This is an exclusive BHB+ article
Therapies for substance use disorders have been relatively stagnant for the last few decades. But some providers are looking to change that by moving the dial on new treatment modalities and innovation.
Caron Treatment Centers is looking at care differently by including research as a key part of its organization. The provider is now zeroing in on research efforts, from including GLP-1s in care to taking a neurorestorative approach to behavioral health.
Wernersville, Pennsylvania-based Caron is a nonprofit provider that serves patients with substance use disorders. It operates in Pennsylvania, Florida, Washington, D.C., Georgia and New York. The company employs roughly 755 people.
In this BHB+ TALKS conversation, Senior Editor Laura Lovett sits down with Caron Treatment Centers CEO John Driscoll to discuss new treatment modalities, payer trends and service lines.
Laura Lovett: Hello, I’m Laura Lovett. I’m the editor over at Behavioral Health Business, and we are so lucky today to be joined by John Driscoll, who is the CEO of Caron, which is one of the largest SUD treatment centers in the US. I am so excited to have him on to talk all about advancements in SUD treatment, reimbursement, and anything you can think of in that space. I encourage the audience to ask questions, and we will try to get to those as we go. Welcome, John.
John Driscoll: Thank you, Laura. Pleasure to be here with you today. Looking forward to our conversation.
Lovett: If anyone doesn’t know Caron, could you talk a little bit about Caron and place us in the space?
Driscoll: Sure. Caron Treatment Centers has been around for nearly 70 years, and really started by a family, the Carons, Dick and Catherine Caron, got sober early on, was a contemporary of Bill Wilson. We have correspondence between the two. Dick, really, in a way to help him remain sober started a newsletter called the Chit Chat newsletter, and was known throughout the local community helping people and their families find their way into early recovery.
As a result of that work, they decided they could help more people, and they started what was called Chit Chat Farms here in Wernersville, Pennsylvania, back in the late 1950s. We’ve been a part of advancing the field of treatment, advancing and innovating care, starting up some of the first standalone detox centers in the state of Pennsylvania, starting family programs, integrating mental health services into co-occurring care. We were on the forefront of using medication-assisted therapies, and today we hope to be leading the field in treating the organ of the affliction, which is the brain. We’ve been innovating since the very beginning, and we hope to continue to do so.
Lovett: Actually, I’d love to dig into that research. Caron is at the cutting edge of a lot of the research. What are you most excited about in addiction treatment right now?
Driscoll: Sure. At Caron, we’re not just a treatment center. As I like to say, I’m not in competition against any other treatment center. We’re in competition with a deadly chronic disease. To be a center of excellence, we really have to go after the disease the way other health care organizations go after it. We’re about advocacy, education, prevention, early intervention care, ongoing care throughout the course of the disease. Research is a key part of that.
For decades, our industry has fought to be a part of a legitimate health care movement. Going back over 30 years about fighting to get parity, being accepted into the ACA as an essential benefit, and really making sure that we’re recognized not as a moral deficiency, but as a true chronic disease. It’s important then that we follow– The game plan that we follow is that of health care. We use research to guide us in our best practices to improve outcomes. That’s a piece that is core to what Caron’s belief is, and where we have our benefactors. Some of our strategic focus going forward is, how do we advance the science of addiction treatment and overall care and outcomes?
Lovett: Diving into that even a little bit more, I know Caron has been a vocal advocate of neuro restorative approach to behavioral health. Can you explain exactly what that means? Why is focusing on brain health so critical and effective in treating substance use disorder and other co-occurring conditions as well?
Driscoll: Sure. There’s really two pieces that we’re doing here with brain health. The first one is actually going against the number one barrier to people seeking treatment for this chronic disease, which as I mentioned earlier, is the belief that there’s something morally wrong with them, that they’re weak-willed individuals. We hope by labeling this as a brain disease that it is, we can start to work our way around the stigma that keeps so many people out of it. Denial, minimization, justification, those are things that keep people from seeking care early.
It’s equivalent to the person with blurry vision looking at themselves in the mirror each morning and saying, “Not today. Today I’m going to see in focus.” Good luck with that, changing that organ of the disease. For the most part, you’re going to need treatment, maybe assessment, maybe some glasses, maybe some contacts, maybe even corrective surgery. There isn’t a moral dilemma to it. It’s like, “I’ve got this issue with one of my organs, I’m going to treat it.”
