What is the most effective way to treat addiction?
As concerns around the opioid crisis dominated headlines over the last several years, it was a question a group of healthcare industry veterans wrestled with before coming up with Waltham, Massachusetts- and Asheville, North Carolina-based Eleanor Health.
The addiction and mental health services startup—which launched last October in partnership with Blue Cross Blue Shield of North Carolina—is no 28-day program. Instead, they say it was designed to be the first to use a value-based delivery and payment model for substance abuse treatment delivered on an outpatient basis.
They've got backing from some heavy hitters. To date, the group has raised more than $15 million in investor backing including from Town Hall Ventures, the venture firm started by former Centers for Medicare & Medicaid Services (CMS) acting Administrator Andy Slavitt and Oxeon Holdings.
Now, amid the COVID-19 crisis, it's expanding with a new value-based partnership with Horizon Blue Cross Blue Shield of New Jersey. Eleanor plans to serve hundreds of patients across New Jersey with ten additional clinics in 2020 and 2021.
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New kind of addiction treatment
Eleanor began with a mission to deliver evidence in a setting that was designed to be warm and welcoming.
Treatment is based on what Petro called a "harm-reduction approach" which measures success based on improvements rather than black and white metrics. That means a patient doesn't get disqualified from care, for instance, if a patient only reduces but doesn't completely abstain from alcohol consumption, Petro said.
The organization officially launched its first clinics in North Carolina with the help of partner BCBS of North Carolina, an insurer that has established itself as a leader in value-based care. It was a move that was key to standing up a care model that would be more effective, she said.
"That's the tough part, being able to do this work and do it sustainably. In order to do that, you really have to get buy-in from payers," Petro said.
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When it comes to insurers investing in value-based payments for chronic conditions, there is always the hurdle of churn: Will their members stay members long enough to reap the benefits of their improved long-term outcomes?
"When you think about Blue Cross of North Carolina, they are by far the dominant health insurer in that state. They have such market share, they're not losing a lot of people. For them, from a business perspective, they have patients longer than a state where you might have five or six competitors."
They are also philosophically committed to the idea of value-based payments.
"They're doing that on the primary care side with Aledade, with City Block on the Medicaid side. Iora is coming into the state," Petro said. "So they're really trying to push value-based care as sort of a fundamental principle with the hopes of longterm gain. And part of it is, they just don't see as much churn."
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Kate Hobbs Knutson, the chief of behavioral health at BCBS of North Carolina, said the insurer decided to partner with Eleanor because of the strength of the talent behind it as well as its commitment to the comprehensive approach needed in value-based care.
"There are a few key things: One of them is same-day access. That’s really important with substance use," Knutson said. "If a person is in a place where they are ready to change and seek treatment, you have to be available to help that need and that intention at that moment. Eleanor being able to do that has been really important."
Going virtual
Of course, access is one of the primary challenges for any addiction services provider in the midst of shelter-in-place orders. Eleanor quickly had to shift to expand its virtual services, Petro said.
"Quarantine, isolation, and lack of mental health services can have an adverse effect on those in recovery and the public at large,” she said. “Because we recognize the increased need for mental health services, higher incidences of alcohol and other drug use, and decreased access to addiction treatment as a result of COVID-19 and social distancing, Eleanor Health is now opening our suite of fully virtual services to anyone living in NC."
The virtual clinic was the fifth of more than 10 Eleanor Health plans to open in North Carolina this year, officials said.
It will be fully staffed for virtual care, offering medication-assisted treatment, psychiatric management, therapy, nurse care navigation and recovery support services online, they said. It will also have limited walk-in hours and in-person appointments for those who are unable to connect virtually.
"We built our model to be comprehensive and flexible—able to be delivered in our clinics, in patients' homes or communities, and virtually—100% of our clinical model has always been able to be delivered virtually," Petro said. "Still, some patients want to come in person, and we have enhanced procedures in place and screen all patients for COVID. We have delivered care from behind glass, in the car, and adhering to the six-foot distancing.
Petro said the group has seen increased anxiety from community members being treated for addiction. That can make them more susceptible to more negative outcomes since they are still building their recovery capital. "We’re doing a lot more checking in and outreaching to community members, and seeing a lot more inbound emails, phone calls, and other correspondence."
The goal is to ultimately continue proving Eleanor's model by capturing data that shows its ability to engage retain and improve the outcomes of our patients.
"Really our goal ultimately is to provide a national platform for substance use disorder and addiction," Petro said. "In 2021, our aim is to go into an additional three markets, grow the markets we’re in, and partner with innovative plans that really want to address this."