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The Volpicelli Addiction Treatment Center uses psychosocial methods and digital therapeutics.
Bambi Francisco Roizen speaks with Dr. Joseph R. Volpicelli who runs the Volpicelli Addiction Treatment Center for drug and alcohol addiction using psychosocial methods and digital therapeutics. He is currently engaged in the recruitment and study of a clinical trial of the MODIA program, developed by Orexo. MODIA is a digital therapeutic used in connection with Buprenorphine, a medication used to treat opioid addiction. Digital therapeutics are psychosocial software products that deliver behavioral programs, such as cognitive behavioral therapy.
On the VatorNews "Invent Health" podcasts, our overall goal is to understand how technology is radically changing healthcare: the way we screen, treat and measure progress and outcomes. How we’re empowering the consumer. Whether we’re creating productivity that drives economic costs down? And how tech advancements change the role of the doctor.
Takeaways [slightly edited for clarity]
– Why start the Addiction Center?
A: I was a tenured professor at UPenn teaching for 25 yrs. Conducted research trials to look at effective treatments for addictions. I discovered that Naltrexone can reduce relapse in people who have alcohol use disorder. But one of the limitations of using this medicine was that people didn’t always take it. I designed a psychosocial treatment to increase patient engagement and retention. People were getting better in our clinical program. When it became time to apply that in clinical practice I met a lot of resistance since UPenn was more interested in clinical research than clinical practice.
– Impact of Covid mandates?
A: It’s clear that during the pandemic, the rise of behavioral health problems has increased. There’s been an increase in drinking, depression and anxiety. While lockdown helped slow the progression of the virus, prolonged lockdown has had profound effects on our mental health.
– What’s the challenge of addressing the alcohol epidemic?
A: People in the addiction community often have programs that are financially viable but aren’t programs that actually work. Also, we know what works but it’s not applied clinically and that’s due to systemic problems like reimbursement rates and having professionals who are well-trained to provide care.
– What can the government do to address systemic problems?
A: Reimbursement doesn’t always cover the expenses. When you integrate medical care with psychosocial care that’s the best approach to success. But often care is delivered and paid in silos. For instance, a primary care physician will prescribe Buprenorphin and Suboxone. But without psychosocial care, medication alone won’t be sufficient for people to recover from addiction. Then there’s psychosocial care that is typically in-patient and can cost up to $60,000 a month. So people go in for a month but then relapse right away. We need an approach and payment system that combines the two.
- How can we fix that broken reimbursement stream around behavioral health treatments? A: When you have a process where people are constantly changing insurers, it doesn’t pay to do high-quality treatment up front where you may not reap the financial benefits down the line. There’s also concern that an insurer showing great outcomes for high-risk individuals would then attract more high-risk individuals, which isn’t financially beneficial.
Separately, Dr. Volpicelli sent this via email: “Practically, the problem with addiction treatment is not so much the lack of insurance policies that offer coverage. Rather, I'm concerned about the types of services covered, the reimbursement rates that discourage programs from using highly trained (expensive) treatment providers, the absence of integrated care where psychosocial treatment is combined with medications, and the lack of value based reimbursement plans that encourage patient recovery rather than plans that reward readmission into expensive residential treatment programs.”
- What's the downside of digital therapeutics?
A: Privacy. It's important that people can trust that the data they provide is protected. If their name is listed in a program in the cloud, then their addiction problem may be exposed.
Dr. Volpicelli also talks about how significant the alcohol and drug addiction problems have risen in the last two years; how to know if you’re addicted to a substance; what’s driving the opioid crisis; how psychosocial treatments can be 10% of typical in-patient treatments.
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