Some in the addiction treatment space are using novel conceptions of the marketing jargon “lifetime value” as a tool for assessing new programs and strategies.

Because addiction treatment providers are so different from the average business, the typical application of business rules and concepts often yields different outcomes than would be expected. In turn, some switch the meaning of the term “lifetime value” from the amount of revenue generated from a client over time to the amount of value the addiction treatment provider generates for the client, i.e., the patient. 

Bob Poznanovich, the now-retired chief growth officer for the Center City-based Hazelden Betty Ford Foundation, said at the Addiction Treatment Forum in July that he first heard the term “lifetime value” outside of the context of marketing at a meeting of health care executives, including several who led now-defunct health operations led by retailers.

“They all pointed to some of us who were traditional providers and said, ‘You’re all in trouble because you chase episodes, and we understand the lifetime value of a customer from a retail perspective,'” Poznanovich said. “And that scared me at the moment.”

Poznanovich said that specific encounter taught him two things about value generation from the patient’s perspective. First, the benefit of engaging with a provider must be felt by the patient and beyond, to the patient’s family and community. Second, the experience of care must generate enough trust to overcome stigma and the specific shame of relapse.

“The return on investment for being able to keep your current relationships and grow them or the add-on sales could be as much as 50% to 100% in additional margin for us,” Poznanovich said, “So this makes good business sense, and it makes good patient sense and outcomes sense.”

One key misunderstanding of many retail health care operations, Poznanovich said, was that health care — especially behavioral health — is centered on relationships of trust with providers. The concept of $1 a minute for therapy made transactional sense but didn’t account for the intangible elements of value that patients are seeking.

Understanding what patients are seeking requires work on the part of a behavioral health provider.

“[Patients are] reaching out to improve the quality of their life on their terms, measured by their metrics,” Boulder Care COO Rose Bromka said during the panel discussion. “Internally, I think about the metrics that capture that. Of course, [it includes] retention in care because of the connection to the dramatic drop in return to use and overdose. I think about patient satisfaction. I think about the number of reviews on an app store that talk about how lives are changed.”

Establishing deep relationships within specific communities enables the discovery of client needs as well as solutions for said needs, Bromka continued. That is an interactive process. It starts with addressing what is obvious and then getting to deeper issues through a virtuous cycle of establishing trust. And trust, Bromka said, is the North Star for Boulder Care. The company’s objective is “to be the most trusted name in addiction care.”

This process of building relationships and trust has resulted in new initiatives.

“We had patients saying scheduled visits don’t work for [them] — so we created an on-demand intake clinic with one psychiatric mental health nurse practitioner in the summer of ’23,” Bromka said. “By January ’24, 90% of our clinical visits were on demand.”

The iterate-and-start-small approach is based on a sustained focus on internal success metrics. It also required a “transparent” assessment of whether or not the on-demand model was indeed successful. 

That experience of starting a small project to solve a discrete need with a keen focus on its immediate impact and potential for scaling across a business requires executives to be clear-eyed about failures. Bromka added that Boulder Care needed to “be willing to kill our darlings.”

A more mature program example: Cityblock Health’s behavioral health program emphasizes patient engagement through care management by care coordinators, whom the company calls community health partners. By increasing the frequency at which the company can engage with patients, Cityblock Health hopes to spur better outcomes, ensuring people get the care they need.

“Engagement is probably the toughest piece of the puzzle, engaging people into healthcare,” Cityblock’s head of behavioral health, Ruby Mehta, said at the panel. “This team of nonclinical workers develops those deep relationships with members.”

These community care partners assess and address the social determinants of health barriers. This can be done in simple ways, such as providing rides to appointments.

Poznanovich said that one often overlooked element of developing programs meant to drive greater lifetime value is answering the question of who will pay for the service. This is where payers ought to be concerned. At times, it makes sense to engage with responsive payer partners early on in a product development process.

One payer partner he’s turned to in the past was Deb Nussbaum, the senior director of behavioral health, evidence-based services and national SUD strategy lead for Optum, who also joined the panel.

“Our lifetime value is making sure that we can help people get well and guide them on that wellness journey with the networks that we utilize and the provider relationships that we have,” Nussbaum said at the Addiction Treatment Forum.

Nussbaum acknowledged that not all health plans have sympathetic clinician executives in leadership decisions. But she acknowledged that industry champions can be found across the industry. She said that she wants to be a part of early conversations for programs that help her deliver greater lifetime value for patients and the organizations that sponsor a health plan. Doing so will help her manage the “little pool of money” given by sponsors each month to ensure patients get well.

“I want to see this industry evolve,” Nussbaum said. “I want to see outcomes. I want to see us talking about measurements and show that people are getting better from the interventions that we’re doing. So please, keep innovating and keep looking forward and bring [ideas] to your health plan partners.”