The substance use disorder (SUD) industry has dramatically changed in recent years, adjusting to new technology, regulations and medications.
The SUD platform of the future will take into account trends with payers and technology, industry insiders told Addiction Treatment Business, and continually re-educate itself on the best treatment modalities.
Still, future-proofing SUD providers must keep in mind basic tenets like developing their people and listening to patients or risk falling into manifold pitfalls.
Many providers are still adjusting to the evolution of the industry over the last decade.
“So [the SUD industry] really transitioned in a relatively short period of time, from an industry that was fighting the battle to say we are a chronic disease, …we are [treating] legitimate health care needs,” John Driscoll, president and CEO of Caron Treatment Centers, told Addiction Treatment Business. “Today, that business model has shifted. Most [patients] are now in-network and want to use their health care benefits. … So it’s forced us in the industry to really change our model.”
Caron Treatment Centers, headquartered in Wernersville, Pennsylvania, is a nonprofit offering inpatient, outpatient, intensive outpatient programs (IOP) and partial hospitalization (PHP) SUD treatment for teens and adults, as well as medication-assisted treatment (MAT) and other services.
Continuum of care
The SUD platform of the future will require a full continuum of care for the benefit of both patients and providers.
“It’s not just 28 days of residential treatment anymore,” Driscoll said. “It’s a continuum. As we titrate down clinical management, from residential, to PHP, to IOP, to [outpatient programs], to individual, to peer counseling, we’re also standing up the patient’s ownership of the clinical management of the disease.”
Caron offers a continuum of care for people with SUD. The industry overall is heavily focused on outpatient treatment modalities, with 83% offering outpatient services and only 24% and 75% offering residential and inpatient services, respectively, according to KFF.
Payers are increasingly looking for a full continuum of care, Tom Greer, partner at Fulcrum Equity Partners, said. Making a diversified offerings list is key for any forward-looking provider.
“As in any health care setting, as health care has evolved, being in-network is just critical,” Greer said. “You have to have it. You’re under the threat of surprise medical billing or other things if you’re not a network provider.”
Atlanta-based Fulcrum is a private equity firm that invests in health care services and B2B tech companies seeking. Its portfolio includes Defining Wellness Centers and Addiction Campuses.
In-network providers may also have a leg up when attracting investor attention.
Technology shaping SUD industry
Advancements in AI and machine learning have been top-of-mind for behavioral health providers. Industry leaders predicted that AI would be one of the top trends of 2024, easing behavioral health diagnoses and prescribing.
In the SUD industry, technology has the potential to help patients by sending digital warning alerts or even congratulations as people navigate treatment, Driscoll said.
Providers should use technology to measure outcomes, Greer said, but doing so comes with security challenges.
“We started doing that with Addiction Campuses,” Greer said. “The challenge with all of that is that it requires information going into a system. … Can you trust what is being put in there?”
While technology will play a critical role in SUD treatment in the future, brick-and-mortar locations will still be needed.
SUD is a “social disease,” Lynda Micheletti, COO at Praesum Healthcare Services, said, suggesting that getting people off the couch and into treatment facilities will always be crucial.
“Doing it all virtually through the computer is definitely a fallacy,” she said.
Lake Worth Beach, Florida-based Praesum Healthcare Services offers SUD treatment services at 32 locations across New Jersey, New York, Virginia, Massachusetts, Georgia and Florida. The company, which historically opted for de novo growth, executed its first acquisition in the summer of 2023.
Praesum plans to build out its inpatient and outpatient mental health programming, including adding two acute psychiatry hospitals in the first half of 2024, Micheletti told ATB.
Leaders, clinicians as the future
Technology is one component of the SUD industry’s evolution, but at its core, the SUD industry is only as good as its people.
“This is about good operators, good leaders that have been through the ups and downs that can navigate the different reimbursement and regulatory environments but also have access to those relationships of the next layer of management,” Greer said.
Shifts in regulations have already impacted the SUD industry in 2024. The Substance Abuse and Mental Health Services Administration (SAMHSA) set in stone telehealth methadone flexibilities introduced during the onset of the COVID-19 pandemic on Jan. 31. Providers are required to be in compliance by Oct. 2, 2024.
Not only do leaders need to be forward-looking, but having the right mix of staff is required too.
In addition to offering care from professional clinicians, paraprofessionals and peers will also be key for the SUD platform of the future.
The peer workforce could be used as a tool to combat the national workforce shortage. SAMHSA released national model standards for peer support certification in 2023 to pave the way for a credentialed peer workforce.
Regardless of title, continuous training and education is key to continuing to successfully adapt to changing times. Micheletti said that clinicians must be educated annually to ensure that the right treatments are delivered.
Increased education is also key to bracing for the continued opioid epidemic, Micheletti said.
“You would be shocked at the amount of clinicians who are partially licensed or about to get a license who wouldn’t know how to access Narcan or direct the patient to Narcan,” she said.
Beyond just education, providers need to stay in touch with patients in order to successfully adapt with the times.
“It’s constantly being educated, constantly looking at the trends, constantly speaking to the patients that you’re serving,” Micheletti said. “That’s how we’re able to stay ahead of the curve and educate ourselves on what next things to introduce next.”
Although providers need to evolve, change for change’s sake is not advised. Potholes are everywhere, Micheletti warned.
“You can only go based on what history has told us,” she said. “With this population, proceed with caution. The Sacklers, Purdue Pharma has taught us that one little misstep can create a big crisis.”
