Applying Technology-Enabled Contingency Management for Alcohol Use Disorder At Scale in a Medicaid Population

7. Project Abstract This application proposes to continue clinical effectiveness and cost-effectiveness testing of the DynamiCare Health platform. This is an innovative smartphone-based digital coaching program that offers remotely-delivered contingency management (CM), Recovery Coaching, and cognitive behavioral therapy (CBT) content to address alcohol use disorder (AUD). CM, which uses financial incentives to reward abstinence and treatment attendance, is one of the most effective, evidence-based, and overlooked intervention for substance use disorders (SUD). DynamiCare, through its remote delivery system, has addressed the logistical barriers to adoption, and now seeks, through this proposal, to drive payer adoption. Our Phase 1 preliminary data shows that the intervention is acceptable and can be highly effective when delivered as a supplemental therapy to persons with AUD enrolled in treatment. Phase 2 proposes to partner with Vermont (VT) Medicaid to deploy and test the fully developed intervention in an RCT among individuals with AUD (n=300). Our goals are to: 1) Deploy the DynamiCare CM and digital coaching program at scale among VT Medicaid members with AUD; 2) determine clinical effectiveness; and 3) evaluate the cost-effectiveness and return-on-investment from the payer perspective. This study design addresses a lack in the CM literature of empirical evidence on the cost-savings for payers from CM. If CM can be shown to create cost-savings for payers, the final barrier to widespread adoption would fall. Overall, this Phase 2 project, which follows a highly successful Phase 1, will provide critical data to advance the utility of this innovative digital platform as it is deployed in the real world to help the millions of people with AUD.8. Project Narrative DynamiCare Health has developed a digital coaching program to address alcohol use disorder (AUD), combining Recovery Coaching, cognitive behavioral therapy content, and contingency management (CM), which is one of the most effective yet under-utilized interventions in addiction treatment. This project builds on initial clinical success in Phase 1 to deploy this program at-scale in partnership with a state Medicaid agency, to measure clinical impact and cost effectiveness. If successful, this project will provide the national healthcare system a powerful new multi-modal intervention to decrease the harms and costs associated with AUD.