With addiction and mental health, the organ of the affliction is the brain. We’ve known this for decades. We have the scans. We can show, here’s a normal brain, here’s a normal brain, or here’s a brain on drugs and alcohol. We’ve known about the early etiology, as we develop as human beings, our brain is developing. That’s one of the reasons why the earlier the onset of the use of chemicals assaulting the brain while it’s developing really creates poorer prognosis going forward.
It’s time that we as a field begin to treat that organ. Now, over the last several decades, we’ve seen tremendous advancements in the technology and the ability to see what is occurring into the brain, whether it’s traumatic brain injury, dementia, Alzheimer’s, concussions, that the technology is out there and exists. It’s time for our field, addiction and mental health, to step up and utilize that medical technology and not just stay where we were in the past.
Lovett: One of the big barriers to getting some of this is reimbursement. How do you think about reimbursing for some of those cutting-edge technologies? I spoke last week at the Addiction Treatment Forum to Dr. Adam Scioli, who is the chief medical officer over at Caron. He mentioned GLP-1s as well. All these cutting-edge aspects are going on at Caron, but how do you get that reimbursed?
Driscoll: I think there, the key is to talk to our insurance companies. Actually, at your October panel that I was a part of last year, I was on stage with an insurance company that was talking about possibly doing a pilot project to look at this. When you treat this as a healthcare disorder, the things that we’re utilizing right now are being reimbursed by insurance for these other diseases or disorders. For example, and I hope this doesn’t happen, but if I walk out of here today, slip and bump my head on the sidewalk, I’m going to be transported to the emergency room. That’s going to be covered by my insurance.
They’re going to give me blood tests. They’re going to scan me to see, is there a reason that I fell? Do I have an infection? Do I have a tumor? Do I have something going on inside my head that caused that fault? They’re also going to look to see, did the fall cause problems? Do I now have a bump? Do I have internal bleeding? All of that’s going to be covered by my insurance because we’re utilizing that science. What we’re saying here is, we know stress is a major indicator and can lead to relapse. Stress can be measured through hormones measured in the brain.
Today we take blood tests. We get reimbursed for blood tests all the time, cholesterol, blood sugar, et cetera. Yet why don’t we utilize these same blood tests to look at our hormones in our brain? We’re getting reimbursed for scans to say the brain is an amazing organ. It is structural. It is electrical. It is chemical. We have the tools and technology to look at those. They’ve already been certified. They’ve already been reimbursed in the process. What we as a field need to do is partner with our payers to say, “Let’s advance the science of this together.” It really takes both of us working together as partners moving forward, just like the way healthcare does.
Lovett: I think that makes a lot of sense. Thinking about reimbursement, what are some of those trends that you’re following at Caron? Value-based care, bundle payments. I know there’s a lot out there right now. What are some of the opportunities, and then what are some of the challenges associated with those new trends?
Driscoll: I think one of the main opportunities is to get out of the trenches of us against them and begin to find a way to partner with individuals. That’s something that we’ve been very successful at in my tenure here at Caron, is to look at our insurance companies as a partner. There’s really a triangle here of three of us. There’s the patient that needs the care, their family, their friends that need that piece. There’s the provider, and then there’s the payer of these services. Most people access healthcare through their insurance. Making sure that we work as partners to talk about how do we advance this. Let’s look at the outcomes. Let’s move away from fee-for-service. Let’s look at opportunities for value-based care.
Today, most of the contracts that we’re signing do have some quality standards in there. We’re looking for outcomes. We know that the research shows that there’s three key ingredients to improving outcomes. Length of engagement, not necessarily level of care, but length of engagement. Therapeutic alliance, that’s that connection where the patient is able to follow some good orderly direction. Finally, an internal metric on the patient, which is self-efficacy. The belief that this will work for me.
In the 12-step program, we call it HOLD. In a lot of ways, what we’ve been doing over the last 70 years here at Caron since the AA movement started is actually being proven through the science and the research of things that we’re doing today. Utilizing that in a partnership manner between the patient, the payer, and the provider really provides us a pathway to success and progress. Yes.
Lovett: Another big trend that I’ve noticed in SUD care is that more employers are actually getting involved in offering care for their employees. Have you seen this? What do you see as the role in addiction care?
