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Medicaid cuts threaten app for recovering opioid users

Hey,Charlie is an app that seeks to help people recovering from opioid addiction rebuild their social networks. But Medicaid cuts would mean a difficult road ahead for the app, which wants to remain free to users.

“It’s just a very big unknown right now,” said co-founder Emily Lindemer.

“It’s going to be tough,” said Ben Pyser, head developer. “Having a new, paid-for-by-Medicaid app is going to be something that is on the chopping block off the get-go.”

The Senate’s plan would cause 22 million more Americans to be uninsured by 2026, according to the Congressional Budget Office. Medicaid and other health insurance subsidies would be cut by more than $1 billion per year within five years. In Massachusetts, 264,000 residents would lose coverage under the Senate bill, according to an estimate from Governor Charlie Baker’s office.

These cuts are especially daunting for programs and initiatives addressing the opioid epidemic. Many people struggling with opioid addiction rely on Medicaid for health insurance. “If you think about it, most people who are very deep into the struggle of addiction have lost their jobs, so they’ve lost private insurance,” said Lindemer. “If they are insured, it’s on Medicaid. [Cuts] will be very devastating.”

Massachusetts had the highest rate of opioid-related ER visits among states, according to a 2014 federal report, the latest data available. The report reveals that more than 450 opioid-related ER visits were made for every 100,000 residents in the state. Opioid addiction is also a difficult habit to kick. Last year, nearly 2,000 people throughout the state died of opioid overdose. The relapse rate is about 80%.

Hey,Charlie, which began at the MIT Hacking Medicine hackathon in 2016, seeks to help people recovering from opioid addiction rebuild their social environments. Lindemer pitched the idea after watching a close friend struggle with addiction and relapse.

The app runs in the background of the user’s phone, using a machine learning algorithm to analyze peoples’ behavior. When people demonstrate behavior that the app considers risky, based on behavioral psych research about relapse, the app sends push notifications, which Lindemer calls “nudges,” to ask people if they’re sure they want to continue. Hey,Charlie doesn’t block phone numbers or censor texts, but it hopes to help people reconsider before making decisions with potentially negative consequences. In addition, the app sends aggregated information about peoples’ behavior to their healthcare providers, hoping to foster more meaningful conversations around recovery.

Hey,Charlie has sparked interest among the Boston healthcare community, particularly at MIT, where it drew initial funding, and the PULSE@MassChallenge accelerator, which it recently completed. It’s wrapping up the IRB approval process and preparing for a pilot project at Boston Medical Center later this summer.

But as the possibility of Medicaid cuts looms, the startup is weighing its options for funding and survival.

“If Medicaid were to be cut, I think what would be next for us is that we are definitely interested in trying to get reimbursed by ACOs,” said Lindemer. “They tend to take on very high-risk patients and bundle them together and say, ‘We’re going to buy the patients’ insurance plan, because we think we can take care of them for cheaper.’”

“We’re going to always be 100% free to the user. That’s our mission,” said Pyser. “Our goal is to get ACOs to be the ones that are paying for this.”

Recently, the team ran a series of IRB-backed clinical trials to prove efficacy. This process has delayed the app store launch. But the team wants to demonstrate results.

“We want to show that we can actually help people,” said Lindemer. “If we can do that, we have a chance that we can get reimbursed one day by insurance networks.”

Proving efficacy could be crucial to securing funding down the road, especially if Medicaid is cut.

“If we’re starting to cut that [Medicaid], it’s not going to change the number of people who are going to be relapsing and need this help,” said Pyser. “The problem’s not getting less—it’s going to keep on happening.”

“There are some fantastic organizations out there that help people no matter what their situation is, if they have insurance or not,” said Lindemer. “But those organizations run on grants. They’re nonprofits. They just can’t help everyone.”

The Senate has delayed a vote until after the July 4th recess.

Amy Pollard

Amy Pollard

    Amy Pollard is a candidate for the MA in Communication and International Relations at Boston University. Her interest in health care began with her first trip to Tanzania, where she volunteered at a medical dispensary in a rural village and saw firsthand how access to health care impacts patients. She’s excited to learn about health care technology in Boston. She’s originally from Seattle and holds a B.A. in English from Saint Martin’s University. When she’s not writing, she’s probably drinking coffee, making tacos or watching Parks and Rec. Follow her @amyannexu.

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