The last five months have been hard for behavioral health providers to weather, with many being forced to cut back services as a result of COVID-19-related financial strain. Some are even facing the risk of closure.
Then there’s Pinnacle Treatment Centers, which has actually been expanding.
Pinnacle is one of the largest substance use disorder (SUD) treatment providers in the nation. It serves about 32,000 patients per day, with about 115 locations across eight states. Pinnacle offers the full continuum of care, but specializes in Medicaid-reimbursed medication-assisted treatment (MAT) using methadone.
Right before the coronavirus hit the U.S., the Mount Laurel, New Jersey-based organization acquired Aegis Treatment Centers, a large outpatient opioid treatment provider (OTP) serving California. Amid the pandemic, Pinnacle has rolled out more than five new programs and centers, with the latest being an OTP in Marion, Ohio. Plus, it acquired HealthQwest, a Georgia-based medication-assisted treatment (MAT) provider last month.
CEO Joe Pritchard says its secret to success lies in asking states what they need, then building its programs out from there.
Pritchard shared Pinnacle’s growth strategy during a recent conversation with Behavioral Health Business. During the call, he also stressed the need for flexibilities for methadone MAT and the streamlining of state and federal behavioral health guidelines.
You can find the conversation below, edited for length and clarity.
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BHB: Pinnacle is one of the few behavioral health providers growing amid the coronavirus. For example, you recently opened a new detox unit and completed an acquisition. How have you made it work?
Pritchard: In addition to that, we’re about to open another three OTPs within the next month or two.
I think it goes to our team. I have an incredible senior leadership team. Many of our regional leaders have worked with me for 15 to 20 years. We’re fully aligned on our mission. We have a special operational cadence where we prioritize and segment out where to put the focus.
We are dealing with an epidemic in the middle of a pandemic. The pandemic has distorted our daily routine, so we have to do everything we can to focus on offering patients the kind of care they need consistently. But at the same time, we have a company to operate that will go beyond the pandemic.
Our census has increased by over 600 patients directly related to the pandemic. People who are displaced from care or are not able to get drugs on the street are relapsing.
The states and counties that we work in know that. They have worked closely with us to be creative on how we can still move through the regulatory process and all the licensing that has to occur so things don’t get held up.
So far we’ve been fortunate. We’ve had a couple slow ups, but nothing that would ring any alarm bells.
Can you tell me a little bit more about those OUD treatment centers in your pipeline?
A couple of them are in Ohio. We have been building our platform of care there for the past five years, so it’s just a continuation of our growth plan there.
We’re also in the middle of opening a couple more OTPs in New Jersey. We have one in Virginia that’s in the later stages of being ready to open, and we have more than 15 new programs on the docket to be opened between now and the end of next year.
In terms of those 15 programs in the pipeline, what’s the strategy there and with your growth goals overall?
It comes down to creating a value proposition, for the company and for the states that we’re in.
We never assume that we know what a state needs. We always have conversations with stakeholders and say, “How can we fill a need that you have?” We build out from there, so it’s different wherever we go.
I’m in Indiana now looking to expand services here because the state knows that there’s a need for our programs. We’re looking at how we can develop services to meet those needs.
As we go from state-to-state, that will be the initial blueprint. Sometimes we will be building programs from the ground up with de novos. Some growth will be bolt-on or organic, where we take an existing program and attach on other services.
We do a lot of that. Half of our growth has come from being asked by other payers or the state to expand.
We’re also in an acquisition mode. Where it makes sense for us to acquire, we do. Aegis in California was a great acquisition for us.
Our new acquisition in Georgia was the same story. It was a company with 12 to 13 years experience and an incredible reputation. We see that as a platform to add more services throughout the state.
There’s such a need there, especially in rural areas. Everybody seems to be clustered in the metro areas. So we’re committed to developing those types of programs.
We know what we do, and we do it well: that’s community-based, hub-and-spoke SUD treatment and MAT. We’re not a destination location. Most of our people are within 30 to 45 minutes of an outpatient location and within 90 minutes of the residential. We build our roots and in the communities we’re in.
How important is that community model right now, with travel being essentially unheard of amid the pandemic?
Quite honestly, there’s absolutely no need to ever go out of your state to get care. If you can’t find care in your state, somebody needs to get in front of that state and talk about how to build services.
The fact is, this individual, their family, their loved ones and their support network are there in the community. You should be able to develop the programs and services and support necessary to meet that need there.
I know you pride yourself in being a community provider that offers the full continuum of care, but what does your patient mix look like?
We’re treating close to 32,000 lives every day, and the vast majority of those are in ambulatory settings.