Driscoll: Yes, absolutely. There again, the employer is invested in their employee. We’re a self-insured organization. We have roughly 700 employees and countless family members that are on our insurance. That’s a big cost to the company to provide that. It’s in our best interest to make sure our employees are well and healthy, that they’re taken care of, that their family members are taken care of. All that energy and worry and concern about a loved one that’s not doing well holds away from their ability to really help focus on their job and be present.
We work with other employers. It’s one of the things we’ve done with our insurance to get in there and say, “As much as a physical injury, a broken leg may keep somebody out of work. Now you’ve got absenteeism, and it’s costing your company money. We see the same thing with addiction and mental health issues.” We’re partnering with employers. We’re being a part of their health fairs. We’re looking at addiction, mental health, and overall wellness. When the employee is well and they’re focused, they are more productive.
In today’s world, helping to make sure that we’re balancing that productivity with taking care of themselves and controlling their costs go hand in hand. As a business, and I just talked about this to all of our employees, there’s really a couple of levers here. There’s revenue, dollars coming in, and there’s expenses, dollars going out, and the margin is what’s left. By taking care of employees, you’re really helping on the expense side and help the employees also help produce more revenue. The companies get that. It is a business case. It makes sense for them to make sure that they’re doing what they can to keep their employees employed, staying sane, and striving for good things for their company.
Lovett: That makes so much sense. I foresee that trend continuing to go in that direction in the future too, I think. We’ve been hearing so much about it, but I’m curious to see how that goes. Switching gears a little bit, Caron’s Ocean Drive and Grandview programs are tailored to the needs of individuals of influence, affluence. What makes these programs different, not just in terms of amenities, but in clinical sophistication?
Driscoll: Sure. Great question there. We do have two product lines at Caron. We have our signature product lines, which are self-paid product lines. Then we have our core programming, which is geared towards in-network insurance. That’s a key differentiator. We want to be an in-network partner with the payers so that we’re working on this partnership together. Now, when it comes to that, again, this is very much like other healthcare out there. Today, I can utilize my insurance card, and I can go to my local provider and receive a history and physical, and they’re going to do a nice job for me.
However, there’s also opportunities at the Mayo Clinic in Minnesota, John Hopkins, and other areas where I can go and get an executive physical where they’re going to give me three days of additional assessment care. They’re not going to just give me the standard protocols. They’re going to go above and beyond. They’re going to do things beyond that. There’s a fee for that. There’s a service for that above and beyond.
What we do with our Ocean Drive, our older adult, and other signature programs that we have is really provide that option to say, “If you want this more comprehensive care in a setting that is more comfortable and appropriate for your lifestyle, for your friends.” Many of the people that attend these programs are people of high profile, high influence, are key members of their families that are used to, and as they experience barriers getting into treatment, removing some of these types of concerns from them where they’re getting the exceptional care, that they’re being delivered that core service.
Today, we have a lot of the doctors that are out there that are considered concierge doctors. There’s thousands of them around the country. What this does is give these individuals that similar access to mental health and addiction services that is widely available among other medical services as well. Caron’s strategic plan is to keep both of those pieces going. Our ultimate goal, though, is to serve more people. Although that’s a steady part of our business, there isn’t a lot of growth potential in that arena. Our growth is going to be much more down the middle of the plate with in-network commercial insurance individuals that are seeking treatment. Again, very similar to traditional healthcare.
Lovett: It’s interesting because I think a lot of the industry is turning away from higher-end programs, looking more at the Medicaid space, commercial insurance space. What do you see– When you were developing those programs, what is that opportunity there?
Driscoll: In many ways, it’s not a broad-based program. It’s a tertiary program. People are going to travel in for it. Most substance use disorder programs are community-based because people need to come in and out. They need to keep working. They need to be involved with their community. They’re not able to be away from family and friends for an extended period of time.
One of the things that we’re able to provide here is that you can be away from family and friends, but you’re still connected. You’re in an environment that allows you to perform, that allows you to take care of the broader aspects of running your business, overseeing the family, and participating in care and services at the level that you’re looking to do. Most of us that live in the country, we call up and make an appointment. When are they available for us, and then we go to that appointment.
