Aware Recovery Care knows that it faces a tough road in growing its in-home addiction treatment model.
The issues raised by using a poorly understood model — coupled with the challenges of focusing on value-based care contracts — highlight the slog Aware Recovery Care and other companies face when trying to push the innovation envelope in substance-use disorder (SUD) treatment.
“Managing an in-home addiction treatment program is challenging — [it’s] definitely going against the grain,” Maks Danilin, senior vice president for growth at Aware Recovery Care, said during an interview at the Behavioral Health Business event VALUE.
Operationally, those challenges include managing and ensuring accountability with a large mobile field force as opposed to a digital workforce or one that’s tied to a facility.
But the main barrier to the company’s nationwide expansion goal is that many payers don’t have a frame of reference for what Aware Recovery Recovery does and struggle to equate it to something else.
“There are some challenges contracting-wise because we were not a traditional level of care,” Danilin said. “So it creates a lot of challenges.”
Aware Recovery Care presently operates in 10 states. The company raised $22 million in a Series A funding round from New York City-based Health Enterprise Partners in January 2021.
So far, about 80% of Aware Recovery Care’s revenue comes from value-based care arrangements after being founded as a cash-pay business. The company is transitioning from structured case rates, which Danilin said is the “very beginning of value-based care,” into more shared-risk arrangements where Aware stands to share in savings with successful treatment or take on added care costs if a patient experiences setbacks.
Eventually, Danilin could see Aware Recovery Care eventually negotiating capitation rates with payers in the future.
“I do think that the capitated rates [are] probably a little bit of a stretch but the future is moving farther along that continuum for value-based care,” Danilin said.
He estimates that it takes payers and facility-based operators six to 12 weeks to hash out reimbursement agreements for fee-for-service, facility-based intensive outpatient programs (IOPs).
“If I was an IOP looking for just a normal in-network contract, I can speed that up fairly quickly,” Danilin said. “We’ve got it down to nine months to a year. One day, it’ll get down there to two to three months.”
Danilin is confident that there is demand in the market for in-home SUD treatment, claiming that “thousands” of people reach out to Aware Recovery Care for services but aren’t served because Aware isn’t in the patient’s provider network.
“We get so much member interest; we know it’s there,” Danilin said. “We have to turn them away. If I had my one wish, and I could wave a magic wand, it would be to speed up the contracting period.”
Aware Recovery Care brings multi-disciplinary teams of clinicians and other professionals into the homes of people seeking recovery. In contrast, more familiar models for SUD treatment for IOPs, partial hospitalization programs or residential treatment programs require patients to leave their homes and potentially disrupt their lives to get treatment.
Stephen Radazzo founded Aware Recovery Care in 2011 and is now the company’s chairman. It’s now led by CEO Dr. Brian Holzer. The company’s president previously told BHB that part of the company’s focus is carving out and legitimizing a new lane of SUD treatment.
Making the case to payers
Tracking demand from members whose plans don’t include Aware Recovery Care is one tool that the company uses when trying to land new agreements with insurers.
Another is bringing in data from a third party — the In-Home Addiction Treatment (IHAT) Institute — that assesses Aware Recovery Care’s outcomes. The IHAT Institute was founded in 2018 by a group of people that includes several Aware leaders.
Radazzo, Aware Chief Operating Officer Matt Eacott and Aware Client Engagement Director Tracie Samuelson occupy three of the institute’s six board seats, according to publicly available information.
“That’s really what’s going to hold weight,” Danilin said. “Taking a look at claims and being able to see over the past six years what has happened with these members — let’s take a look at pre-Aware Recovery Care, then during the course of treatment and then two, three, four, five years out — that’s been the most valuable.”
Another contributing factor to the length of time it takes to land new contracts is the present focus on value-based care. Norms in value-based care, especially in the SUD treatment space, have not yet crystallized.
Aware Recovery Care sees retention pop up as a key measure in its value-based care contracts. The standard Aware program runs for 12 months; the company’s average length of stay is nine months, Danilin said.
About 63% of patients engage the full year while 78% of participants maintain abstinence a year after treatment. In-patient admissions drop 85% while patients are in the program and drop to about 73% a year after treatment, according to data previously provided by the company.
Even with data and studies on the effectiveness of the Aware Recovery Care model, value-based care contract talks drag on.
“As some of the earlier panelists said, you’re looking at a year to two years to get somewhere along the spectrum of the value-based contract live,” Danilin said, adding that there is some variation among payers. “Certain payers are more innovative than others and are more comfortable trying out the shared risk savings.”
Where Aware Recovery Care is going
While the company isn’t completely alone in trying to reach people seeking recovery in their homes, it still stands apart from digital mental health companies that raised over $5 billion in 2021 by offering care exclusively via telehealth or bricks-and-mortar providers offering telehealth.
The on-set of the pandemic and the relaxed regulatory environment were a boon for digital mental health companies that treat SUDs, especially those that offer medication-assisted treatment.
Aware Recovery Care, by contrast, doesn’t lean into technology in its care model. Rather, it uses technology as a way to ensure regulatory compliance, Danilin said, opting for a care model that drives high engagement because the care goes to wherever the patients are.
Other challenges in expanding into other states and adding new services include finding the right number of clinicians — nurses and social workers especially — to meet potential demand.
Aware Recovery Care’s new service is an in-home detox and withdrawal management program. Patients can begin their treatment with the detox program before transitioning to the year-long clinical and care coordination program.
The detox program so far has been doing triage work with local hospitals to help move patients from hospital beds to their homes to open beds for more acutely ill patients, Danilin said.
The company is eyeing expanding into mental health services, the intellectual and developmental disability care space as well as primary care.
In the future, more players could enter the space with stand-along addiction treatment offerings, through established home health care providers adding addiction treatment, or will payers and large health care systems moving into the space.
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