Boulder Care, a virtual substance use disorder (SUD) provider, has been awarded $1.8 million in National Institutes of Health funding to design and test care pathways across marginalized settings.
Millions of Americans have opioid use disorder. Though medications for opioid use disorder (MOUD), such as buprenorphine and naltrexone, are considered the gold standard of care, fewer than one in five people get it. The gaps are even wider in underserved settings, which Boulder plans to focus on with the grant. Participants will be Medicaid enrollees.
“We have all of these tools to be delivering this excellent care across the country and it’s really about recognizing where there are cracks in the system,” Ayesha Appa, M.D., told Fierce Healthcare.
Boulder will use the NIH funding to tailor virtual MOUD pathways for patients in the following settings:
- Community corrections and reentry programs: Overdose risk is up to 129 times higher in the two weeks after release.
- Pregnancy and postpartum care settings: Overdose is a major contributor to pregnancy-related deaths. Discontinuing MOUD postpartum increases overdose and relapse risk.
- Tribal Nations healthcare systems: Indigenous populations have among the highest rates of SUD and face drastic care access barriers.
- Transition from residential treatment settings: Nearly half of Medicaid enrollees coming out of rehab don’t receive a timely outpatient visit or MOUD.
- Transition from emergency departments: Patients who present to the ED with overdose have a 6% risk of dying in the following year. Yet just 16% of privately insured patients get follow-up care.
“We know it works. We have fantastic effectiveness data,” Appa said of telehealth. The funding will be used to take it a step further: to figure out how to design telehealth for the neediest patients.
As part of the research, Boulder will work with five sites to provide patients a smartphone preloaded with the Boulder app, plus cellular service and Wi-Fi, setting-specific infrastructure and support with transitions between care settings. Boulder will build a tailored care pathway for each population, deliver the care and then measure outcomes. About 50 patients per site will participate.
So far, the selected study sites include an ED in Oregon, a perinatal program in Ohio and a corrections program in Washington. The study will measure both care continuity and retention, as well as other factors like employment, incarceration, ED and hospital visits and quality of life.
“Medicine is very good at asking, ‘Does treatment work,’ and implementation science is about asking the next question: ‘How do we get that treatment to people who need it in the real world?’” Appa said.
Boulder has seen promising results already through an existing partnership with Jackson County Community Justice, which provides parole, probation, detention and residential services in Oregon. A 2026 analysis of 290 individuals found average arrests per year dropped from 3.4 to 0.9 for those who got care with Boulder for at least six months after release. The average time to intake for an incarcerated individual was 0.8 days and the time from expressed interest to receipt of buprenorphine was two days.
“We know that that moment of fracture post-release is both this huge clinical vulnerability and also a real systems failure that needs a bridge,” Appa said.
The NIH study will last about two years. Boulder’s grant is supported by NIH’s National Institute on Drug Abuse.