There is another segment of the population, though, that in some ways the doctors come to them. Having that avenue – again, it’s a small portion of the overall population out there – but as we see more and more people come into the space and be able to deliver that, there is a viable group there that we believe we need to continue that service. It allows us also to be able to break down the stigma and begin to lean into some of these new technologies that it may take our insurance partners a little longer to agree to cover, but we can then begin to move forward utilizing this with the direct patient to provider-payer model.
Lovett: That’s really interesting. Switching gears a little bit, I’d love to talk about the alumni network. I know Caron has a pretty robust alumni network. How does that network support long-term recovery, especially rather for individuals who may not have peer support in their professional or personal circles?
Driscoll: The alumni network is so valuable to us in many, many ways, and it traces its roots back to basic AA, where one alcoholic helps another alcoholic. The sayings is the most important person in the meeting is the newcomer. In a lot of ways, it allows people to work that connection. At its core, addiction is an alienating, isolating disease, and at its core, recovery is about connections. Having an engaged, robust alumni network, we have them at all of our programs. They come in, they were lecturing last night, they were visiting with the patients today, talking about, “I know where you’re at. I know what you’re feeling today. It’s not a great feeling.”
I talk about the toughest step somebody has to take in recovery is moving from the door of the car through the front door of the building. It’s such an impactful experience, that powerlessness that people feel. Having somebody there from an alumni that’s walked through the steps is extremely helpful and powerful, not just for the new person, but also for the person giving back. It’s such a fulfilling feeling that they experience. That is core to helping people recover.
Now, from a business standpoint, it also helps us with referrals. People say, “I got a great experience at Caron. I think you should go there. I have a friend, I have a colleague, I have a relative that’s struggling.” They’re able to be our best word-of-mouth proponent of accessing care and service. Nearly a third of our business comes from our alumni referring people to us. In some cases, we know addiction is a family disease. We end up with other family members, not just the first one. We get them through.
Then the third area that we benefit from is as a nonprofit organization, as a 501(c)(3), able to accept charitable contributions. Our alumni network gives back to us in big ways. They give us their time. They give us their talent, but they also share some of their treasure with us as well to help support some of these programs that aren’t always going to be covered by insurance or other payer activities. Matter of fact, our donors help us really support the spiritual care that we offer to people. They help us support our alumni events, actually, because most of those aren’t about making money. They’re about making connections with people.
They help us support other non-typically reimbursed areas. It’s not an area that you would see. It doesn’t get reimbursed with health care. Again, you hear me making that connection. I’m not looking for something different. I’m looking for something that is similar. We’re looking for parity. Reimburse us the same way that you reimburse other health care, and then we’ll find a way to do the support with the other things. Alumni are key.
Lovett: We did a story about alumni not too long ago. I believe we spoke to some folks on your team for it. One thing I did want to talk about, larger picture, I know Caron works a lot with commercial payers, but there’s a lot of regulatory changes happening in DC, and I know you have larger policy roles. Could you talk to me a little bit about how some of those changes? Obviously, Medicaid is the hot topic. How could those ripple through the entire SUD industry? What are you foreseeing, and how will that impact all providers?
Driscoll: The changes haven’t quite been impacted yet, so we don’t quite know exactly what they’re going to look like. We do know that there’s a large segment of the SUD population that experiences treatment as a result of some type of federal, state, or local funding outside of commercial insurance. In one of my past lives, I was the chair of the board of a critical access rural hospital in rural Wisconsin. Most of our patients utilized Medicare or Medicaid. That allowed us to keep the doors of the hospital open because we had that regular source coming through.
As we look at here, the idea, and I’m all for it. People aren’t supposed to. If people are utilizing fraud, if people aren’t utilizing proper forms to be a part of something, yes, that’s against the law, they shouldn’t do that. If people need to be and legitimately should be on these things, we have to make sure that they receive those services. What I get concerned about is not just the person that is no longer on the rolls, but how does that then impact the infrastructure of that hospital? If we were to see a reduction, using that as an example, because Caron does very little Medicare, Medicaid business. We do have some, but it’s not a big impact on who we are.
As I see it as a ripple effect across the communities, what does that do to those institutions that rely on that baseline to keep nurses employed, to keep doctors employed, to keep care and local services available and accessible for people? That is still yet to be determined. I know that we have a lot of our lawmakers that are out there, especially from our rural states, mostly rural states, that are really looking at this issue and saying, “How do we make sure that we are good with protecting fraud and waste and misuse of funds, but ensuring that those that need and deserve that care and coverage get it?” It’s a complex issue, and a little bit more will be revealed.
