Aware Recovery Care Inc.’s chief goal is a herculean task. It’s nothing short of carving out a whole new industry-wide recognized level of care within the addiction treatment space.
The Wallingford, Connecticut-based company provides in-home addiction treatment services. Most addiction treatment is based out of dedicated facilities. That makes Aware Recovery Care’s model of providing a team approach to addiction care in the home seem all that more novel.
While the company is most appropriately thought of as a startup, as Aware Recovery Care Chief Growth Officer Dr. Andrea Auxier puts it, a major first round of investment appears to validate the company’s approach to care.
Aware Recovery Care operates in eight states: Connecticut, Florida, Indiana, Maine, Massachusetts, New Hampshire, Rhode Island and Virginia, where the company launched last week. It also employs about 650 people and has an annual census of about 1,000 patients. In total, it has served about 4,200 people since its founding in 2011.
The company has another bold goal that acts as a companion to defining a new level of care in addiction treatment — operating in all 50 states. Combined, Auxier calls Aware’s expansion ambitions and the regulatory objective its “big, hairy, audacious goal.”
To reach those big goals, the company raised $22 million in a Series A funding round from New York City-based Health Enterprise Partners in January of this year.
The investment by Health Enterprise Partners helped it build out a full executive leadership team. This helps “infuse the company with discipline and sound business practices to be able to scale,” Auxier said.
“In some ways, the company is growing up,” Auxier said.
On top of organic growth, the company also plans to grow via M&A; the company’s leadership team is presently evaluating a target company, but Auxier declined to share further details in a recent interview.
An addiction recovery pioneer
While the company provides services in a patient’s home, Auxier said it technically isn’t a home health company. Founder and CEO Stephen Radazzo based the approach of the company on his own addiction recovery experience.
But in-home care is not a widely used model in addiction treatment. Before becoming aware of the company, Auxier had never heard of a treatment company providing in-home care in her wide-ranging career as a clinical psychologist and health care executive. She previously worked as a senior vice president for Quartet Health, chief commercial officer for New Directions Behavioral Health and as national director of integration focusing on strategy and development for Beacon Health Options.
Providing this treatment in the home confuses commercial health plans, which are currently the only payer type Aware Recovery Care works with. There isn’t a standard billing code for the service they provide.
“Our ability to grow is hindered because it’s a very idiosyncratic conversation with each and every payer,” Auxier said. “We’ve had conversations with a lot of large payers. We were successful with Anthem and there are others that are in motion. It tends to get caught up in this ‘what level of care are you?’ vortex.”
These conversations with payers are key, according to Auxier. Aware Recovery Care’s growth hinges on being able to work through the “vortex” with payers. The company’s current growth rate stands at adding two or three new states in a year.
“You have to figure out with every single [payer] how it’s going to work,” Auxier said. “Whereas if we were a recognized level of care, if in-home behavioral health care were recognized, it would be easy.”
Another potentially complicating factor is the company’s value-based care reimbursement approach. Payers tend to have trouble handling value-based care in behavioral health.
“Aware has value-based reimbursement models including bundled payments and other value-based arrangements, limiting risk to the payer by focusing on a whole-person health curriculum,” Auxier said in a follow-up email.
Auxier maintains that it would be possible to establish partnerships with larger commercial insurance providers and work on expanding into multiple states at once, scaling the company up much faster than grinding through state-by-state partnerships.
A more short-term goal for the company is to double its census in 2022, Auxier said.
Inside Aware’s in-home model
In industry jargon, Aware Recovery Care provides “a multidisciplinary team of paraprofessionals and professionals that goes into the patient’s home,” Auxier said.
In more lay terms, the company brings to bear several levels and types of engagement into people’s homes.
After an intake process that determines if a potential patient would be well served by Aware Recovery Care, it conducts a clinical assessment of the patient. This is mostly done by social workers or nurse practitioners. The company also performs a psych evaluation on the patient.
At that point, a team of professionals guides the patient’s care through a year-long program. The average engagement with the program is about 8.5 months with 63% of patients engaging the full 52 weeks. Auxier said the program follows all National Institutes for Health recommendations for chronic disease.
The company assigns each patient two certified recovery advisors. These advisors get certified in in-home addiction treatment and are peers who themselves have recovered from addiction. They meet with the patient in their home or other community settings.
The patients are also assigned to a social worker or nurse who acts as a care coordinator. They are the proverbial quarterback for patients’ care, including helping patients get connected with primary care or more acute levels of care if needed from partner providers.
In certain states, Aware Recovery Care is able to provide in-home detox services. In others, it provides in-home internal psychotherapy.
Aware Recovery Care also provides family therapy and family training to address the setting that the patient lives in as well.
The company touts the outcomes of this team-based approach to providing addiction treatment in the home.
Data provided by Auxier states that 78% of participants maintain abstinence a year after treatment; in-patient admissions drop 85% while in the program and drop to about 73% a year after treatment; and overall medical claims drop 6% at six months after treatment.
Aware Recovery Care acknowledges that comparing the in-home treatment to facility-based care is an apples-and-oranges comparison. But one analysis done by Aware payer partner Anthem Blue Cross/Blue Shield found that in-home addiction treatment was six-times more effective than traditional substance-use disorder treatment.
Auxier also pointed to data from the U.S. Substance Abuse and Mental Health Services Administration that finds that in-home addiction treatment has a completion rate of 94% at the 6-week mark and 82% at the 12-week mark. Rates for the same periods in intensive outpatient program treatment were about 32%.
Exploring the future, new growth opportunities
To this point, Aware Recovery Care has not yet built out a business segment that can take on the unique challenges of the Medicaid population. The Medicaid program is the single largest payer of mental health services. One government estimate shows that Medicaid spending makes up about a fourth of all spending on mental health and substance use disorder treatment.
In part, the reason for not serving the Medicaid population is organic. The company got started working with a commercial insurance entity within the Anthem company and has stuck to that type of payer source.
“It’s primarily a clinical staffing consideration,” Auxier said, adding that other challenges such as a higher prevalence of comorbidities, higher rates of homelessness and higher regulatory strictures as additional challenges they haven’t worked out in their business. “It really comes down to just resources.”
Auxier hopes to see the company launch its first Medicaid business in 2023. She believes that the company will be able to build the infrastructure and discipline it needs in 2022 to take on Medicaid the following year. But it’s definitely part of the plan, she said.
“All of our payer partners would love to see us go into Medicaid, and we would love to go into Medicaid,” Auxier said. “Our philosophy is [that] we’re not just going to say we do something and wing it — we’re going to build it right because these are real people with real lives. Medicaid is a different population with a different set of needs [that’s] more complex in some ways.”
The company also hopes to provide addiction treatment to people younger than 18 years old as well as expand its straight mental health services, Auxier said. Aware Recovery Care is also working to develop a new service line that integrates what the company learned from the COVID-driven shift to adopting technology in a meaningful way.
“What came out of [COVID] is a pretty clear direction going forward, which is that we definitely see ourselves as a tech-enabled company,” Auxier said, declining to go into the specifics of what the new service line would entail. “Stay tuned for that.”
Companies featured in this article:
