Bicycle Health, Override Health team up on chronic pain, OUD care referrals

Bicycle Health, a virtual provider of opioid use disorder (OUD) care, is teaming up with Override Health, a virtual chronic pain management clinic, for a bidirectional patient referral relationship.

Bicycle will refer patients to Override for chronic pain care, while Override will refer patients in need of OUD treatment to Bicycle. The partners’ goal is to increase access to chronic pain care and OUD treatment, two areas they say have a lot of patients in common.

“When we speak with leadership at major health insurance plans, one of the first questions they ask is typically about how Override Health addresses opioid use,” David Shulkin, M.D., co-founder of Override, said in an announcement. Data used to evaluate Override’s potential impact are “frequently related” to opioid use among patients with chronic pain, he added, “so this partnership makes a lot of sense.”

“The two issues really go hand in hand,” Jennie Shulkin, co-founder and CEO of Override, told Fierce Healthcare. “There’s so much overlap within both companies’ patient populations.”

Opioids are responsible for a growing proportion of drug overdose deaths in the U.S. In 2020, an average of 44 people died each day from overdoses involving prescription opioids, totaling more than 16,000 deaths or a quarter of all opioid overdose deaths in 2020. At the same time, 25 million Americans are estimated to be suffering from daily chronic pain.

The vast majority of Americans with OUD cannot access any form of treatment, a statistic Bicycle Health’s founder and CEO Ankit Gupta frequently cites as making the case for telehealth. 

Bicycle leverages full-time clinical staff and wraparound support services to treat patients with medications for OUD, widely considered the gold standard for care. Override, founded in late 2022, offers non-opioid chronic pain solutions. It relies on a tech-enabled, team-based approach to care as well as pain neuroscience education to engage patients and design individualized treatment plans. 

“We’re always looking for best in class solutions to bring to our patients,” Gupta told Fierce Healthcare. 

Of more than 13,300 people who applied to be treated with medications for OUD at Bicycle in the second quarter of 2023, more than half report first developing a problem with opioid use through a legitimate prescription. 

Typically, Bicycle refers its patients who have other conditions that need a specialist out to a provider it has a relationship with. For chronic pain, that has been difficult to date, Gupta said. “It’s quite challenging to find providers who are philosophically aligned in the treatment of pain without opioids,” he said.

As OUD continues, pain becomes a side effect and withdrawal symptom, according to Gupta. Since buprenorphine—a medication for OUD—is a partial agonist, it can help manage pain, he added. Patients can also use over-the-counter medications to relieve pain symptoms. “But that doesn’t mean the pain is fully managed, and often, pain could lead to a relapse,” Gupta said. 

The vast majority of people who applied for Bicycle’s program in the second quarter of 2023 reported not having a primary care physician. For these, “we also have the opportunity to help them with their entirety of medical care,” Gupta said. “Our vision is to build this network of really high quality providers with seamless referrals.” 

When it comes to OUD, Override screens patients but to date has had no formal partnerships with providers specializing in treatment of the condition.

“It’s really cruel to cut a patient off their opioids without giving them any sort of alternative pain management techniques,” Shulkin acknowledged. When a patient coming to Override is on a high dose of opioids, Override can work with their primary care physician to taper the patient if necessary.

Though the startup is technically a non-opioid offering, with none of Override’s staff prescribing controlled substances, the company is not anti-medication, Shulkin added. 

“We don’t think that opioids have no place in patient care. There are certainly patients with intractable pain who rely on opioids to control it and aren’t misusing them,” she said.

Both providers will now be implementing heightened screening protocols for chronic pain and OUD, “because now we actually have somewhere we can send these patients. Previously we didn’t,” Shulkin said.

“Now that we have a peripheral partner where we can be confident about quality and outcomes, that itself provides our providers more comfort in having these conversations,” Gupta echoed.

Bicycle accepts Medicaid in several states, two of which overlap with Override’s existing Medicaid contracts. Possible overlap in commercial payers was not disclosed.