Hazelden Betty Ford Foundation bills itself as the largest nonprofit substance use disorder (SUD) treatment provider in the country, with 17 locations and counting, in addition to a slew of other business arms focused on topics such as addiction education, research and publishing.
Next up, the organization has its sights set on achieving national scale — but not necessarily through traditional growth avenues such as de novos and acquisitions. While those types of expansion aren’t off the table, the provider is most bullish about telehealth and creative partnerships, according to Hazelden Betty Ford’s Vice President of Business Development Bob Poznanovich.
“The whole telehealth space will be where most of our future growth comes from,” Poznanovich told Behavioral Health Business. “We will be able to treat more patients in new ways and help other providers treat new patients in new ways as a result.”
In fact, the goal is to roll out virtual services in all 50 states over the next couple years, Poznanovich said, reiterating ambitions previously highlighted by Joseph Jaksha, vice president of Hazelden Betty Ford and publisher of Hazelden Publishing.
Already, the nonprofit is making headway toward that target. Since last March, it’s rolled out its insurance-eligible virtual intensive outpatient program (IOP) — known as RecoveryGo — in about a dozen states, with the most recent being Montana in early February.
Plus, Hazelden Betty Ford’s expansion into New Mexico and Arizona is “imminent,” according to Poznanovich, who says the organization will continue planting virtual flags in “a couple states per month” until it achieves national scale. Currently, it’s approved to deliver RecoveryGo telehealth services in 13 states.
Hazelden Betty Ford’s use of telehealth in and of itself isn’t unique; however, its deployment process and timeline is. While every behavioral health provider rapidly adopted telehealth when the coronavirus swept the U.S. last March, Hazelden Betty Ford was ahead of the curve.
Its journey to provide SUD treatment virtually began back in 2018, when the organization was exploring ways to reach more people across larger geographies.
“Nobody at that point was doing tele-substance abuse treatment in a one-counselor-to-many-patients environment,” Poznanovich said. “So we saw an opportunity to take our clinical curriculum and to deliver that curriculum in a video environment with a peer group, just like we would do in a facility.”
Hazelden Betty Ford began the process to make it possible: talking to payers, exploring technologies, digitizing its programs, repackaging its resources and creating new content and assets such as educational videos, anonymous online support groups, podcasts and meditation apps.
By March 2019, the continuum of virtual products, tools and services known as RecoveryGo was ready to pilot. Hazelden Betty Ford did the test run with a couple different payer partners in California for about nine months, wrapping up in December 2019.
Ultimately, the project was a success, with virtual IOP patients making essentially the same progress as those receiving services on site. As such, the plan was always to roll out RecoveryGo nationwide; COVID-19 just accelerated the timeline.
Originally, the plan was to enter one state per month with the virtual IOP from March 2020 on, until all 50 states were covered. But just a few days before Hazelden Betty Ford was slated to enter its first non-pilot state, the coronavirus hit.
“From a product development and market development perspective, I felt like the Pony Express did the day that the telegraph came out,” Poznanovich said. “We had the fastest horses, we were ahead of everybody and then all of a sudden it’s like, ‘Uh oh, now what?’”
The coronavirus prompted state and federal governments, as well as payers, to relax a number of rules and regulations around the delivery of telehealth. Essentially, the flexibilities made it so that any behavioral health provider with access to a smartphone or laptop could deliver virtual services to its patients.
Overnight, Hazelden Betty Ford made the decision to transition its 1,500 outpatient clients from facility-based to virtual care in light of COVID-19 and the new flexibilities. Plus, it sped up its plan to enter states with its virtual IOP on a more formal basis.
“We were very fortunate that we had more than nine months of planning,” Poznanovich said. “We had really good technology platforms that were secure, confidential and had workplace productivity … and other resources built into it. … We had protocols for patient safety, confidentiality, documents and engagement figured out.”
How it works
While patients can self-pay for Hazelden Betty Ford’s virtual IOP, the services are primarily targeted toward commercial customers. That’s in line with the organization as a whole, which counts more than 93% of patients as commercially insured, according to Poznanovich.
To access virtual care, customers can call or reach out through the RecoveryGo website. From there, patients are directed to a call center and scheduled for an assessment to make sure the services are right for their needs.
The company starts patients off with three to four virtual visits per week, with intensity decreasing over time as needed. In addition to outpatient SUD care, patients also have access to virtual mental health care services, recovery support resources, family services and community solutions.
Hazelden Betty Ford is mapping out its virtual expansion based in part on the regulatory climate in various states. For example, some states require SUD providers to have a physical presence in order to deliver virtual care, while other states only require a licensed counselor in the state.
Hazelden Betty Ford is prioritizing states with fewer barriers to entry first. Additionally, it’s waiting to see whether certain COVID-19-related telehealth flexibilities remain in place permanently post-pandemic.
“We need states to continue to support this kind of care model for substance use, and we need payers to continue to pay for it,” Poznanovich said. “We could always go into a market if it was legal, but without payers, that’s a burden on the consumer.”
Meanwhile, Hazelden Betty Ford wants to remain in-network.
Additionally, Poznanovich said the workforce demands of the virtual model are challenging and can be prohibitive to growth depending on the state. Not only does the company have to find staff to cover new markets, but it also has to get them licensed and credentialed, which can be an arduous and lengthy process, depending on which state it’s entering.
Partnerships — like the one Hazelden Betty Ford recently struck up with Emory Healthcare in Georgia — are another avenue the nonprofit is pursuing to expand its virtual care presence.
Hazelden Betty Ford and Emory teamed up back in October to form the Addiction Alliance of Georgia, which aims to bring SUD treatment and education to the Peach State. Jaksha previously said the creative arrangement looks more like a joint venture than a traditional partnership.
“That’s a whole new approach and way for us to expand, scale and grow geographically,” Jaksha said late last year during a American Health Law Association (AHLA) webinar. “We aren’t putting a physical presence into Georgia with Hazelden Betty Ford. We’re collaborating with Emory to do that, along with bringing virtual care … into that partnership.”
Meanwhile, Poznanovich said partnerships like that are part of the nonprofit’s strategy to extend care into all 50 states. In fact, he said the organization will soon be announcing another big partnership in Oklahoma.
Creative collaborations are nothing new for Hazelden Betty Ford.
Several years ago, it created its patient care network to identify like-minded, evidence-based, ethical providers in the markets where the company doesn’t operate to help patients find treatment. Today, it has about 500 of those members around the country.
On top of that, Hazelden Betty Ford has about 20 collaborative partnerships with large academic health centers and health systems across the country, in addition to the affiliate-level partnerships like the one it has with Emory and that it will soon be announcing in Oklahoma.
In the end, Poznanovich said it’s all about expanding access to SUD treatment.
“We’re not trying to steal anyone’s patients,” he said. “What we’re trying to do is provide access to more patients. There’s a ton of people who are not being served behavioral health-wise, and less than 10% of the people who need services are getting them.”