For years, health systems have been teaming up with external providers to better serve the individuals entering and exiting their facilities. A prime example of this trend is post-acute care, with most of the nation’s large health systems now having robust home health and hospice strategies.
To some degree, this trend hasn’t hit behavioral health care yet, at least not in full force. But that’s starting to change, and a new strategic initiative in the substance use disorder (SUD) space is serving as a roadmap to what’s possible.
Earlier in September, in-home SUD provider Aware Recovery Care announced that it had clinched a long-term partnership with Hartford HealthCare, a large Connecticut-based health system with a deep behavioral health background.
The deal could be the first of many for Aware, which operates in 11 total states, according to CEO Dr. Brian Holzer. As the arrangement evolves, it could blaze a trail for SUD providers to forge similar relationships with large health system partners, filling gaps in their care continuums and keeping patients in recovery for longer.
“I view this as a population health approach to SUD,” Holzer told Addiction Treatment Business. “We’re wrapping a fence around the communities that we jointly serve in Connecticut. … If [folks] find Aware and they relapse and start using again, which is unfortunately common, we now have a partner to escalate that care to provide stabilization treatment. If they find Hartford Healthcare first, whether it be detox or residential, they are more likely to find their way to a continuum program that can provide long-term care in the home.”
Wallingford, Connecticut-based Aware provides in-home addiction treatment and operates in Connecticut, Florida, Georgia, Indiana, Kentucky, Maine, Massachusetts, New Hampshire, Ohio, Rhode Island and Virginia. The company has raised a total of about $60.5 million, including a $3.5 million raise in July and a $35 million Series B round in 2023.
Aware and Hartford already had a “collaborative working relationship,” Holzer said. But the companies have now developed a “true clinical care collaboration,” based on evidence and test cases from the collaboration thus far.
Hartford, Connecticut-based Hartford HealthCare is an integrated health system that includes seven acute care hospitals, a medical group, a comprehensive ambulatory network and multiple same-day surgery centers. The overall organization, which employs 41,000 people, also has developed its own Medicare Advantage product with Optum.
Hartford’s behavioral health arm generates $350 million to $375 million in net revenue on an annual basis, according to Dr. James O’Dea, senior vice president of the Hartford HealthCare Behavioral Health Network. The segment has over 3,500 employees, 337 beds, over 90,000 inpatient days annually and about 750,000 ambulatory visits annually.
Hartford provides “great” residential care, O’Dea said, but lacked some step-down options for people for whom partial hospitalization programs (PHPs) or intensive outpatient programs (IOPs) were too intensive.
“We have needed something that is more a concierge, in-home solution, because if we can take that detox and residential rehab and then connect somebody to in-home services that add to a level of sobriety and recovery with the right team of doctors, nurses and recovery support specialists, … people’s lives transform,” O’Dea said.
The path toward recovery
Recovery paths are not linear, Holzer told ATB.
People with SUD often cycle through facilities and periods of sobriety, as opposed to methodically going through levels of care and remaining in recovery for the rest of their lives. Aware’s clinical model keeps people in treatment for up to 12 months to address a patient’s stressors and environmental conditions, with the goal being to “rewire” the individual for long-term sobriety.
“Addiction recovery is a zig-zag,” Holzer said.
Transitioning patients through step-down care models also builds cost-effective care models, Holzer said.
Disconnected silos prioritize care utilization without follow-up, he said, while the collaboration between Hartford and Aware can stop the cycle of patients repeatedly entering and leaving residential care.
“When somebody touches residential rehab, they feel like that’s the solution,” O’Dea said. “They will feel better for a short period of time, but if they’re not connected to an in-home program that goes on for 10 to 12 months, they’re likely to cycle back, rinse, repeat, and … become disheartened and feel like treatment doesn’t work.”
On its end, Aware also operates an alumni program to foster lifelong connections to care, allowing patients to easily navigate back into care if needed.
Holzer sees the Hartford partnership as the “tip of the spear” in what he sees as an increasing trend of behavioral health providers partnering with health systems and insurance companies.
Along with Hartford, Aware in its core markets seeking partnerships with other health systems, employers, employee assistance programs (EAPs) and other strategic partners.
“Hospital systems and payers are going to realize the benefits of partnering with downstream providers of behavioral health services, particularly those that are operating in the home,” Holzer said.
Aware’s CEO saw this concept play out in post-acute care, so he’s speaking from experience. Holzer previously served as a leader with Kindred Healthcare, and he spent a portion of his career leading post-acute care operations at the Allegheny Health Network.
O’Dea similarly views his organization’s partnership with Aware as a case study for others moving forward.
“We’re a very, very well-established, really high-performing hospital,” he told ATB. “To have our organization link to [Aware] sends, I think, an incredibly important message about what the future of addiction psychiatry should look like. We want to be an exemplar to others.”
