Groups Recover Together made a name for itself in the substance use disorder treatment space by zeroing in on value-based care ahead of the curve.

The provider has tapped its president, Cooper Zelnick, to step into the CEO role. Zelnick has been with the organization since 2018 and has served in various capacities, including chief of staff, chief strategy officer, and chief revenue officer.

Behavioral Health Business sat down with Zelnick to discuss his top priorities, Groups Recover Together’s growth trajectory and how the company is future-proofing itself amid regulatory uncertainty.

Day one, what are your priorities? 

We have built something really amazing. Our clinical system drives better clinical outcomes than have ever been seen in the industry. When individuals come to Groups, they are less likely to die from this disease and more likely to find, achieve, and maintain recovery than if they do anything else, period, full stop; that’s the data. Also, our clinical system directly reduces cost across physical, behavioral and RX. The first thing I want to do is protect the mission, protect the people, and continue doing what has made us awesome.

The second priority is to ensure that our organization is responsive to the macro environment and all the uncertainty that surrounds it. So what does that mean? One, I want to ensure that in a universe where access will likely be constricted, we are ready with open arms to catch the individuals who need care. There will be more people who need care. We are making a massive investment in our access function. We’re investing in our clinical teams. We’re investing in our operations teams. We want to be there for the communities that we serve today and for new communities.

What we believe will happen for the coming couple of years is as follows: there will be a constriction in Medicaid, and as a result, individuals who struggle with addiction and who need care will need support from other places. We’re investing in grant funding opportunities. We’re investing in our discounted or fully free programs for uninsured and self-pay members. We are investing in exchange contracting. We’re investing in all the activities that I believe will enable us to serve people regardless of their payer class.

And then, when it comes to Medicaid beneficiaries and Medicaid plans, I think a result of that contraction will be that acuity will rise in the Medicaid population. We are addressing this by building ancillary services to meet the needs of what we believe will be an increasingly acute, complex, and sick population.

Regarding Medicaid, I’ve heard that other providers are establishing support systems to help eligible beneficiaries maintain their enrollment. Is Groups considering a similar approach?

We built that competency around Medicaid redetermination in 2023. We have invested a significant amount of time in developing our recovery support specialist teams, who excel in benefits, enrollment, and re-enrollment navigation. Those teams have continued to grow, and we are actively expanding them now.

You mentioned growth briefly. What does that mean to you? Does it mean growth into new states, services, or partnerships? 

It’s all of those vectors. Our mission is to bring our care to everyone who needs it, and that means expanding to new towns, new states, and working with new health plans and referral partners. That means growing brand awareness. At this point, we are the largest value-based provider of care of our type in the country, and we’re serving only a tiny fraction of those who bear this disease burden. So for sure, growth means helping the folks who need our care access it. Growth also means doing more for the individuals we serve today.

The individuals we serve have needs that extend far beyond what we can currently offer, and this aligns with our mission and strategic roadmap to expand into ancillary services.

Then, I think that this is a really interesting moment where there will be contraction in the provider landscape. There will be a contraction in the Medicaid roles. We have an opportunity to grow by being of service to states, other providers, and the broader community in ways that could be new. I believe there are opportunities to raise the bar on treatment across the entire industry.

Groups has been involved with value-based contracting for some time. What are some lessons learned from your experiences and how are you taking value-based care contracting into the future? 

The way we’ve historically defined value-based care is a reimbursement framework that empowers us to deliver our unique model of care and holds us accountable for the clinical and financial outcomes achieved through our unique model of care.

I think too many providers view value-based care as premium reimbursement. Those two are not synonymous. Value-based care is not 103% of the Fee Schedule Plus upside only shared savings; that’s not a thing.

What we’ve known from the start, and what we believe from the beginning, is that value-based care must align incentives between those who receive care, our members, those who pay for care, our health plan partners, predominantly, and those who deliver care, our organization and our providers; that’s unchanging. Our clinical model genuinely reduces the total cost of care, so contracting against that is not super challenging.

The lessons learned, unfortunately, are that in US health care, incentive alignment around total cost reduction isn’t always enough. You still need to meet the needs of a wide range of stakeholders.

There are other lessons as well, such as being really thoughtful in encounter submission, showing that our work matters to our plan partners and to our states. Being really thoughtful about HEDIS metrics and closing gaps matters to our partners, matters to our states. Implementing innovative structures that create incentive alignment without taxing our partners, claim systems or their operational teams has been a big learning.

We spoke a few years ago about collaborating with the prison system and the Department of Justice. Is that still a part of what Groups is focusing on?

Yeah, criminal justice remains our biggest referral partner. Since our conversation, we have established a referral partnership with the Indiana Department of Corrections, and we have formalized our relationships in Tennessee, Indiana, and New Hampshire. We also have informal relationships and are working to formalize them in numerous other locations.

But fundamentally, we are continuing to do the work that we talked about a million years ago, which is one, re-entry needs assessment for folks before they are back in the community, to rapid access to care for individuals upon release, and then three, dedicated programming that addresses the needs individuals face when they’re leaving corrections. It’s really important to us, and we’ve been able to demonstrate 70% reductions in one, three, and five-year return to custody rates and 70% reductions in fatal overdose upon release for this population.

I believe, if you want to address the opioid epidemic from a public health perspective, the most impactful thing you can do is actually, like, address that transition from people leaving prisons and jails.

What are you most excited about starting off in this new role? 

I’ve been at Groups the majority of my career. I’ve been doing it for almost 10 years. I started as the chief of staff to our founder. That was my first role. And if you had asked me, back then, we were serving maybe 200 to 300 patients or members a week. If you had asked me, what would my wildest dreams be? My wildest dream was to serve tens of thousands of people a week, to have a clinical model recognized by the industry as driving significant public health impact and cost reductions, and maybe one day to be able to help lead that organization.

So, what I’m most excited about now is that I’m enormously grateful for the opportunity. I am still pinching myself and I’m really confident that we have the right team and the right model.