MCO Serving Medicaid Members

Driving Down Healthcare Costs in Substance Use Recovery: WEconnect Health’s Impact on Claims Reduction

Executive Summary

The cost of treating individuals with substance use and behavioral health conditions remains a major challenge for Medicaid programs and Managed Care Organizations (MCOs). While traditional interventions can improve outcomes, few demonstrate measurable cost savings at scale.

WEconnect Health provides a digital recovery support platform that combines contingency management, personalized goals, and peer support—accessible through a mobile app. Since launching in 2022, WEconnect has not only improved engagement in recovery but has also produced substantial reductions in healthcare utilization and claim costs.

Among Medicaid members enrolled in WEconnect, total claim volume decreased by 57%, and total claim costs fell by 33%. This resulted in more than $1.6 million in total savings, including a 52% decrease in per-member-per-month (PMPM) claims cost.

Key Results

Introduction: Medicaid and the Cost of Substance Use Disorders

Substance use disorders (SUDs) are a leading driver of healthcare costs across Medicaid populations. Individuals with untreated or unstable SUDs experience higher emergency department use, hospitalizations, and mental health crises—straining both care systems and budgets.

While Medication for Opioid Use Disorder (MOUD) and behavioral therapies are effective, they often lack the daily support and engagement tools necessary for long-term success. This gap leads to high relapse rates and repeat utilization of costly services.

WEconnect Health addresses this challenge by offering a digital platform that helps Medicaid members stay engaged in their recovery—every day, from anywhere. By reinforcing positive behaviors and providing real-time peer and app-based support, WEconnect is able to help members avoid crisis-level care and stay connected to treatment.

Program Overview and Population

Since 2022, WEconnect has supported a Medicaid MCO population with access to its digital recovery platform. Members receive:

• Daily engagement through a mobile app
• Incentives and rewards for recovery-based goals
• Access to virtual peer support and recovery meetings
• Tracking tools to monitor personal progress

All claims data included in this analysis reflects actual claims incurred pre- and post-enrollment in the WEconnect program, across all care categories.

Outcomes: Claims and Cost Reductions

After enrolling in WEconnect:

• Total claims decreased by 57%, indicating fewer acute care and behavioral health episodes.
• Total claim costs decreased by 33%, representing substantial savings across the board.
• Average PMPM cost dropped by over 50%, from $1,142 to $544—a reduction of $598 per member per month.
• Total program savings exceeded $1.6 million, based on claims impact alone.

This data underscores how digital recovery engagement not only supports members in treatment, but also directly reduces high-cost utilization across the Medicaid population.

Why It Works: A Proven Model for Engagement

WEconnect’s success stems from its ability to keep members consistently engaged outside the clinical setting. Key differentiators include:

• Digital contingency management: Rewarding positive behavior reinforces treatment adherence.
• Peer support access: On-demand coaching helps members stay motivated and connected.
• Daily structure and goal setting: The app empowers members to create and meet achievable recovery goals each day.
• Accessibility and scalability: Available 24/7 via mobile device, the platform meets members where they are, regardless of location or resources.

This model reduces missed appointments, minimizes crisis escalation, and supports long-term behavioral change—leading to fewer claims and better outcomes.

Implications for Medicaid MCOs

The economic impact of WEconnect’s program demonstrates its value as a scalable, high-impact solution for Medicaid plans seeking to:

• Reduce unnecessary utilization and claims volume
• Improve treatment engagement and retention
• Lower overall cost of care for high-risk populations
• Deliver measurable ROI from digital health solutions

WEconnect can be integrated as a benefit for members with substance use or behavioral health needs, with minimal operational overhead and significant potential savings.

Conclusion

The data is clear: WEconnect Health helps Medicaid members recover more consistently—and more affordably. By reducing claims by more than half and driving down monthly costs by 52%, WEconnect proves that digital behavioral health support is not only clinically valuable but fiscally responsible.

For Medicaid MCOs looking to invest in outcomes-based care, WEconnect offers a scalable solution with proven financial and clinical returns.

Contact

To request the full claims impact report or explore partnership opportunities, contact us.