Out of the 32,000, approximately 30,000 are being treated every day with medication with MAT. The vast majority of those are methadone. We have a growing population with buprenorphine, and we have vivitrol.
The rest of the population is treated in our residential setting or our non-MAT outpatient.
In the residential programs, between 45% and 65% are primarily opioid-dependent, and we support them with MAT. In our sober houses — we have over 100 sober transitional beds in our network — we’re running about 95% capacity.
It’s about an even split between male and female. Our average age for demographics is in the early to mid-30s.
On the MAT side, it’s primarily Medicaid, but we do have, across the board, about 20% to 25% commercial. And Medicare is now reimbursing for MAT, so we have about 7% of our current population that would qualify under Medicare, and there’s a vast number of people who could benefit from our services that have Medicare that now can come in.
On the residential side, depending on the state, it’s heavily weighted on Medicaid. But we do have a mix of commercial, and we have relationships with payers at both the local, regional and national levels, as well as work organizations and employee groups.
Amid the coronavirus, SAMHSA has added some flexibilities when it comes to using telehealth to prescribe buprenorphine. What kind of impact is that made for you guys, as a prescriber of primarily methadone?
We’ve seen an increase in patients coming in for buprenorphine. A lot of their care providers are shut down because they were one or two physician office practices and they had limited resources.
We believe people should be able to access care as quickly as possible. We think the regulations that were eased around induction for buprenorphine and it being able to be done through telehealth was a very positive move. We were hoping they would do the same for methadone, which has not occurred yet.
A patient needing methadone coming in has to wait for the physician to be there — or the extender. Part of the issue is that physician coverage is one of the areas that can be limiting.
A lot of our physician are semi-retired or retired, and they’re at risk. So it puts a burden on the program to try to provide support.
Our proposal has always been to bring the person in, have the medical team assess them, put them in front of the physician via telehealth and start the induction.
We don’t give take-homes [for new patients]. We believe for the first 30 days of that induction period that the person should be coming in every day, or at least six days a week, until the clinical team feels that they’re ready to take home medication.
We’re still pushing for that. We’re hoping that that will occur. But that has been one of the limiting steps to get somebody on induction with methadone — not having the same regulation [as] buprenorphine.
What long-term impact do you think the coronavirus will have on SUD treatment?
Everyone’s trying to read the tea leaves.
From a historical perspective, when we had devastating events like 9/11 and Hurricane Katrina, all these same emergency measures, to some degree, were deployed. When those emergencies ended, the rules went back to what they were pre-emergency.
I think a lot of the regulations will go back to the way they were, but using things like telehealth and technology to increase a person’s opportunity to get services is absolutely industry-changing.
I don’t believe how we’re doing telehealth today is how we’ll do it post-pandemic — people are just out there using laptops and phones. But the fact is we’re developing a more well-defined permanent process that will be deployed, post-pandemic, that should be longer lasting and more impactful.
I’m the chair of the MAT committee for NABH. One of the things we have been pushing for is more of a level playing field when it comes to managing regulations.
There’s federal guidelines, but states can interpret and deploy their own rules, so you might be in one state where they’ll allow you to have 21 days of take-home medication, but in other states the same type of patient can only get a week’s worth.
So how do you create a blanket of rules that are consistent across the country? Those are the things from a federal and state level we’ll have to figure out. Engaging mental health, physical health and public health initiatives to all work together will be another one.
Lastly, I think one of the big ones — and states have done this because of the pandemic — is around corrections.
There’s been a lot of advancement in deploying treatment behind the walls and doing warm handoffs when a person is released from jail. There’s been a lot of talk with CMS around how you provide reimbursement so there’s no break in that care continuum. I think … people will start to put more focus on how we take some of the opportunities that we’ve had to work together during the pandemic and make sure that those things don’t stop.
But I think people should not be surprised if, initially, some of the core rules go back to normal.
You were one of several large behavioral health providers to recently receive a letter from Sen. Elizabeth Warren (D-Mass.) and Reps. Carolyn Maloney (D-N.Y.) and Katie Porter (D-Calif.) requesting more information regarding your coronavirus response efforts. What did you make of that?
I always see these things as an opportunity to educate and promote what we do.
There’s so much noise that I think going directly to care providers and saying, ‘We want to hear from you’ is very important. We have answered their questions, and we sent them our COVID manual.
What will be critical here is that this goes from a questionnaire to a work group. You need to get some of us that deal with this every single day around the table and say, “Let us tell you what is working and what’s not and what we need.”
If they’re willing to listen and try to provide support, that’s where the rubber will hit the road.