Improved Outcomes & Healthcare Savings: The WEconnect Solution
Introduction: My Summer with WEconnect
My name is Doug Pollack, and I was WEconnect Health’s first graduate student summer intern. Right now, I am wrapping up a joint-degree MBA and MPH program UC Berkeley, with one semester to go. At Berkeley, I’ve focused on health economics and healthcare strategy. Most importantly: I am passionate about working in behavioral health and treatment for substance use disorder.
In early March, the Berkeley Haas Healthcare Association held a student-run conference in San Francisco that was nearly cancelled due to the start of the COVID-19 outbreak. The CEO and co-founder of WEconnect Health, Daniela Luzi Tudor, was a speaker on the first panel about the opioid epidemic in the US that I attended: “Dismantling America’s Addiction Complex.”
Daniela was an exceptional speaker. She added insights on the current crisis and shared about the WEconnect app—how it uses contingency management to drive behavior change for members in recovery in addition to providing online peer recovery support services and live digital recovery support meetings.
One of my favorite public health courses that semester, Population Health Economics, had just covered the strengths of contingency management—rewarding behavior with incentives—as a public health intervention. In the course, I learned that even after the extrinsic motivation of the rewards has ended, good habits tend to persist after the conclusion of the treatment.
To conclude my successful internship with WEconnect Health, I prepared a white paper that summarized key findings from my summer’s research on the evidence supporting the effectiveness of WEconnect’s digital health solution. I hope that the substantial evidence supporting contingency management and peer recovery support services will allow these effective treatments for substance use disorder to become more widely available in the face of the opioid epidemic in the US.
In the United States, about 10% of the population is living with a substance use disorder (SUD), and only about 19% of those with an SUD are able to access treatment (Bose, 2017). Patients who go untreated for SUDs are more likely to have frequent emergency department visits and repeated hospitalizations. People living with SUDs have 2.2 times higher odds of hospitalizations relative to abstainers, and SUD and its treatment can significantly impact costs of care for other physical and behavioral health conditions, in addition to the cost of care directly related to SUD (Gryczynski et al., 2016).
WEconnect Health, a digital behavioral health solution, provides an effective treatment option for members in recovery from SUD. The WEconnect platform actively strengthens patient engagement in their recovery process. Through the WEconnect app, contingency management, peer recovery support services, and online group meetings drive patients to partake in healthy behaviors such as adhering to their pharmacologic therapies, or Medication-Assisted Treatment (MAT).
Evidence-Based Treatment through WEconnect Services
Contingency management, a key pillar of the WEconnect platform, is an evidence-based behavioral therapy that rewards positive behaviors, applying principles of operant conditioning theory and positive reinforcement to promote cognitive and behavioral modifications. As a form of contingency management, WEconnect rewards members with Amazon gift cards for adhering to their treatment plans developed with their providers or peer recovery support specialists (PRSS, or “peers”).
Substantial evidence from dozens of studies supports the effectiveness of contingency management. A report of literature on contingency management interventions for SUD from 2009 through 2014 showed that 86% of the studies reviewed (59/69) “reported significant (p<0.05) during-treatment effects (Davis et al., 2016).” Furthermore, a 2017 meta-analysis of 22 studies on the effectiveness of contingency management in treating SUDs indicated that contingency management performed significantly better than controls in reducing substance use with a Population Effect Size (d) of 0.57 for the longest duration of abstinence when analyzing differences in mean abstinence rates (Ainscough et al., 2017). In another study, 31% of participants with opioid use disorder (OUD) engaging in contingency management alone achieved abstinence in comparison with 13% in control conditions (Dutra et al., 2008).
The more recent supporting evidence for contingency management as a treatment for SUD is also extensive. Studies have shown that it can lead to “reductions in drug use that persist for 12–18 months after treatment completion (McPherson et al., 2018)." Preliminary evidence also showed that contingency management for treatment of methamphetamine use disorder had a secondary effect of decreasing rates of cigarette smoking. One study on its application for cannabis use disorder showed that the intervention with contingency management and CBT was "just as efficacious in abstinence rates and reduction in days of use over time when delivered by computer as it was when delivered by a therapist (McPherson et al., 2018)."
Peer Recovery Support Services (PRSS, or “peers”), another pillar of WEconnect’s treatment for members, is also supported by research to show improvement in several recovery-related outcomes. In addition to increased access to telehealth/telerecovery services, peer support can lead to extended periods of abstinence from an individual's substance of problematic use, reduced hospital readmissions, and improved post-discharge treatment adherence (Ashford et al., 2020). Digital recovery support services (a form of telehealth service) can also help to remove barriers—such as transportation, employment schedules, child care, etc.—in accessing traditionally effective recovery support mechanisms.
WEconnect peer specialists work with members to develop a comprehensive recovery plan that is tailored to each members’ individual strengths, needs, and goals. Recovery plans focus on helping members to build their recovery capital and to improve their social determinants of health in recovery.
