Caron Aims to Avoid SUD ‘Whack-A-Mole’ with Integrated Approach, Specialty Programs

Caron Treatment Centers is doubling down on its differentiators: its specialty treatment programs and ever-growing medical expertise.

Headquartered in Wernersville, Pennsylvania, Caron is a not-for-profit substance use disorder (SUD) treatment provider with more than 60 years of experience under its belt. It offers a variety of services in Pennsylvania, Florida, Philadelphia, Washington, D.C., Atlanta and New York City, accepting several major insurance plans and providing financial assistance for certain patients.

Last fiscal year, Caron served over 2,500 patients in inpatient and residential settings, as well as over 1,200 outpatient clients, according to the company’s annual report. Meanwhile, Caron provided family services to 3,827 people.

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For the past several years, the not-for-profit has distinguished itself with specialty, targeted treatment offerings. Called Signature Programs, they address the SUD needs of certain unique populations, such as older adults, business executives, health care professionals, first responders and high-net-worth individuals.

As of late, Caron has also started to focus on growing its medical expertise, allowing the organization to treat complicated SUD patients with comorbid conditions like diabetes, cirrhosis and hypertension. 

Those differentiators will be an increasingly important part of the organization’s strategic plan for the year ahead, according to Bradley Sorte, chief growth officer at Caron.

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Behavioral Health Business recently connected with Sorte to discuss all that and more. Also on the docket for Caron: growing its presence in existing markets, adding strategic partners across the nation and avoiding SUD whack-a-mole.

You can find the conversation below, edited for length and clarity.

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BHB: Caron has a couple key differentiators. Let’s dig into those, starting with your focus on medical expertise. It sounds like you’re doubling down on integrated care for complicated patients, especially as of late. Why?

Sorte: We’ve seen a lot of those folks coming through our door during COVID-19.

When you begin to peel the onion back, the vast majority of people seeking care at one of Caron’s residential facilities are being impacted significantly in multiple major dimensions.

Treatment of any just one or two of those issues and not effectively treating the others in concert makes it too easy to set up a game of whack-a-mole. You may be able to deal with some of the drug and alcohol use, but if you’re not focused on the psychological, social or other issues, recovery is going to be elusive.

Being able to have that integrated approach is the best pathway to get to long-term recovery.

When did medical expertise become such a big focus for Caron?

About three years ago, up here in Pennsylvania, we opened a brand new 45,000-square-foot medical center. Within the Neag Medical Center, we have our medical detox unit and our residential unit, which has historically been our older adult unit.

The older adult piece is somewhat flexible in terms of its definition because it’s more looking at people who might have comorbidities. You might have your traditional 75- or 80-year-old in that program, and you might have a 45-year-old who has 80-year-old issues, along with SUD.

When we opened the center, we began to increase the number of full-time physicians, psychologists and nursing staff we have at Caron. We’ve got around 10 full-time physicians between the two campuses, all fully on staff. It gives us the ability to manage a lot of these more complicated comorbidities.

Alongside that, we’re well down the path of the larger project in Florida, where we’re building a 90,000-square-foot medical center, which will provide similar services to our Florida programs, where we have an additional 120 beds in Boca Raton.

Construction on that Caron Florida Medical Center was slated to start this year. Is that still on track?

It’s now being called the Keele Center. Site work is beginning as we speak.

It’ll probably be about 22 months until it’s open, just because of the size of the project. The goal is to have that fully operational by July 2022.

Exciting. Getting back to those differentiators, let’s talk about Caron’s Signature Programs, which are specialty treatment offerings for select populations. How are those holding up amid the coronavirus?

The signature programs fall into a couple of broad categories.

It’s our executive program — our Grand View Program — which has historically been largely a men’s program. However, we just opened a women’s program for that group as well.

[We also have] our Older Adult Medical Program; our Ocean Drive Program, which is our most up-market program down in Florida; and our Health Care Professionals Program.

Increased stress, trauma and uncertainty correlate very strongly with the onset or exacerbation of SUDs and mental health conditions, so we started to see that be a driver for a lot of people amid the pandemic.

You had the high achieving potential patient — who has enough autonomy over their life that they need to become internally motivated to [get help] — start feeling enough stress to actually engage. We also saw that with some of our first responders [and health care professionals].

For the older adult and medically compromised population, family members were very concerned about their loved one contracting COVID-19.

But because of the size of our facilities, the protocols we put in place and the control we have over our environment, this is one of the safest places they could actually be. So it ended up being a positive motivator for those families.

So overall, what has your patient census done? You just mentioned a number of up-sides, but I know some residential providers have struggled census-wise due social distancing.

There’s usually two types of people who would be seeking Caron care. You have quick turnaround cases, with somebody calling in crisis. Those cases didn’t slow down. They actually picked up a bit.

The other chunk of cases we get are the planners. They’re scheduling out anywhere from a couple of days to a week in advance. The planners went quiet for about a month.

