Marianna Zaslavsky has joined Boulder Care, a telehealth provider for substance use disorder, as vice president of growth partnerships.
While Zaslavsky will be leading all payer relationships, the company is particularly interested in expanding value-based care. A value-based approach also lets Boulder take care of patients in a holistic way, the company said, by driving lower overall costs for payer and health system partners.
Substance use disorder is a chronic disease, but the country largely does not treat it that way, Zaslavsky said. The harm reduction model is considered niche, despite evidence that it works. “The approach that we take with our members in terms of harm reduction, kindness, individualized care planning … I’m very proud to work for such an organization,” Zaslavsky told Fierce Healthcare.
Zaslavsky hails from a similar role at Groups Recover Together, a hybrid substance use disorder provider focused on group therapy, where she structured value-based agreements with some of the country’s largest payers. As VP of partnerships at Emergency Care Programs, previously known as Ready, she helped transition the company from DTC to a value-based, partnership-driven model.
Zaslavsky also has experience in women’s health. In 2018, she founded and led a fertility insurance company, Norka Health. She also briefly led partnerships and business development at Modern Fertility, where she led execution of the company’s first B2B partnerships. And Zaslavsky serves on the advisory board of Flourish Care, a tech-enabled maternal health platform.
What Zaslavsky brings to the table is deep expertise in provider Medicaid contracting, a skill she argues few have. “Value-based contracting is kind of nascent overall, but in particular in Medicaid it’s very new, and even then in particular in behavioral health Medicaid, it’s very complex and new,” Zaslavsky said.
Medicaid covers more than a third of non-elderly adults with opioid use disorder in the U.S. At Boulder, 80% of its patients are on Medicaid. To that end, Zaslavsky is particularly interested in Medicaid’s innovation potential. The road ahead, though exciting, is also filled with challenges. Among the latest uncertainties is the Trump administration and how it will impact Medicaid.
“This year poses a lot of unknowns for anyone operating in Medicaid, whether on the provider side or on the payer side,” said Zaslavsky. The states that have already heavily invested in the Medicaid space, like New York with its 1115 waiver, will likely continue to do so. “I just don’t see that changing, in terms of the ethos of New York.”
But in other markets, it’s a different story. Many states are in a wait-and-see period. Estimates suggest that more than 8 million Americans will get booted off Medicaid under the Republicans’ proposed reconciliation bill currently making its way through Congress. If tighter eligibility rules for new beneficiaries come to pass, “it will leave a much sicker population in Medicaid,” Zaslavsky warned.
Already, 25 million Americans were disenrolled from Medicaid during COVID-era redeterminations. A recent study found that losing Medicaid, at least for some populations, can be deadly. And Medicaid cuts do not reflect a lack of healthcare needs. In fact, the broader system will be left holding the bag, Zaslavsky suggested.
Given the potential for tightened budgets and lower reimbursement rates, “you really have to use each dollar wisely, so I think that there could be a positive there,” she noted.
Additionally, several states carve out behavioral health from physical health. “The incentive is therefore fragmented, and that makes it hard to innovate from a care delivery and reimbursement mode [perspective].” Besides that, the best care approach should encompass both mental and physical health. “We should think about treating the body as a whole and the human as a whole, but we haven’t come around fully as a Medicaid system to reflect that,” Zaslavsky said.
At the same time, there is an opportunity for exchange plans to step up—particularly in states where many adults may no longer qualify for Medicaid. The payer offering the exchange plan may often be the same one with Medicaid and commercial lines of business. “It does create some complexity in all of that.”
Zaslavsky hopes to lead Boulder into more innovative payer partnerships and be a stronger strategic partner to states as a whole. “There’s so much that Boulder can do,” she said. “We’re of the community in so many ways, and I think there’s room for us as a company, as an organization, to even take that up a level.”
In 2024, the company doubled its number of value-based partnerships, including with UnitedHealthcare Community Plan, a Washington state Medicaid plan. Since its first agreements in 2018, Boulder has never lost a client and has earned 100% of all quality payments that it has been eligible for to date.
Boulder’s Medicaid MCO plan partners have seen 40% reductions in ED use, 65% reductions in behavioral health expenses and 77% reductions in physical health expenses, per the company.
Boulder also works with community harm reduction organizations, local governments and health networks more broadly. It recently announced a collaboration with one of North Carolina’s largest health networks, Cone Health. These partnerships are core to the company’s philosophy around holistic, thoughtful care.
“Medicaid is local, and there is nuance in terms of what the population that we’re treating looks like state to state,” Zaslavsky said.