While many behavioral health providers have ambitions to enter into value-based reimbursement contracts, relatively few have managed to secure them. And even fewer have managed to build their models entirely around value-based care.
But then there’s Groups Recover Together, a group-based medication-assisted treatment (MAT) provider, which has done just that.
Founded in 2014 and headquartered in Burlington, Massachusetts, Groups treats opioid use disorder (OUD) patients out of more than 70 locations across 12 states, though it temporarily switched to all virtual care amid the coronavirus.
Rather than using private pay or fee-for-service models, Groups’ business is all performance-based. It has more than 70 value-based contracts nationwide with individual health plans in the commercial, Medicaid and Medicare spaces. Those arrangements allow Groups to provide a bundle of wraparound services in addition to MAT, which it delivers in supportive group settings.
The model has helped keep 65% to 75% of Groups’ members in treatment at month six, versus 25% to 30% in traditional MAT models. Plus, it recently scored the company $60 million in a Series C funding round led by Oak HC/FT, who joins other big-name investors such as Optum Ventures and Kaiser Permanente Ventures.
Behavioral Health Business recently connected with CEO Colleen Nicewicz to discuss how the funding will help Groups expand into nearly half a dozen new states and enhance its technology capabilities by years’ end. Nicewicz also shared which new markets the company is targeting, how it succeeds in value-based care and more.
You can find the conversation below, edited for length and clarity.
Inside the C-Suite shines a spotlight on executives in the behavioral health space. Know a top leader who’d like to be profiled in an upcoming Q&A? Drop us a line at [email protected].
BHB: Congratulations on the new funding. Can you provide a little more color on how you’re planning to use it? The press release mentioned expanding into new states, for example, so I’d love to hear which states you’re looking at entering.
Nicewicz: I’ve been with the company now for about two years, and in those past two years, we have been aggressively pursuing becoming the largest and highest quality virtual and in-person treatment provider for people battling OUD. A big reason we decided to go to market and fundraise was to make sure that we had the ability to move as quickly, swiftly and efficiently as possible in pursuing that strategy.
Now, with the new capital, we’re thinking about how we can continue to not only get new states up and running, but also, once we’re in those new states, how we can serve anybody in any geography overnight. Our investment in telehealth solutions allows us to do that.
Today, we’re in 12 — and growing — states. By the end of the year, we’ll be in the high teens.
There’s a couple of different layers to the way we think about expansion. First and foremost: Where is the need? We have a team here at Groups that looks at different parts of the U.S. that don’t have good access to care and also have been significantly impacted by the crisis. The second dimension is we work closely with some of our strategic payer partners and talk to them about markets where various folks in their patient population are struggling with OUD.
It’s a little bit of an art and a little bit of a science.
In 2020 and into 2021, we’ve continued to expand our foothold in the Midwest and in the Mid-Atlantic. We have a ton of operations today in the state of Indiana and are growing in Kentucky, Virginia, West Virginia, etc. Then we’re making our way down down the East Coast throughout the remainder of this year.
And going forward, we’ll pop up in a few other areas of the U.S. In the very near term, we’ll be looking at a number of other states — Texas, California, and a few others.
When you talk about investments in telehealth — another area where you plan to use the newly raised funding — what kind of priorities do you have?
We’ve always used a number of different forms of technology to engage our patients outside our in-person treatment window. We know that, while our members are receiving care from us every single week, it’s only a short period of time, and there’s so much that happens outside of that care window.
We want to make sure our members can engage with us outside that in-person part of treatment when they need help, whether that’s calling our 24/7 crisis line or texting and having one-on-one time with a counselor, a therapist or a doctor.
Can you tell me a little bit about how Groups’ approach to virtual care evolved amid the pandemic?
Like many others in our space, when the pandemic hit, we benefited from the fact that a lot of the regulatory restrictions around how we deliver care were lifted.
There were a number of parts of our treatment experience that had to be delivered in person prior to the pandemic, and once COVID happened, those requirements got rolled back — and they remain rolled back to this day, though the future of those regulations remains unclear at this point.
It really removed the geographic barriers that many of our potential members and members saw to obtaining access to treatment. We’ve benefited from being able to provide more people access to care.
We’re in the process now — like so many other companies in the behavioral space and even outside of healthcare — of starting to plan what our quote, unquote “return to office” looks like.
There is a very important in-person element for many people as they’re experiencing our services, so we’re starting to plan out what that means and are hopeful we’ll get it there later this year.