From March until Easter weekend, we saw our census decline about 20%. But since that time, it has climbed pretty steadily. It’s become clear that now is a good time to go to treatment because life is on hold anyway and we have been able to articulate the safety of our environment.

That was largely for our Pennsylvania programming. For our programs in Florida, our smaller boutique program, Ocean Drive, never saw census drop. The one Florida program that did have some challenges, but is coming back around, was the larger Renaissance program. A lot of that was driven by travel concerns.

Starting at about the end of June, almost all aspects of our residential programs, other than Renaissance, were back to pre-March levels — and in some cases nearing the upper end of that.

Caron’s most recent annual report lists Signature Programs as an area you’re looking to enhance. Why — and what’s that going to look like?

We used to have one big program, but we kept finding these pockets of people that were fitting into our program — but not quite right.

For example, you had a handful of doctors in a primary treatment program. They got the care they needed, but you could tell there were times when they just weren’t getting as much from the experience.

We were able to create something separate for them, so they would have a better experience, a better outcome and we could partner with health care systems.

We started doing this year after year, in response to seeing certain people not getting the care they needed. Having stayed focused on being invested in our clinical care has allowed us to put these programs together and add value so that when somebody comes they can really feel the difference.

It’s worth it to fly across the country to go to a specialty cancer hospital or a specialty hospital to get your knee operated on by one of the best surgeons in the world. Similarly, that’s what the focus on Signature has been about.

We created a bifurcated approach, which is specialty programming for these groups and then specialty contracts with a few select insurers that give us the ability to provide access to what has traditionally been Caron’s programming for people who use their insurance.

We did it in such a way that we don’t deal with managed care. It’s a case rate.

So if somebody is coming to us, for example, from a Highmark Blue Cross plan — or one of the other national Blues — they come, get admitted based on their approval and are here for 28 days. They don’t have to worry about being here for two weeks then needing to recertify or move to a lower level of care, which has been really successful in us bringing that quality of care to people who need to use insurance to get treatment.

What will acceleration of the Signature Programs look like?

It’s probably going to be a combination of expanding some of the populations we’re already serving, where we’re a bit oversubscribed, as well as identifying new populations we would want to be able to engage.

For example, with Grand View, we saw that we were running up against capacity, so that’s why we opened the women’s program. That doubles our number of beds and gets us to just over 22 between the two programs.

The medical center here, and adding more beds in Florida, that was part of that strategy. That’s more of an expansion, and a lot of that has to do with the fact that a lot of our medically-oriented folks tend to stay geographically close to where they’re coming from.

We’re looking at wading a little bit more into not just SUD primary treatment, but expanding our ability to help people who have primary mental health conditions. We’ve actually gotten a license in Florida, which will be in both Renaissance and Ocean Drive, which allows us to treat primary mental health without a SUD. We’ve had that license now for the better part of this year.

Under that license, we’re able to take people with primary trauma, primary personality disorder and, probably most exciting out of that, our gaming and digital addictions.

Speaking of growth, Caron’s coming off a five-year, conscious growth pause. Last year, the company said it would pick things up in 2020. Is that still the plan?

It is definitely still the mindset, but it’s circumscribed by the uncertainty of the COVID world.

The areas that have really weathered the COVID storm quite well have been residential treatment because of the control over the environment.

We feel our continued investment in our Florida medical center still fits very nicely and squarely within the plan in the context of COVID-19.

We have regional outpatient sites treating patients in Atlanta, Virginia and Pennsylvania. We’ve kind of taken a wait-and-see approach about expanding to any of our licensed services to other regions for the moment to get a better understanding of the trajectory of COVID in 2021.

Alongside that, we’ve been adding different forms of telehealth for those folks. Payers have been more flexible. Licensing in the states has been more flexible. We had the infrastructure ready to roll out, so we were able to go virtual almost overnight.

But [outpatient] is a relatively small part of our growth strategy. It’s an important one because it touches a lot of lives, but it’s one of the areas that we’ve taken a very thoughtful approach to. The story isn’t fully written yet.

Going forward, what does your best-case-scenario growth strategy look like?

From a marketplace standpoint, we are heavily invested in doubling down on existing markets.

That’s basically Boston to Northern Virginia, where we have historically drawn a lot of folks from. Our other key areas are the Atlanta metro area and South Florida.

We are also turning our attention to the national stage. We created a new department this year, and the team’s job is putting together areas where we have opportunity for partnership.

We know that we’re good at doing a lot of things. We also know we’re not the best at certain things. We need good partners for psychiatric treatment [and] medical care. We need good partners who have great insurance programs, if it’s not an insurance that we’re in contract with.

Doing strategic partnering from a business-to-business or individual professional standpoint is important to us. The Midwest, Texas and the Rockies are all areas where we have had some history and are looking to re-engage, as well the Piedmont area in the Carolinas.

Also, if we see … a good organization that’s having operating struggles and fits within our strategic plan, we’re going to look to potentially partner. We keep our minds pretty open to that, and if the right opportunities were to come our way, we’d take a look.

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