The addiction treatment market — estimated to be worth $42 billion — has grown alongside the nationwide rise in substance use disorders (SUDs). A number of multi-state providers have consequently emerged in the treatment field, among them being BrightView Health, whose homebase is in a region significantly wracked by SUDs.
Headquartered in Cincinnati, BrightView operates 45 treatment clinics across Ohio, Virginia, Kentucky and Delaware. Backed by health care-focused private equity firm Shore Capital Partners, BrightView offers a range of services to patients with Medicaid, Medicare and various commercial insurances, including medication-assisted treatments (MATs), individual and group counseling, peer recovery support and wraparound social support services.
BrightView was co-founded in 2015 by Shawn Ryan — a local physician who had been working in emergency medicine at the University of Cincinnati — along with Ray Compagna and current CEO Chad Smith. Ryan had seen his fair share of patients caught up in southern Ohio’s SUD epidemic before helping start BrightView. And, like many area residents, he also witnessed loved ones fall prey to addiction.
Today, as BrightView’s president and chief medical officer, Ryan is helping oversee the company’s current and future plans, which include opening new centers, keeping patient services affordable and facilitating growth goals through private equity investment. Ryan talked about those plans recently in an interview with Behavioral Health Business, which has been edited for length and clarity.
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BHB: Give some background information about BrightView and how it became the provider it is today.
Ryan: We started because I was alerted to the overwhelming need for mental health and addiction treatment not being served in my local area of Cincinnati. I started my own office with [co-founders] Chad [Smith] and Ray [Compagna] because of that need.
When you go from having a couple of overdoses a week, to every day five or six times a day, that stuff catches your attention, especially if you’re an analytical guy like I am. It was a combination of local community recognition, some data science and review, and my involvement in some different committees trying to figure out what was going on.
Then like everyone else, there were personal tragedies with friends and family. There’s almost no one who wasn’t touched by this. It was everyone from the homeless patients I was treating to professionals and family members that had significant needs.
BrightView this year has grown by a combination of acquisitions of existing providers as well as opening of new facilities. At the current time, does BrightView have a preference of expanding either by acquisitions or new openings?
There’s really no preference, but it’s a balanced approach between the two. We like all of the pros of our own facility, our own novel staff and growing from the ground up in a location. But at the same time, staffing is a huge challenge for everybody across the country in medicine right now, but definitely in behavioral health and addiction.
One of the challenges we’ve found in forming partnerships or acquisitions has just been making sure that the partner can be brought up to the standards that we hold very dear. Unfortunately, a lot of behavioral health addiction treatment is not a quality standard in our country to be measured against.
We’re very particular about our quality of service delivery, and so it takes the right partner to meet that need. We’re happy to take on partners through acquisition that have growth potential and opportunities for advancement. But sometimes we just don’t see that. We’re taking a balanced approach of reviewing the pros and cons of de novo growth versus acquisition.
There have been some multi-state SUD treatment providers that have opened locations in BrightView’s backyard of southern Ohio. In your opinion, how might BrightView stand apart from those providers?
It’s a comprehensive approach. So very few of our colleagues in this space are adherent to the biopsychosocial model, especially any of them that incorporate medications and laboratory services as we do. We strive to deliver what I would describe as the most complete model of addiction care possible within reason, because there’s always going to be upper limitations.
In comparison to most of our colleagues in the addiction treatment space, we have a very broad model. That includes medical providers, psychological providers and social support staff. We also deliver medications and perform laboratory services. It’s very much a refined but comprehensive model.
We’re also very focused on individual patient treatment and non-punitive treatment philosophies. Historically with a lot of treatment providers, you will hear things like, “Three strikes in your out,” or even terms like “clean/dirty urine,” which are not accurate at all. We’re very particular about the personal nature of treatment and the compassionate care necessary to deliver it.
We have strong attraction and retention numbers, because someone will come to us thinking that treatment is one thing, even despite our best marketing efforts to inform them that we’re a different kind of model. Their coming in is one thing, but they’ll see we’re delivering evidence-based treatment, and they’ll refer a lot of their associates, friends, family, etc.
Tell me about your payer strategy for BrightView.
It’s born out of a mission and vision of serving anyone, anytime, anywhere. What I mean by that is a lot of providers have a very narrow insurance panel, because it’s easier. I joke sometimes with my revenue cycle and payer relations teams about how I know it would be easier if we didn’t take anyone, anytime, anywhere. But that’s not that’s not what we’re doing.
When I started the organization, I said that if at all possible while maintaining financial feasibility, we are going to see anyone with or without resources. I actually understood the payment system reasonably well, and I knew that it was quite a challenging map to navigate. I had been involved in too many conversations where parents were refinancing their house to send somebody to treatment in California on the beach. I didn’t want to be that. I wanted us to be in-network at all times, with the lowest cost structure to the patient’s family if at all possible, and zero cost structure for Medicaid patients.
It’s tough enough to admit that you need to get treatment and to go and obtain it, and then the financial burden of that is overwhelming. It’s just a nightmare for folks involved. We’ve just striven to make it as cheap as we can for the patients and families and easy to access.
Do you think there is play for SUD treatment in value-based care? Do you see it being a big part of BrightView’s business going forward?