But all-in-all, we were able to shift all of the elements of our care model virtual pretty much overnight when the pandemic started and have been tweaking and refining and making them better over the past year.
Our clinical outcomes and clinical quality drive every single thing we do because we really want to make sure we’re providing excellent member care. We’ve been tracking those the entire way, and they’ve given us the confidence that virtual care is an offering that we want to make sure we continue to have, even as we emerge out the backside of this pandemic.
So in the future, what sort of a role is virtual care going to play for Groups? Or is that still somewhat up in the air depending on federal and state guidelines?
It’s absolutely somewhat to be determined based on the regulations. But what I’ll say is, in the near term, it’s going to be an offering that we’ll continue to provide for our members and prospective members as long as we can.
And if you decide that an in-person treatment experience is for you, you’ll also get the best parts of the digital treatment experience, too. Whether that means being able to text your counselor outside of treatment hours or the ability to consume content or talk with other members, we’re really thinking about making sure all of our members have access to these really important engagement features that help keep people actively managing their recovery, because it’s something that’s so important and necessary for our members to be doing every day.
Another item in the funding press release that I found really striking was the fact that Groups has increased its member base 45% over the past year. Was that spike driven by the coronavirus? Did it just happen to line up with the growth you were already seeing? Or what caused that?
It was a confluence of factors.
First and foremost, we’ve had a lot of success over the last 18 months with entering into really great value-based contracts with our payer partners. A lot of those contracts went live here over the last 12 to 18 months.
We know the more we’re able to provide covered services for our members, growth will come with that — versus people paying out of pocket for care because it’s obviously so much more burdensome.
Then, the pandemic itself was and continues to be incredibly challenging for people. We’ve definitely seen demand for our services increase, just as a result of the isolation and the challenges people are feeling as a result of being in a pandemic.
One of the things that interests me about Groups is how unique its model is, both in the fact that it leverages value-based care and that it provides group-based MAT. Why don’t we see more companies using those approaches, which have helped Groups’ deliver such impressive outcomes?
When Dr. Jeff De Flavio founded the company, now almost seven years ago in the state of New Hampshire, he grew it up as a self-paid business and was able to get a lot of early data on how this model worked. A lot of what we’re doing today is addressing the same kind of things that Jeff designed the model to combat around the group therapy component, utilizing prescribers who have the data waiver and leveraging the community, etc.
Many providers would love to go and provide value-based care, but in our experience you can’t start there. A lot of payers will say, “Okay. You want to have a value-based arrangement? Fine. But I need some data first.”
Then, what providers are forced to do is operate in a fee-for-service relationship. And when providing outpatient treatment for OUD in a fee-for-service environment, you’re not always providing all of the services you otherwise would, as you’re trying to maximize for the fee schedule. And if you’re not maximizing for the fee schedule, it’s quite honestly tough to run a business.
We have the benefit of being able to provide exactly the care folks need exactly when they need it through these value-based arrangements. We have had the ability to run our care model, which combines medication-assisted treatment, group counseling and the community element. The three of those things together provide really, really great member outcomes.
What needs to change to allow more providers to adopt value-based models and ultimately offer more comprehensive OUD care?
There’s only so many reimbursement codes that you can use when you’re providing this type of treatment. They’re medication management-type codes and urine analysis-type codes, when the reality is there’s a question around how beneficial those are for the patient in recovery.
The incentive structure really needs to be looked at — because a lot of a lot of providers out there probably do know what works. But again, when you look at what works and you try to make a business out of it on a fee-for-service basis, it doesn’t always make sense.
We’re having this conversation just a few weeks after the Biden administration introduced new flexibilities to make it easier for doctors and other advanced practitioners to prescribe MAT medications. What are your overall thoughts on those relaxed rules — and could they have any impact on Groups?
We are hopeful that it brings more prescribers to the table willing to treat people who are in need of services. But it remains to be seen if it’s actually going to drive more prescribers to help battle the crisis.
We’ve covered a lot of ground here. For my final question, I’d like to jump back to talking about Groups’ goals: Apart from its multi-state expansion plans and tech investments, what else can we expect to see from the organization in 2021 and beyond?
I’ll go back to how I started: We are in this multi-year march to become the largest and highest quality virtual and in-person treatment provider for people battling OUD, and we want to bring together the best of the in-person and virtual treatment to do so.
I’m hopeful that we’ll be able to make some traction with this new funding and with some of the new legislature that’s coming down.
Companies featured in this article:
