This is an exclusive BHB+ article
Addiction treatment is generally seen as a continuum of care tailored to a person’s needs and stage of recovery. Still, taking time away from work and family can be challenging for many people seeking treatment
In recent years, we have seen a new in-home model begin to emerge. Some of these models provide in-person home services, while others rely primarily on virtual care
In-home care offers a few unique advantages, allowing patients to stay at home and creating more opportunities for family involvement. Yet this type of service also poses some challenges, including workforce logistics, privacy concerns and insurance coverage
The landscape for these types of treatments has changed even over the past few months. For starters, Aware Recovery, one of the pioneers in the space, has faced several challenges, including eviction from its headquarters and wage-and-hour litigation alleging employee misclassification
Aware Recovery’s recent challenges don’t necessarily invalidate the in-home model. However, they do highlight the difficulties in scaling a labor-intensive, value-based approach in addiction treatment
At the same time, there are some glimmers of hope for the practice. Earlier this week, the U.S. Department of Health and Human Services (HHS) announced a new initiative that includes intensive in-home clinical treatment to support parents of young children with chronic addiction
Despite the headwinds facing this treatment modality, I think the government’s interest could signal that more re
In this exclusive BHB+ Update, I will explore
–What the challenges facing an in-home addiction-treatment pioneer could mean for the industry
–Why the federal government is investing in in-home substance use disorder care
—What the SUD sector could learn from other home-based behavioral-health models
The landscape
It would be difficult to talk about in-home addiction treatment services without mentioning Aware Recovery
Founded in 2011, the Wallingford, Connecticut-based provider has since raised more than $57 million in equity capital. It currently operates in-home addiction treatment in Connecticut, Florida, Georgia, Indiana, Kentucky, Maine, Massachusetts, New Hampshire, Ohio, Rhode Island and Virginia
Aware Recovery’s in-home model was one of the first to offer alternatives to clinic and residential programs. The other major differentiator with the provider was how it worked with payers. At one point, the provider noted that 80% of its revenue came from value-based arrangements. Since 2016, the provider has used a bundled payment method
And while the company appeared to be growing through the early 2020s, the provider has had some recent challenges. Aware Recovery faces several legal issues and has lost possession of a 12,000-square-foot office in Wallingford following eviction proceedings. The provider is also facing a lawsuit alleging that it misclassified care coordinators and other employees as exempt, salaried individuals, thereby failing to pay overtime
Although the eviction does not provide a complete picture of the company’s finances, it suggests that the company may be facing financial difficulties. Because in-home care remains a relatively small segment of the addiction-treatment landscape, and value-based care is still a nuanced concept in the sector, this situation could illustrate some of the broader challenges associated with both models
At the same time, I covered digital health for years before turning to behavioral health, and one lesson from that sector was clear: being first does not always pay off. Early adopters of new modalities often have to prove the concept and pave the way with payers and patients
And there have been some newcomers in the space. For example, Nest Health, a home-based health provider, launched an SUD treatment program that blends in-home clinical assessments, medication monitoring, pharmacy coordination and care management for mental health services with its medical approach to support patients and caregivers
When the company launched its program, it touted the benefits of the in-home model for family involvement
“Being in the home critically shifts the power dynamic, giving patients and families a sense of agency they often don’t experience in traditional health care settings – instead of asking patients to navigate complex systems or unfamiliar environments,” Kelsie Brandt, chief clinical officer of Nest Health, previously told Behavioral Health Business
And there could be some new possibilities for the sector. The new HHS announcement is focused on providing addiction refoster care entry. The initiative includes two services, one of which is an in-home clinical treatment component that will also include weekly peer support meetings. The second is a peer facilitator group program
As family tends to be a major part of in-home recovery, this HHS initiative to focus on parents is a stepping stone for the industry
Still, there are unique challenges in the substance use disorder (SUD) sector when it comes to home care. For example, many patients need privacy to talk to their providers about their condition; this could be more challenging in a home setting. Payers tend to favor traditional levels of care; providers using new models must demonstrate their efficacy
In-home models across behavioral health
While SUD services at-home are still relatively new, in-home services have been around in the behavioral health sector for decades
One of the most popular types of services is home health care provided by providers with additional behavioral health training. For example, Innovive Health is an in-home skilled nursing company focused on keeping high-acuity, high-risk patients out of the hospital, and specializes in treating patients with serious mental illness (SMI) in their homes
It does this care through Medicaid and state Medicaid ACOs, and charges an annual care and coordination service cost per patient. Still, one major difference in this model is that it doesn’t employ its own behavioral health providers; instead, it trains its frontline staff, primarily registered nurses, to care for individuals with behavioral health conditions and chronic diseases
While this model makes sense in many ways from a reimbursement perspective, it would be challenging to duplicate from an SUD care perspective, as it would require different clinicians. At the same time, chronic disease is often a co-morbidity of SUD
One theme that appears to run throughout these models is the move away from fee-for-service. That shift may be necessary for in-home addiction treatment to work, as it requires coordinated care, family engagement and clinical support that is difficult to cover in a fee-for-service environment
Federal attention to the space could create more policy openings in the future. However, it will need to make a business case to payers in both the commercial and public sectors to really sustain it long-term
Companies featured in this article:
Aware Recovery Care, Innovive Health, Nest Health