Lovett: We’ll be watching it closely. Another big topic right now is digital tools, especially in the past five years since the pandemic. How are you thinking about digital services at Caron? Then also, what are the limitations that you’ve seen in that?
Driscoll: We’re part of an advancing, evolving technology. You heard me mention earlier that the heart of recovery is really about connections. One of the things the pandemic taught us is that you can form a meaningful connection virtually. Now, I don’t know if it fully replaces in-person communication and networking, getting to know somebody, but it can certainly supplement it. There’s a way in there. I use it with my grandkids on a regular basis. It allows me to stay in touch with them, have communication with them, know them, so when I come in and visit, I’m not some stranger that just shows up randomly.
We’re able to utilize that same thing with health care. What it does is expand our ability to deliver services, and for Caron in particular, which is more of a tertiary center. We do have local people that come in to do treatment with us, but we also have people that live further than an easy commute to access services. Being able to tap into that technology, helps them with chronic disease. It really helps on both sides of the scale, just like an emergency room with health care. You’re always going to need an emergency. You’re always going to need a surgeon to be in there.
There’s things that we can do on the prevention side through virtual care and technology that can interrupt future issues before they get to that phase, and just like on the back end, can help people engage in helpful ongoing care services after that acute phase is needed. That’s what I’m looking to build out throughout our industry. For the last 30 to 50 years, most of our resources have really been the equivalent of an emergency room.
When you look at where most resources and most people seek treatment, it’s in that detox and early stabilization phase without a lot going into prevention and without a lot going into aftercare. We need to spread that continuum and begin to do it. I’m not saying we’re getting rid of residential care. We need to add in other modalities. Technology can simply aid us to do that on both sides of the spectrum.
Lovett: Actually, I’d love to dive into preventative care a little bit. I heard quite a bit about it last week at the Addiction Treatment Forum. One of the things that I’d heard is that we really haven’t had this in the past, could be something in the future. What could prevention look like? How do we implement that? What does that look like in the future?
Driscoll: Yes, absolutely. One of my favorite sayings is that the best way to treat a chronic disease is to prevent a chronic disease. This is where the brain science of addiction really comes in. We all know that as we grow, our bodies are developing. The brain isn’t fully developed until the early 20s. When we talk about addiction, mental health, and the impact that it has on the brain, especially when you consider the chemicals we’re using to assault the brain. Nobody’s addicted to blueberries. It doesn’t have that same effect. You get addicted to these other chemicals because of where and how they impact you in the brain.
The first thing that we need to do is start with the education pieces. Prevention works. It truly does. When you look at the work that we’ve done with adolescent and young person smoking, pregnancy, bullying, all of those items are shown to have positive effects going forward. At Caron, we have a prevention arm. As a matter of fact, last year we had over 100,000 student encounters throughout the East Coast with our prevention material. This year and over the next three years, we’re looking to grow that substantially as we can work our way into that program.
Thankfully, we have a private grant from a wonderful partner that helps us be able to provide those services. Even with some of the potential government restructuring and movement around funding, we hope not to be too horribly impacted by that. It’s really a key piece here. It also goes to fight the stigma of the disease when people understand that if you do begin to struggle with this, if you begin to have access to these drugs and it starts to create problems with you, is that you don’t need to feel bad about yourself. You need to seek help and care.
Therefore, as an industry, we’ve got to invest in prevention, early intervention, early SBIRT things where we’re doing screening and brief interventions. When necessary, refer to treatment. 54 million Americans meet SUD criteria in the past year alone. They can’t all be treated in a residential center. They can’t all even be treated in an outpatient setting. We have to do a better job of stemming the flow of people into this disease and utilizing technology to really help provide the right level of treatment at the right time for the right duration.
Lovett: No, that’s so interesting. In physical health, we have all these screenings, and your annual physical, but what could that look like for other parts of healthcare?
