstrated efficacy in increasing drug abstinence and medication adherence in people with opioid use disorder. There is a huge gap between the evidence in support of this approach and its dissemination in practice. A digital health program that surmounts most of the barriers to dissemination has been developed that collects all the relevant data and implements all of the contingency management procedures automatically. This program has been shown to be efficacious in several peer-reviewed studies. However, one key barrier to dissemination remains. In order for contingency management to become truly impactful on a national scale, providers must actively engage patients by informing them about it, encouraging them to use it, assisting their enrollment, and then using the data generated by the platform to inform their ongoing care. The best way to surmount this final barrier is to use the motivational technique of contingency management itself; incentivize the necessary provider behaviors. Thus, this SBIR Fast Track application proposes to develop and evaluate a novel incentivized collaborative care model for the delivery of contingency management services for buprenorphine pharmacotherapy patients with opioid use disorders. We believe this model will have the important secondary effect of increasing access to buprenorphine pharmacotherapy, as prescribers will be indirectly incentivized to maximize the number of buprenorphine patients in their practice. Phase I will begin with preparatory activities, including streamlining the enrollment system so that any buprenorphine prescriber can use it, adding data collection systems for provider information, and data display systems that providers can use to easily access the patient data they wish to see. A Phase I feasibility study (n = 10) will follow. The milestones require the potential of the incentivized collaborative care model in disseminating contingency management to be demonstrated. If successful, the feasibility study will pave the way for a randomized controlled trial (RCT). This RCT will be the primary activity of Phase II of this SBIR award, and is designed to evaluate the efficacy of incentivized collaborative care in the dissemination of contingency management. Primary outcome measures will include the engagement in collaborative care in relation to the contingency management intervention, as well as buprenorphine prescribing trends. Secondary analyses will be designed to assess the economic effect of DynamiCare on providers. The RCT will also include exploratory analyses of patient outcomes. Overall, this project is highly consistent with current ONDCP priorities to, “Identify and address policy barriers related to contingency management interventions (motivational incentives),” and “Explore reimbursement for motivational incentives and digital treatment for addiction.” If successful, this project could lead to rapid dissemination of contingency management and improved access to buprenorphine pharmacotherapy to people with opioid use disorder throughout the United States.