Addiction to opioids, alcohol, and other drugs have devastating individual and family effects and too often end lives prematurely while driving enormous inefficiency in health care. Unlike many other chronic conditions — where “standards of excellence” inform consumers, health systems, and payers about best practices and services that should be available — today’s recovery services are delivered through a method often lacking alignment or integrated economic structures that incentivize long-term recovery. In late 2016, the U.S. Surgeon General issued the seminal “Surgeon General’s Report on Alcohol, Drugs, and Health: Facing Addiction in America.” The report issues a call for mainstream health systems to begin integrating substance use services was afforded an entire chapter. In response, organizations have formed the Alliance for Addiction Payment Reform (Alliance) to: Provide guidance, recommendations, and tools for the development of integrated delivery models of care for addiction; Collectively champion payment reform and shifting towards value-based purchasing in addiction care; and Advance value-based models nationally through private and public channels. ​ The Alliance, comprised of dozens of health care institutions and professionals, developed the Addiction Recovery Medical Home Alternative Payment Model (ARMH-APM) to establish a structure that promotes the type of integration and patient care capable of producing improved outcomes for patients, payers, and health systems long-term by aligning all incentives. The ARMH-APM was initially developed by a multi-sector process convened by Leavitt Partners, Facing Addiction with NCADD, and Third Horizon Strategies and published in 2018. In 2019, Third Horizon Strategies continued to manage the work on behalf of the Alliance and released an updated paper coinciding with the announcement of pilot explorations of the model in local markets.

U.S. health care is truly transforming in a very unique and exciting way. Third Horizon Strategies focuses on the confluence of key market trends and signals that indicate how the health care ecosystem will operate in the future. This “third horizon” vision is critically important to organizations making serious strategic, investment, and partnership decisions that will fundamentally shift the way key assets are managed and deployed. Together, policy makers, market stakeholders, and consumers will shape a future system that actualizes common access to health care, improved efficiency, and sustainable culture of health. Third Horizon Strategies provides the strategic planning, intelligence sharing, and collaborative problem-solving necessary to arrive at that future state.

Wellth’s smartphone-based Medication Adherence Rewards Program motivates and empowers individuals diagnosed with chronic behavioral health conditions to engage in the daily healthy behaviors that generate actual clinical outcomes. Using a repetitive trigger-behavior-reward interface, Wellth develops a long term habit of self-management and has shown the ability to improve outcomes for our partners including ED utilization, readmissions, and metrics like A1c control for Diabetics. ​ Wellth’s solution is offered to high-acuity health system patients through an intuitive smartphone app that includes daily personalized nudges as well as quick photo ‘check-ins’ for daily medications. Patients enrolled into the program are endowed a $30 reward balance on the first day of each month, but must consistently upload their medication photos each day to earn the full reward. Deductions of $2 per day are made for missed photo uploads (until a minimum balance of $0). Our Wellth Member Educator team regularly monitors enrolled member behaviors, outreaches to members flagged as nonadherent, and initiates motivational interviewing discussions with nonadherent members if appropriate. The Member Educators also communicate regularly with health system care managers to report on patient adherence behaviors.

Wellth is a behavioral economics company focused on helping patients with chronic behavioral and physical health conditions improve the daily behaviors that actually determine outcomes. Wellth is the only digital intervention in the market that gives the necessary daily financial incentives to overcome patients’ Present Bias, which means that human behaviors are motivated by immediate and tangible benefits, not what we rationally know is good for us in the long term. Wellth’s smartphone-based Medication Adherence Rewards Program has consistently produced adherence rates of 85-90%+ even in behavioral health populations diagnosed with serious mental illness, heavily impacted by substance use disorders, and comorbid with physical health diagnoses.

Third Horizon Strategies is a Chicago-based, boutique advisory firm focused on shaping a future system that actualizes a sustainable culture of health nationwide. The firm offers a 360º view of complex challenges across three horizons – past, present, and future– to help industry leaders and policymakers interpret signals and trends; design integrated systems; and enact changes so that all communities, families, and individuals can thrive.

Health systems and providers give great care within the provider setting but lack the ability and resources to motivate and engage with and serve their patients at home. They must fully rely on their patients to not only pick up their prescriptions but actually adhere to their treatment plan at the right time every single day. Health systems largely do not have the expertise or capabilities to drive real behavior change in the most complex populations that have a history of being unresponsive to standard care management protocols. Although some providers may have implemented digital or remote solutions to improve adherence, they are limited by the large number of patients who eventually stop engaging with those devices. Finally, health systems may not have adequate resources or integration capabilities to support additional care management workflows. Wellth has the expertise to implement the optimal incentive design to motivate the highest acuity portion of a health system’s population, which has historically been unresponsive to all other self-management and adherence initiatives. Our solution streamlines disparate health system care management efforts by improving adherence to behavioral health, physical health, and SUD care plans at the same time. Our daily adherence insights extend much farther than the limited pharmacy claims data that health systems currently use to triage their patients, and we have the resources within our Wellth Member Educator team to act on those insights immediately and outreach to nonadherent members.

Wellth’s key differentiator from all other adherence-focused vendors is that it applies the most appropriate strategies from behavioral economics, choice architecture, and habit science at every patient touchpoint, to maximize engagement and behavior change. For instance, Wellth successfully increased enrollment rates by endowing members with a financial rewards balance upon enrollment; this is explained by a behavioral economics concept known as the ‘endowment effect’. Furthermore, one of the optimal incentive designs within the Wellth program is to require members to consistently demonstrate adherence each day to avoid deductions from their endowed balance; this concept is defined as ‘loss aversion’ and has been proven to be highly effective in incentivizing behavior compared to gain or lottery incentives in certain situations. Wellth has also carefully designed daily medication check-ins to ensure an enjoyable process for the patient that takes less than 2 seconds. Compare this to other solutions which require patients to show themselves swallowing each pill individually, in a time-intensive, unenjoyable interaction that provides no reward for doing so.