Driscoll: Absolutely. I joke about it a little bit here about the dentist. My dentist is the best healthcare provider out there. Every six months, as soon as I go in, it’s preventative screening. It’s a check, it’s a cleaning. If I begin to miss that, even for a day, I’m getting calls from them all the time, like, “Hey, it’s time to reschedule. You’ve got to show up. We’ve got to make sure that we’re there.” They do a wonderful job in the prevention of long-term tooth decay and all these other things. I don’t want to get into dentistry here, but they’re a great model of how it’s not about shame. It’s about taking care of yourself over a lifetime. It really fits well with addiction and mental health.
Lovett: That’s a great example. Looking down the line at Caron, what’s next? What are some of the projects you’re most excited about? What can we expect coming down the pipeline?
Driscoll: Thanks for the question there. We’ve just launched a new three-year strategic plan just here. We’re on a fiscal year, so we operate July 1st, starts anew. Our board of trustees tweaked our mission and vision statements a little bit and gave us a new five-focus area going forward. The first thing we’re looking to do is serve more people. That’s how we started here on the Hill from Dick and Catherine serving people in their own home. They needed to help more people, and they bought an old worn-out hotel that they began to refurbish and fix.
That’s been our legacy, is, we are blessed with talent. We are blessed with resources and there are 54 million Americans that are suffering. Our first focus area is to serve more people. We plan to do that by being an in-network provider. Our legacy over the last several decades has been more of a private pay provider of services. Like I said, we’re going to continue to do that with our signature business, but our growth is really going to be with our partnerships, with our payers out there.
The other area is going to be to continue to improve the quality of care and push to move innovations into treatment, much like we’ve been talking about the brain health. There’s things that we can do to assess, there’s things that we can do to treat, there’s things that we can do for ongoing care that we need to treat the organ or the affliction like the rest of the diseases do.
The third big focus area, at the end of the day, all of us that employ people, it’s about the people that work for us. Now, AI is going to help and assist our patients. It’s going to help and assist our employees. At the end of the day, it’s about a relationship. It’s about a connection. That means that we need people– we need good people. Being a place people love to work, really channeling that connection that Dick and Catherine had when they started to help people in the beginning. We want people that are dedicated to the mission of helping people move from active addiction to active recovery.
Along with that, we need to continue to think about the future. How are we here for the next generation of leaders? That’s my role as the CEO, is to provide a sustainable organization. There’s been many ups and downs in the addiction treatment field. I’ve been a part of it myself for 35 years, seeing a lot of comings and goings, expansion, contraction. We’re in a very interesting phase now. Caron has been able to weather the storm for the last seven years. It’s my job to make sure that we’re a sustainable organization going forward.
Then the fifth focus area that we’re trying to do is to help transform the field. Caron has been a long-term leader of the field. The field needs us more than ever right now to stand up and say, “Follow us.” We’re not just a treatment center. We’re combating a disease. We need to treat the brain. We need to do research. We need to do prevention. We need to continue to advance, not eliminate what we did in the past, but build on it. If you’re looking for our pathway, all you have to do is say, “What is healthcare doing to improve and advance the treatment of care?” Whether it’s heart disease, lung disease, kidney disease, that’s what we’re looking to do at Caron.
Lovett: Exciting few years ahead. The last question I always like to end on is, if you could change one thing about how the healthcare system views and funds behavioral health treatment, what would that be?
Driscoll: The one thing, treat us like the rest of healthcare is, you pay for tests, you pay for screenings. You allow us to treat the organs of the affliction. You allow us to utilize new technology to help us figure things out. I think about heart stints. My father is an individual who had a massive heart attack back in the ’80s, underwent long-term surgery by a team of dedicated individuals, and then spent three months of follow-up.
Where today, we have the technology and the availability to see that heart attack coming before it happens, that in his local community, because he had to fly five hours away to Milwaukee to be treated in the Midwest, that a mid-level provider could have inserted a balloon through a vein, expanded that, put in a stint, and he could have been home for dinner. That’s the type of medical advancement that we’ve been able to do on the healthcare side.
We have the same ability to do that with addiction and mental health, and Caron wants to be a part of that and at the forefront and say, “This is the pathway forward.” We don’t want to fight the old battles. We won those battles. There is parity. There are essential benefits. What we need to do is not focus so much on where we were, but where we’re headed.
Lovett: Yes, love that. Thank you so much for coming on. I did want to let folks know that there will be a story up with the transcript of this, as well as a recording if you missed any of this. Thank you so much, John, for coming on, and thank you to everyone for listening.
Driscoll: Thank you, Laura.
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