That’s been a huge focus of ours. I’ve known about the issues in value-based care for a long time. What we have done is work with different payers and states and Medicare to leapfrog the very inadequate situation of our system to something more adequate by promoting value-based care. The complexity of services that go into a good addiction treatment plan are best served in a non fee-for-service way.
Has COVID impacted your business strategy?
This kind of event is literally the worst thing you could do to a population with mental health and addiction issues. If you were to write a list of things you never want to happen to patients of mental health and addiction, it was all of them put together. The needs of our patients skyrocketed. It forced us to escalate and advance our virtual programming or telehealth quite significantly.
We already did that at some reasonable measure, but didn’t have as robust of a system because it wasn’t required. When COVID jumped on, it was all hands on deck. We had to focus on virtual programming and telephonic services. But what does that mean for testing perspective? How do you get people their medications?
We really had to understand how to do those remote services quite substantially in a matter of a couple of weeks. It catapulted our technology capabilities and utilization around virtual services, which was a good thing. We appreciate the latitude by state and federal governments on telehealth and hope that most of those prevail.
We’ve heard alot about clinician shortages throughout the behavioral health spectrum. Are you seeing that at BrightView? If so, what’s your strategy to combat it?
We absolutely are. I think workforce shortages were already present. As with any industry with a complex licensure workforce, supplementation or improvement is not a short story. It’s not a short journey. So with a lot of our staff, physicians, nurse practitioners, counselors, it’s a long educational road.
There were insufficient state and federal efforts to remedy that prior to COVID. There are efforts in place, but we really appreciate the loan reimbursement programs, which is one of the strategies. We really appreciate the educational intention of broadening those workforces or relaxing licensure requirements. Some different programs — Medicare being one of them, — had very restrictive licensure allowance for who could counsel a Medicare patient.
We have a long way to go. If the reimbursement is insufficient, the organizations providing the services can’t pay people. They can’t entice people enough to make them go to school. Promoting reimbursement is one of our strategies.
We work with schools and provide internships in order to get people in and get them their hours and training. I will personally work with state and federal policymakers on loan reimbursement and other programs to help promote people into the field. But at the end of the day, it really comes down to being able to entice people into a field that is rewarding, and then compensating them appropriately to make it worthwhile to spend their time pursuing education.
BrightView currently has financial backing from Shore Capital Partners. What has the investment meant for the company?
It was a necessary investment for us at a time when we were planning on some growth. For us, it’s been a wonderful partnership. They’ve provided not only financial security and support to allow us to deliver on our mission, vision and growth plans, but also a whole lot of support from a staffing and recruiting standpoint.
They helped us find our current chief sales officer and chief financial officer, as well as many others. Those individuals have been critical in the growth and continued delivery of quality service. It was a necessary decision at the time and has proven to be very positive in regards to all of the things that we’ve had to do along the way for the past five years.
You’re seeing a lot of money coming into the SUD treatment space to back providers. What do you make of those investments?
It’s one of many supportive mechanisms to grow the field from where it’s at, to where it needs to be. It is going to take all hands on deck to get us anywhere near a reasonable level of care being delivered. That has to be a combination of public and private investment.
Unfortunately, the public is still somewhat unwilling to recognize how big that gap is. There’s a lot of reasons for that, but the primary reason is stigma. I’m very much a frame-of-reference kind of guy. When somebody says, “Oh, when they invested a billion dollars in this program,” My question is, “Is it the right number? Is that enough? Is that not a lot?” If you were to give a billion dollars for a very large military program, they would know right off the bat that was insufficient.
Although it’s greatly appreciated that there has been significantly more investment by the state and federal governments in the issue, they are not recognizing the magnitude of the problem, which is why we still are seeing terrifying numbers in SUD. It’s a necessary public-private melding, where both parties need to really invest in the space.
Anytime there’s such a need by a population, there’s an investment opportunity, and hopefully like BrightView, they’re saying, “This is both an investment opportunity, financially, as well as in our communities, and therefore you can do well by doing good.”
When it comes to justifying the need for private equity funding, do you think that treatment providers need to do a better job of articulating those reasons to the public?
I do, and I advocate for that. But it’s an issue that is complex and sensitive. I do feel like the field could be better served by talking about the fact that there’s a reasonable return on that investment which is not yet being made by public entities like the state and federal governments. There shouldn’t be an issue by saying these investment entities are going to support closing a gap for community need, while making the necessary return to sustain their business.
A lot of investors talk about doing well by doing good. This is probably the best they can do. Some people say we shouldn’t make money on people’s addiction. That’s not what’s happening, folks are already there. The people in need are already present. The investment entities are not drug dealers, that’s not the same thing. They are investing and returning appropriately on a community gap that is not getting closed otherwise.
As we get ever closer to 2022, has BrightView identified any specific objectives — be it with patient results and/or business operations — that it is aiming to accomplish in the new year?
We’re confident in the fact that we’ll be somewhere around 50 locations by the end of this year, if not more. That does depend on some levers that may be pulled in one direction or the other around merger and acquisitions or partnership. We’re keenly focused on understanding what we’re doing and growing from that.