This is an exclusive BHB+ story
Reimbursement is a struggle for many subsectors of the health care industry, and the substance use disorder (SUD) treatment industry is no exception. For providers, negotiating service rates with payers is a perennial struggle – but some services are worth providing even without payment.
Alumni services, programming offered to patients post-discharge, can aid patients in recovery and decrease recidivism, though the services are not reimbursable. Still, providers find that the clinical benefits and patient referrals make offering alumni programming a valuable choice.
“We’re the top treatment provider in both states that we’re in, and our alumni program, in addition to our social media, is keeping us top of mind of our alumni and our and their families and friends,” Jacob Biddulph, Tulip Hill’s vice president, told Addiction Treatment Business. “When that individual or their family members need treatment again or for the first time, they’re reaching out to a facility that they know offers the best clinical services around.”
Brentwood, Tennessee-based Tulip Hill Healthcare offers residential care, partial hospitalization programs (PHPs), intensive outpatient programs (IOP) services and outpatient services for SUDs and mental health needs. The organization was formed through the merger of two Kentucky-based facilities in May 2024. In August, Tulip Hill announced its first acquisitions, both in Tennessee.
Tulip Hill has a “thriving” alumni program, according to Biddulph. The provider conducts in-person or virtual exit interviews with every client and connects them with alumni coordinators. Alumni can call or text their coordinators 24/7 and receive regular follow-up phone calls. Coordinators first reach out to alumni the day after their discharge date to touch base and hold alumni accountable for planned meetings or discharge plans.
For six weeks after discharge, alumni coordinators call former patients weekly. During the following six weeks, coordinators call alumni once every other week. Moving forward, alumni receive perpetual monthly phone calls. Alumni also receive weekly text messages reminding them of in-person and virtual alumni meetings.
“We do let them know on the front end of the extra interviews that if we attempt to contact them three times in a row to no avail, or they don’t respond to us, we do have them sign a release that we have their permission of reaching out to the emergency contact just to make sure everything is good,” Biddulph said. “Usually, if they’re not responding to us, things aren’t the greatest, or we don’t have the right contact info. So we definitely want to make sure we have the right information in our system.”
Not all providers offer alumni programs, Biddulph said, or they only call alumni when beds need to be filled. Getting readmissions should be a side effect of good work, he said, not the goal of a program.
At-home SUD treatment provider Aware Recovery Care is one provider actively growing its alumni offerings. The Wallingford, Connecticut-based provider recently augmented its alumni offerings to include a digital app that offers users resources, recovery education and the ability to communicate with other users. The app includes affinity groups for specific demographics, including LGBTQ+ members, first-responders and parents.
“It’s something that keeps them engaged in the program,” Holzer said. “This isn’t meant to be an episodic or periodic or point solution in their recovery journey. We are trying to build a relationship that lasts well beyond discharge from the program. We’re just starting the effort of launching and perfecting, but it probably will get introduced during the admissions process.”
Aware provides collaborative, in-home SUD care in 11 states and accepts private pay and insurance from several large payers, including Aetna, Carelon, BlueCross BlueShield and UniCare. In July 2024, the company raised $3.5 million in a round led by Connecticut Innovations. The year prior, Aware announced a $35 million funding round.
A digital alumni-focused component allows users to engage at their own pace in a safe space, which Holzer said is ideal for people with whom it may be difficult to connect over phone calls or email.
The app soft-launched a few months ago, but Aware plans to ramp up use moving forward. Before the app was launched, Aware’s alumni offerings included email lists and quarterly in-person community events, including bowling or other activities. But the alumni process was “really quite manual,” whereas the new app is automated.
Aware’s longer patient treatment pathway makes the company “uniquely qualified” to create a complete patient journey, Holzer said. The provider’s average length of service is six to seven months, with some patients staying in treatment a full 12 months.
“We really do feel the weight of the responsibility to create a longitudinal care program that truly changes the game and stops the cycle, which you commonly see in addiction, where folks that once they seek treatment will commonly have to continue seeking it periodically over years to decades,” Holzer said. “We think we’re well positioned to stop the cycle and take the time, over an extended period of time, to peel back the onion, address short source traumas, which are typically the cause of the addiction. … that cannot be solved in 30 days.”
