Incentivizing Recovery: Payment, Policy, and Implementation of Contingency Management

Audience Q&A

By Bonnie Tse February 8, 2024
Grid image of moderators and speakers who took part in the convening.


Keynote Session

Q1: Can you talk about why a medical team may use design thinking vs. implementation science frameworks to approach the broader adoption of contingency management?

Q2: Once you go through the design thinking process, what is the next step in using the results? Do you suggest advocacy, advertising, applying for funding, or something else?

Panel One

Q3: Hasn't the VA been utilizing contingency management for some time (over a decade)?

Q4: What are the policy arguments against the national use of contingency management, assuming stigma is not a factor?

Q5: Can you discuss any successful programs that use opioid settlement dollars to fund incentives for contingency management?

Q6: Can you discuss the importance of over-amping education in conjunction with contingency management programs in case folks return to use?

Q7: So, right now, would this need to be done at the state level through the Medicaid waiver process?

Q8: One of the top reasons people cite for not entering treatment is not being ready/wanting to stop drug use. How can we use and financially sustain contingency management to incentivize treatment engagement and behaviors beyond negative UAs where abstinence is not desired or realistic?

Q9: The focus has been primarily on stimulants at the federal level, but is there discussion of expanding that to other substances?

Q10: How do we get federal and state governments to approve cash incentives, which evidence suggests may be most effective?

Q11: What’s the recidivism rate of return or increase of use after the incentives are stopped?

Q12: How do we, as contingency management program designers, advocate for reimbursement for these contingency management programs that are equitably adapted to our communities? For example, even where California is lucky to have the waiver, programs are quite rigidly implemented in a few select sites with no room for customization.

Q13: Is there any data on provider bias in administering contingency management?

Q14: I am very curious to hear about the buy-in in Montana because of how conservative it is.

Q15: Does contingency management reinforce individualized solutions to societal problems? For example, focusing on changing individual behavior rather than ensuring widespread access to economic security. Or does contingency management provide a pathway for demonstrating improved outcomes when people's basic needs are met?

Q16: Can anyone speak to the idea of using a third-party contract within your federal/state grant budget to bypass the need for so much program-specific admin? (e.g., Giving a contract to any LLC and then they manage contingency management incentives through payment apps like Venmo? It allows for the identified tracking required for incentive distribution AND gets around gift cards and gets actual cash into participants' hands)

Q17: Some protocols and pilots cap the maximum incentive at $599. What and who should be addressed to make sure that the IRS doesn't require the filing of tax forms? How do we address that issue?

Q19: Can the panelists reflect on the implementation of contingency management in medical settings that offer substance use disorder support? Do we see contingency management as being a potential tool in primary care? Are there examples of contingency management implementation within MOUD treatment, particularly for formerly incarcerated individuals?

Panel Two

Q21: What is the roadmap for state-level advocacy? It was mentioned multiple times that some states (MT, CA, VT) have been able to create state funding mechanisms to supplement the federal funding. In your experience, what arguments moved the needle policy-wise?

Q22: Are there many published testimonies supporting contingency management? It would be great to have these to reference as a way to combat stigma and advocate for the intervention.

Q23: Are there any examples of digital contingency management tools that are getting high marks from both providers and patients?

Q24: If a layperson asks you what contingency management is and why we do it, how do you respond concisely?

Q25: How do your contingency management programs deal with polysubstance use within the implementation structure?

Q26: Can you discuss some examples of contingency management work in the U.S. South?

Q27: Any experiences with video Directly Observed Therapy?