Rewards-based digital coaching for those who misuse alcohol and want to quit is now open to Vermont Medicaid members. The program is part of a research study.
Participants are recruited and can remain anonymous. Once selected, they will have access to digital coaching and information and will be given monetary incentives for staying sober.
VPR’s Mary Engisch spoke with Scott Strenio, Chief Medical Officer for the Department of Vermont Health Access, about the study, its implications and how the pandemic provided a sort of silver lining in terms of participants' willingness to engage with health care platforms online. Their conversation has been edited and condensed for clarity.
Mary Engisch: Just a quick note about what Medicaid is and who it serves in Vermont: It's a health plan, it pays for medical costs for folks in Vermont who are older, blind, disabled or who make under a certain income level. And in Vermont, there are about 190,000 members who use Medicaid.
Scott, I understand you're working with a company called DynamiCare. Tell me more about what exactly this is.
Scott Strenio: What it basically is, is an expanded version of the study that DynamiCare did on Cape Cod, to help people with alcohol use disorder. And it's really quite powerful.
The data that they collected in Cape Cod showed evidently very impressive results, so that the NIH did fund this $1.6 million study; Vermont is not spending a dime on this study.
Okay, so how does it work for folks who use Medicaid and who sign up?
It's a combination of a smartphone with an app that allows people to be remotely tested for different substances, whether it's alcohol, for tobacco and other substances. In addition to that there are incentives. In the beginning, there's small monetary incentives that are automatically uploaded to a Visa card that the participant has, which is actually not able to be used in bars or for other substances of abuse potential. And over a period of time, different participants can accumulate a fair amount of money, I believe, upwards of $800 over the course of the study, which I think is about a year.
In addition to that, they have access to recovery coaches, literature, materials that people can read and actually get a dollar, let's say, here and there, for actually reading the article. It's really quite innovative. We're glad to be participating.
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Scott, let’s say you misuse alcohol, you want to participate, you use Medicaid, how are you recruiting folks for this study?
So our partnership with DynamiCare was twofold. One was to facilitate their ability to recruit independently people from Medicaid. So we helped put them in touch with different organizations, practices, facilities, in which they might be able to recruit people that would fit the bill. And on the back end, we are hoping to supply them with aggregated de-identified data on how that population who was in the study: How did they do? Were there more or less hospitalizations, (emergency room) visits, that kind of thing?
"...we actually have greater morbidity and mortality from alcohol use disorder than we do from opioid use disorder." - Scott Strenio, Department of Health Access
Where does Vermont land in terms of alcohol consumption?
We certainly are in the top 10 in the country. We are above the national average, in alcohol use disorder.
You know, parenthetically, we actually have greater morbidity and mortality from alcohol use disorder than we do from opioid use disorder. That's the other piece that sometimes becomes unattended to, if you will.
If the desired outcome is to continue to have folks abstain, will it last once this trial is over? Is there any data that shows that?
We have [one of] our colleagues at the University of Vermont, Dr. Higgins, who has used similar technology and methodology for pregnant smokers, and has shown really quite amazing outcomes in using this, so we were pretty comfortable in partnering with DynamiCare.
We’re hearing more about the pandemic's effect on people's misuse of alcohol. Was launching the study in place before (the pandemic)?
This actually was in the works before, just because of the amazing results that Dr. Higgins had already demonstrated with pregnant smokers.
If you think about it for a minute, this was sort of a silver lining that during the public health emergency, people have become much more willing and accepting of using remote devices. And so this was a perfect time to implement and deploy a study in which that's the central piece, right?
For the Medicaid population, one thing that is very concerning is that they really are the most vulnerable population that any health plan takes care of. Part of that vulnerability is a lack of transportation, a lack of access to health care and particularly New Americans or minority groups.
So having access to health care through a remote device takes away much of that. You don't have to worry about having a car or transportation to get in. And it's not just about getting tested. It's also about having the coaching and everything else that goes along with it.
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