Why alumni services
For the providers, alumni services offer numerous clinical and business benefits that make offering the programming more than worthwhile. Biddulph has personal experience with the importance of post-discharge support services.
“Staying sober in treatment, that’s not easy, but that’s not the hardest part,” Biddulph said. “The hardest part is when you get home with the wife and the kids, or whatever your home experience is. This gives you an extra layer of accountability. It gives you an extra layer of support and people that really, truly care.”
Recovery is a lifelong journey, Holzer said, and providing resources and connections to other people on the same path can be key for long-term recovery.
Business benefits are a happy side effect of robust alumni programming, Biddulph and Holzer said.
Alumni active in post-discharge programming are likely to be very positive about their experience and refer more patients to the provider, which may be especially important as the behavioral health industry has evolved in recent years.
The behavioral health care industry has ballooned in recent years, with more investor funds and an “enormous amount” of service providers, Holzer said. An abundance of options can lead to confusion for prospective patients.
“To have someone that has been through a program that attests to the quality of care that’s provided, that can answer questions in ways that we wouldn’t necessarily be able to answer on a Google ad … it’s why you see most companies start, or at least have some form of a little alumni program,” Holzer continued.
Payment (or lack thereof)
Neither Tulip Hill nor Aware bill for their alumni services. Holzer said he is not aware of any provider that is able to bill insurance for alumni services, though he suspects some may be able to use grant funding to a certain degree.
While clinical and business benefits make operating alumni programs more than worthwhile, the inability to charge for services similar to alumni programs may be a symptom of bigger problems in the American health care system, according to Holzer.
“It’s an unfortunate nature of our sick care system, not health care system, that we pay for the treatment of things that have already happened, not necessarily things that could prevent future events from happening again,” Holzer said. “It’s a reality and a frustration I’ve accepted through my career, but an alumni program would fall under that. This is something that can truly keep people sober and fulfill monies that are spent so that we don’t have to re-spend them in our system.”
There is some hope that the reimbursement status quo may change. As payers increasingly consider alternative payment models, there is a chance that alumni services could be reimbursed through a bundled payment model, Holzer said. Without some sort of bundled program, he doubts they would choose to reimburse alumni services.
Biddulph does not anticipate that alumni services reimbursement practices will change. Tulip Hill is not interested in seeking out payment, he said.
“Our alumni program is genuine in the sense of, we just want to bring extra value to the clients that we do serve after they discharge from us,” Biddulph said. “That’s not anything that we’re interested in, to be frank. We just want to provide the best care while they’re with us, and the best care after they discharge from us.”
There are some ways SUD treatment companies are currently being paid for post-discharge services, however.
Peer support SUD company You Are Accountable has narrowed its entire business model on post-discharge, maintenance phase services. The New York City-based company raised $2 million in late 2024 in a round led by GEHA Ventures.
Co-founder and CEO Matthew Serel thinks of the company as a “reverse electronic health record” wherein users add family members, clinicians, counselors, therapists, psychiatrists or alumni coordinators to the You Are Accountable platform. Users meet with coaches for goal-driven conversations between one to three times weekly, and can join group meetings and family recovery meetings.
All of the company’s coaches are certified peer coaches in recovery, and all are full-time employees. Coaches generally spend 20 hours per week in face-to-face coaching sessions and another 20 hours a week on care coordination.
The coaching platform is the company’s core business, but it also offers drug monitoring technology. The company offers Bluetooth breathalyzers that pair with users’ smartphones as well as asynchronous AI-driven oral fluid lab testing. Sober living houses and virtual IOPs can partner with the company for drug monitoring services without using the coaching platform.
You Are Accountable’s platform reduces readmission to higher levels of care by 50%, Serel said. Its services are cash pay, though it is reimbursable by some insurance.
“The way I always like to position it is it costs less per month than I was spending per day on drugs,” You Are Accountable co-founder and CEO Matthew Serel told ATB.
While You Are Accountable has made its name through post-discharge services, the SUD treatment industry overall does not pay enough attention to the benefits of alumni services, the CEO said.
“It’s due to broken incentives, not because people don’t care,” Serel said. “The reason we exist and what we really aim to solve, is the disjointedness between levels of care, because that’s where people get lost. … There’s a lot of emphasis towards treatment, and then the actual sustaining of recovery post-treatment doesn’t get as much attention in a cohesive way.”
