The substance use disorder (SUD) treatment industry has a history as a scattered network of small cash-pay providers. It remains largely fragmented.
Delray Beach, Florida-based Guardian Recovery has experience evolving from a founder-led, boutique provider to an expansive network of 17 physical facilities and virtual care options.
The challenge for the provider now is to honor its boutique origins while scaling fast.
Since 2018, Guardian has grown at a factor of 10 across all business metrics, Marco Merida, president of Guardian, told Addiction Treatment Business. The provider has largely ballooned through de novo growth but is now hitting the gas pedal and seeking to acquire like-minded SUD operations.
The company’s immediate expansion plans include launching a new Texas location this November and opening a comprehensive detox and residential care facility in Kenosha, Wisconsin, slated to open by summer 2025.
ATB sat down with Merida to discuss Guardian’s plans to grow its virtual business to be as large or larger as its in-person business, the company’s goal of staying “sticky” with patients and Merida’s ultimate vision for the company.
This interview has been edited for length and clarity.
ATB: What service lines did Guardian start out with when it was founded in 2013, and how has the company grown?
Merida: Our founder, an individual named Josh Scott, who is our CEO, had been a product of excellent treatment himself in the substance use disorder space. He had a vision that he wanted to fulfill his life’s purpose of giving back to the same fractured community that he was a part of. He started with a little program called Guardian Life Skills out of Delray. Essentially, that was an interventionist group that evolved over time into a small intensive outpatient practice a year later.
Effectively, our story is that of a boutique operator born and bred for and by individuals in recovery, looking to fulfill the brand promise around this focus that the client comes first.
The goal has been over the last 10 years to figure out a way to preserve that notion of boutique founder-based care in an ever-maturing and ever-professionalizing environment, but never lose sight and never lose touch of that boutique look and feel.
Guardian offers mental health care as well as SUD services. Why is it important to have diverse treatment options for your patients?
Since substance use disorder isn’t an isolated and singular issue, it became clear that we not only had to increase our depth, but also our breadth of offerings to make sure that we could meet clients where they were and also be relevant to clients’ sort of value web of individuals, the family.
There’s also, coincidentally but opportunistically, a good business model there. If you’re solely focused on a singular vertical in a health care space, you’re subject to some of the movements inside of that space. But if you diversify your offering so that you are now a little more horizontally integrated, then you’re evolving from something that looks and feels like an excellent SUD operator into something that looks and feels a lot more like a behavioral health care platform, which, over time, has become the strategy for our organization.
In 2018, when I came on board, my approach was to figure out ways to create systems, processes and structures that were predictable, scalable and repeatable, and take that model and move us into a behavioral health care approach that allowed us to cast as wide a net as possible. There were strategic implications around that, including moving from an out-of-network cash-pay model, which is great when you’re entrepreneur-led and trying to maintain control of everything, but then realizing that at a certain point, moving to in-network allows you to service and be an asset to a much larger audience.
Over time, we’ve gone from this entrepreneur-led, boutique-oriented substance use disorder program that needed to control as much of the client journey as possible, to this notion of creating a complete, continuous continuum of care in multiple geographies and realizing that we want to be relevant to clients in as broad a space as possible. That required the expansion into the mental health landscape and focusing on creating a behavioral health care platform.
Guardian provides virtual and in-person services. What proportion of your business is virtual, and what are your plans for that side of the business?
Our virtual business is small but growing. There is potential for that, in five years, to be as large, if not larger, than the physical locations only because it’s much more scalable in a quicker period of time.
COVID presented the opportunity to explore and push ourselves to make sure that we were still able to service individual levels of care, and we wanted to be an asset and a partner to those individuals. And post-COVID, we realized that this is just an essential channel for us to provide and that our clients are going to demand it. For us, it’s going to be as big, if not bigger, in the long term.
How has Guardian grown over the past few years, and what are your plans for future growth?
It’s effectively been, almost across the board, a 10 times level of growth in all business metrics from 2018 to today. All while maintaining the internal measures and standards that we hold ourselves accountable to the client journey.
Our goal is effectively to double in size over the next two to three years. We’ve been successful with both de novo and M&A. We have been a de novo-oriented company from our foundation. We do well with that.
But this space, the substance use disorder space, in particular, but behavioral health care in general, is a highly fragmented space. You have a lot of individual, boutique, excellent operators that are at the front end of a growth curve that really could benefit from leveraging the power of an organization that has well-established policies, procedures, operating models or back-office infrastructure. So this notion of being able to identify an excellent and ethical operator and empower their model with the benefits, strengths and learnings of our model, and then taking the best of both and merging those together while preserving the essence of their DNA but imbuing the Guardian culture, ends up being a really powerful combination.
So for us, the M&A space is exciting. It’s a little less exciting when the interest rates have ballooned up. That’s a bit of a factor. But what we have found is that with an excellent product, an excellent plan and a strong track record, it’s not difficult to find investors to help support the vision.
The challenge is to make sure that we continue to scale at a rate that allows us to stick to our fundamentals, which is preserving our brand promise of delivering the greatest care to the most lives in a behavioral healthcare space as we possibly can.
What’s your ultimate vision for the company?
The plan is to be a national behavioral health care platform that’s comprised of both physical and virtual access points. The intent is to be geographically diverse but to maintain centers of gravity, near where we have the efficiency and the ability to support from back office and infrastructure operations so that we don’t spread too thin, but ultimately, where we are offering as many relevant behavioral health services as possible to individuals for as long as is necessary.
The goal is to try to be involved in their lives for as long as possible. It gives us the opportunity to stay relevant to individuals well beyond 120 days of substance use disorder treatment. It’s trying to become as sticky, relevant and valuable as possible.