Digital health startup Boulder Care solves two problems through its local provider partnership strategy.
First, these partnerships get patients care that can’t be done via telehealth. Second, it helps Boulder Care deal with the potential return of in-person visit requirements to start telehealth.
It has also led to most of the virtual substance use disorder (SUD) treatment provider’s growth. About 80% of Boulder Care’s patients come from partner organizations and other organic means.
“We’re working with partners to help meet people where they are,” Boulder Care CEO and founder Stephanie Strong told Behavioral Health Business.
In some cases, the partnership talks lead to strategic engagements. In November, Seattle-based public health system EvergreenHealth launched a partnership with Boulder Care. This made the company Evergreen Health’s dedicated outpatient SUD program.
Boulder Care also works with recovery community organizations. These are local nonprofits led by people in recovery and offer peer support services.
“They typically have so many important services for people … but rarely healthcare,” Strong said.
In turn, Boulder Care is able to use those partnerships to connect patients to nonclinical services it doesn’t provide.
Boulder Care, based in Portland, Oregon has caught the eye of investors with its approach. It has raised over $50 million in investment. It treats opioid use disorder (OUD) and alcohol use disorder (AUD) via a mobile app. Through the app, it manages patients’ medication-assisted treatment (MAT). Its MAT includes the medications buprenorphine-naloxone (Suboxone) for OUD treatment and naltrexone (ReVia or Vivitrol), acamprosate (Campral) and others to treat AUD.
The company raised about $36 million in its Series B round, announced in June. Boulder care is working with a “strategic investor” and may raise more funds, Strong said.
In February 2020, the startup raised about $10.5 million in its Series A round.
Some of its backers include Qiming Venture Partners, Laerdal Million Lives Fund and Tusk Ventures.
Boulder Care and Medicaid
Boulder Care operates in 15 states, Strong said. Its biggest markets are the Pacific Northwest and Ohio. Some patients can access some of Boulder Care’s services outside of those 15 states if their insurance partners with Boulder Care, Strong said.
Across all markets, Boulder Care has contracts with “dozens” of Medicaid managed care organizations (MCOs).
Over 85% of Boulder Care’s patients receive health benefits from Medicaid, Strong said. In its MCO partnerships, Boulder Care focuses on value-based care arrangements.
These include enhanced fee-for-service rates or population management bundles.
“It’s been really core from inception for the company to be growing with payers,” Strong said. “We’re really energized by the mission of helping to bring care to people who typically are excluded from other programs, whether those are digital or in person.”
Strong notes that this approach differs from many of its virtual mental health startup peers. Many first opt for cash-pay or commercial health plan partnerships.
The COVID pandemic drove a wave of Medicaid enrollees to seek care from Boulder Care, Strong said.
Many health care providers were temporarily shut down or limited capacity early on during the pandemic. This led to the massive adoption of telehealth and other virtual services. The pandemic also drove a much higher demand for mental and SUD treatment services.
“So we made it our mission and we told our board this is a great opportunity,” Strong said. “The people who are the most underserved today are also the ones who have the most complex healthcare needs and the most expensive to the system.
“The economic buyer, the Medicaid plan, has an interest in helping to reduce costs and to show that [they] can engage and keep this population well.”
It takes time to establish these Medicaid value-based care relationships.
Boulder Care seeks whatever form of contract it can secure with desired MCOs. Then, it usually takes two to three years to convert those contacts into ones “that reward us for the economic value that we’re creating by keeping people well,” Strong said.
Dealing with uncertainty in telehealth
Strong said providing care via telehealth without barriers “is tremendously important.”
As COVID-era rules wind down, some of the regulatory flexibilities that allowed telehealth to boom could end. This could jeopardize a company’s ability to start care via telehealth.
“A lot of the requirements that states are starting to enact are just going to prohibit people from getting care at all because we’re letting perfect stand in the way of the good,” Strong said.
Boulder Care is lobbying local governments to keep regulations that allow for virtual SUD treatment. At the federal level, Strong has worked as an advisor to the Office of National Drug Control Policy, she said.
“I’m really heartened with the direction that the federal government is taking us and just hopeful that we can work state-by-state to enact policies that are not going to send us backward after such tremendous progress over the last few years,” Strong said.
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