What evidence is there that financing will be sustainable beyond a pilot?

Funding for incentives can be provided by patients themselves (deposit contract), families (crowdfunding), insurers, employers, and/or government agencies. Each of these has been demonstrated to be feasible and sustainable in similar programs:

- Deposit Contracts (patients): We expect 10-15% of patients to be willing to deposit their own funds to earn back as an accountability tool for their recovery. In a study of financial incentives for smoking cessation, 14% of patients were willing to fund their own incentives (Halpern et. al, 2015). This approach has actually proven quite popular among smartphone users -- the commercially available Pact app has attracted 600,000 users who self-funded deposit contracts to incentivize themselves to work out or eat healthfully (Olson, 2014).

- Crowdfunding (families): Crowdfunding has already demonstrated success in helping patients raise money for many medical issues. In fact, three general-purpose crowdfunding websites (Rally.org, GoFundMe, and YouCaring) have found health care to be the most popular category for campaigns on their sites (Sharrock, 2013). Patients have been using these platforms to raise funds for their addiction recovery. We analyzed a sample of 150 patients using the Next Step debit card (a smart recovery-focused debit card) in 40 US private treatment programs, and found that families on average place $340 on each card per month– more than enough for effective CM incentivization.

- Payers: DynamiCare has secured a contract from a major national insurance company in paying for both the DynamiCare app and drug testing, and the financial incentives. Other payers – including managed Medicaid programs – have funded financial incentives in other disease areas to reward healthy behavior. The CeltiCare Health Medicaid program pays up to $210 for healthy behaviors (CeltiCare Health, 2017).

- Government: Researchers have estimated that for every $1 spent on CM, there are $34 in societal benefits. This is a substantial ROI for addiction treatment. DynamiCare’s approach offers a cost-effective way for states to reduce healthcare costs, solve social problems, and improve economic productivity (WSIPP, 2017).