Online Recovery Support Meetings: Online support group meetings for members in recovery (another service provided by WEconnect Health) serve as an additional effective form of treatment for SUD. Support groups provide positive peer support and encouragement to maintain abstinence, reduce the sense of isolation that many in recovery experience, and allow group members to see examples of others in recovery. This allows members to learn how others deal with similar problems, to give and receive feedback, and to instill a sense of hope for the future (Treatment, 2005).
WEconnect Study Results & Implications
A 6-month 2019 study of 190 Pennsylvania Medicaid members showed that use of the WEconnect app was associated with a 35% higher adherence in filling medication-assisted treatment (MAT) prescriptions and a 76% higher rate of primary care provider (PCP) engagement when compared to the control population (p<0.01).
Long-term adherence to pharmacologic therapies, or MAT, significantly reduces overall healthcare costs. In one study, after a six-month period, those on MAT had 29% lower overall annual health plan costs compared to those with no medication, even with higher pharmacy costs (Baser et al., 2011). In a 2010 five-year study, members on MAT had 50% to 62% lower total annual commercial health plan costs, even though the typical pharmacological therapy treatment period lasts less than one year (McCarty et al., 2010).
Higher engagement with primary care providers during treatment for substance use disorder, another result of the Pennsylvania study, is also beneficial for sustaining treatment adherence. Initial visits with PCPs work to facilitate relationship-building and encourage future visits; this allows patients to be referred to the appropriate levels of care, and reduces non-emergent emergency department (ED) visits.
These initial 2019 WEconnect study results with Pennsylvania Medicaid members are promising in validating the effectiveness of the WEconnect platform as it provides evidence-based treatments to its members. The WEconnect evidence-based approaches, including contingency management, peer recovery support services, and online group meetings, work to engage members in healthy behaviors that support their recovery, including pharmacologic therapy adherence and primary care provider visits. Providing access to effective treatment allows WEconnect to achieve its mission to save lives, provide accurate outcomes data, and support healthcare ecosystems, communities and families.
Ainscough, T. S., McNeill, A., Strang, J., Calder, R., & Brose, L. S. (2017). Contingency Management interventions for non-prescribed drug use during treatment for opiate addiction: A systematic review and meta-analysis. Drug and Alcohol Dependence, 178, 318–339. https://doi.org/10.1016/j.drugalcdep.2017.05.028
Ashford, R. D., Bergman, B. G., Kelly, J. F., & Curtis, B. (2020). Systematic review: Digital recovery support services used to support substance use disorder recovery. Human Behavior and Emerging Technologies, 2(1), 18–32. https://doi.org/10.1002/hbe2.148
Baser, O., Chalk, M., Fiellin, D. A., & Gastfriend, D. R. (2011). Cost and utilization outcomes of opioid-dependence treatments. The American Journal of Managed Care, 17 Suppl 8, S235-248.
Bose, J. (2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. 124.
Davis, D. R., Kurti, A. N., Skelly, J. M., Redner, R., White, T. J., & Higgins, S. T. (2016). A review of the literature on contingency management in the treatment of substance use disorders, 2009–2014. Preventive Medicine, 92, 36–46. https://doi.org/10.1016/j.ypmed.2016.08.008
Dutra, L., Stathopoulou, G., Basden, S. L., Leyro, T. M., Powers, M. B., & Otto, M. W. (2008). A Meta-Analytic Review of Psychosocial Interventions for Substance Use Disorders. American Journal of Psychiatry, 165(2), 179–187. https://doi.org/10.1176/appi.ajp.2007.06111851
Gryczynski, J., Schwartz, R. P., O’Grady, K. E., Restivo, L., Mitchell, S. G., & Jaffe, J. H. (2016). Understanding Patterns Of High-Cost Health Care Use Across Different Substance User Groups. Health Affairs (Project Hope), 35(1), 12–19. https://doi.org/10.1377/hlthaff.2015.0618
McCarty, D., Perrin, N. A., Green, C. A., Polen, M. R., Leo, M. C., & Lynch, F. (2010). Methadone maintenance and the cost and utilization of health care among individuals dependent on opioids in a commercial health plan. Drug and Alcohol Dependence, 111(3), 235–240. https://doi.org/10.1016/j.drugalcdep.2010.04.018
McPherson, S. M., Burduli, E., Smith, C. L., Herron, J., Oluwoye, O., Hirchak, K., Orr, M. F., McDonell, M. G., & Roll, J. M. (2018, August 13). A review of contingency management for the treatment of substance-use disorders: Adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies. Substance Abuse and Rehabilitation; Dove Press. https://doi.org/10.2147/SAR.S138439
Treatment, C. for S. A. (2005). 1 Groups and Substance Abuse Treatment. In Substance Abuse Treatment: Group Therapy. Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK64223/