It’s hard to overstate the lasting downstream impact of Covid-19 on Substance Use Disorder (SUD). Already deemed a public health crisis in 2016 by then Surgeon General, Vivek Murthy; the affect stemming from months of social isolation, fear and economic despair is on track to be devastating without a dramatic shift in treatment and payment models.
To date, discussions about how to ‘fix’ this crisis and repair the addiction treatment landscape centered around crucial pieces to the puzzle, namely increased access via telemedicine and removing the “X waiver”, a widely condemned federal regulation that requires providers to obtain this waiver in order to prescribe buprenorphine to patients who suffer from Opioid Use Disorder.
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Josh Nussbaum Joss Nussbaum is co-founder and CEO of Halcyon Health. Prior to Halcyon Health, Josh spent over seven years as an seed stage VC, most recently as a General Partner at Compound. He sat on the boards of Zipdrug and Boost Biomes and currently sits on the BOD of Betterview.
Realizing these two improvements would bring near immeasurable positive results, saving countless lives and changing the addiction care system for the better. However, one major piece to the puzzle still remains – measurement. More specifically, measurement of disease progression, treatment efficacy and long-term outcomes. Such an instrument would lead to a virtuous cycle, positively impacting downstream effects quality of care, cost and better treatment modalities and therapeutics.
SUD is a brain disease, the result of the complex interactions between an individual’s biology, psychology and socio-environmental factors (otherwise known as the biopsychosocial framework). While addiction treatment has traditionally focused on the removal of substance use ‘symptoms’ by collecting urine samples and screening for substance use, the complexity of the biopsychosocial framework requires commensurate measurement tooling.
The power in more precise measurement is immense. As history shows us, it leads to care delivery optimization as the impetus for fundamental reform. As renowned academic and Harvard Business School Professor Clay Christensen wrote,
Before 1980, for example, patients with diabetes could only know whether they had abnormal levels of glucose in their blood indirectly; they used an often inaccurate urine test or visited a doctor who drew a blood sample and then measured its glucose content on an expensive piece of laboratory equipment. Today, patients pack miniature blood glucose meters with them wherever they go; they themselves now manage most aspects of a disease that previously had required much more professional involvement. They get far higher quality care far more conveniently.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Such is the promise of Recovery Capital, defined by William Cloud and Robert Granfield as “the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery.” Recovery Capital looks beyond traditional health screening and builds a more complete picture of how SUD impacts someone’s life, offering a deep understanding of how finances, housing status, occupation, education, coping skills, and more contribute to progression of the disease.
Recovery Capital assessments can be structured to help providers understand the fundamental areas in a person’s life that prevent them from fully engaging in their recovery, offering a lens into whether or not a person’s basic physical and psychological safety needs are being met (akin to the social determinants of health). Examples of which include areas related to safe living conditions, access to food and transportation, and sleep hygiene. Once basic safety needs are met, the focus shifts to building support in other areas of Recovery Capital, like health and wellness, social connectivity, employment, education and skill building.
Recovery Capital offers providers the ability to quantitatively measure each individual’s needs and how care delivery can be tailored to meet these needs at a modular level. For example, if an individual’s Recovery Capital has declined due to a lack of community support and/or access to regular, nutritious meals; then the type of support this individual needs isn’t that their PCP or psychiatrist is necessarily able to provide. Rather lower cost and more accessible resources would be best for this individual at this specific time.
By reorganizing the SUD care delivery ecosystem around each individual’s needs, distributed categorically, the result is increased emphasis on care routing; non-clinical support; and tools that offer high levels of personalization as specialized community workforces begin to emerge. Concurrently, we gain insight into attribution, pinpointing which providers and/or interventions are driving better outcomes in direct opposition to today’s high-cost, one-size-fits-all addiction treatment providers.
Rather than fee-for-service billing codes, which incentivize quantity of services rather than the necessity of services, this level of specificity paves the way for value-based payment models. Forward-thinking health plans can offer bundled payments, while those responsible for care planning and routing can understand specifically which providers, interventions and resources are necessary and pay those providing them commensurate to the value that’s provided.
While the predictive ability of assessing an individual’s Recovery Capital holds great promise, implementation to date has been scarce. Establishing focus on developing the right tools, delivered by the right people, consistently over the right times can lower costs, increase access and improve outcomes.
Photo: Jeffrey Hamilton, Getty Images
Joss Nussbaum is co-founder and CEO of Halcyon Health.
Prior to Halcyon Health, Josh spent over seven years as an seed stage VC, most recently as a General Partner at Compound. He sat on the boards of Zipdrug and Boost Biomes and currently sits on the BOD of Betterview.
