The Business of Opioid Treatment | The Saving Dose Ep. 04

In the fourth episode of The Saving Dose, William Pedranti and Kendra Allen continue their conversation on the operational reality inside opioid treatment programs and get into the part of addiction recovery that almost nobody in the industry talks about publicly: what happens after the patient walks out the door, why most of them do not come back, and why the system was never designed to know the difference.

This episode covers the economics of running an addiction treatment practice, why alcohol addiction is in many ways harder to treat than opioid addiction, how the shame and guilt cycle quietly destroys the clinical relationship, and what one text message from a counselor named Ashley revealed about how close patients can be to relapse without anyone knowing.

In this episode:

Why money is the single biggest barrier to addiction treatment in America, and why insurance coverage gaps mean that many people who need care most are the least able to access it.

Why alcohol addiction may be harder to treat than opioid addiction, and what social acceptability has to do with it.

The shame and guilt cycle: why patients who relapse between visits almost never tell their provider the truth, why that silence is a predictable system failure rather than a character flaw, and what a story about poppy seed muffins reveals about how broken the feedback loop is.

What opioid treatment programs are actually up against: staffing shortages, burnout, Medicaid reimbursement pressure, patient churn, and a geography problem that puts clinics hours away from the patients who need them most.

Alumni programs: what they are, why they matter, and why the story of Ashley texting a patient she had not spoken to in a year captures exactly what the gap between visits actually costs.

How the addiction census grows in economic downturns, why designer drugs and animal tranquilizers are creating new crisis points in cities like Seattle, and what Kendra means when she says we are here to help the desperate.

Where opioid treatment programs are headed, what the industry is trying to embrace, and why the providers who stay in this space are there for reasons that have nothing to do with the money.

William's personal story: picking up a close friend's brother from a sober living facility after thirty days, and what it means when someone says recovery is sometimes day to day and sometimes minute to minute.

About the Hosts

John Hsu, MD is the Founder and CEO of iPill and a practicing anesthesiologist with 25 years in pain management and addiction medicine. He has taken multiple products through FDA approval and commercial launch. Connect with John: https://www.linkedin.com/in/john-hsu-md-300a8b2a/

William Pedranti is the COO of iPill, a Georgetown Law graduate, and co-founder of PENG Life Science Ventures. He has taken a biotech company from founding through FDA approval, commercial launch, and exit. Connect with William: https://www.linkedin.com/in/williampedranti/

Kendra Allen is the CRO of iPill with 20 years in behavioral health revenue strategy, payer contracting, and regulatory navigation. She founded and exited a national healthcare consulting firm. Connect with Kendra: https://www.linkedin.com/in/kendra-allen-cro/

Website: thesavingdose.com

Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare professional before making any treatment decisions.

#OpioidCrisis #AddictionRecovery #OpioidUseDisorder #MedicationAdherence #MOUD #BehavioralHealth #AddictionMedicine #OpioidTreatment #SubstanceUseDisorder #HealthcarePodcast #TheSavingDose #RecoveryPodcast #MentalHealth #PublicHealth #PatientRetention #MAT #AlcoholAddiction #OTPChallenges #PatientChurn #AddictionTreatment

Transcript

SPEAKER_00 0:00

Most of all addiction care, 100%, is just a higher stakes, is a reactive care model. So the person is only there because they're struggling. And then the only time that you can do anything to really change things for them or catch them before they fall is to have constant communication or the ability to have constant communication or watch signals.

SPEAKER_02 0:37

Thank you so much for spending some time with us for the next 30 minutes. I'm really excited about this continuation of part two of the challenges that we are dealing with in the opioid treatment practice space and helping addiction recovery. My name is William Pedranti. I'm one of your co-hosts. I got Kendra Allen in here with us. Kendra, how are you doing?

SPEAKER_00 0:57

I'm doing great today. Thanks for asking.

SPEAKER_02 1:00

Awesome, awesome. Our third co-host, Dr. John Sue, still traveling. Unfortunately, couldn't be here today. So it's just going to be Kendra and I diving deep into this great topic that we got, you know, ran out of time last time. There's so much good stuff. So very excited to be here. Thank you so much for being with the Saving Dose Podcast. Remember, this is about all things addiction recovery. So whether you're a patient or a caregiver or a family member or a nurse or a clinician or a practice group or executive or just somebody that's interested in learning more about addiction recovery and the challenges of addiction recovery. That's what we're all about here is to be an opportunity, a source of good information about addiction recovery and how we can help people in the addiction recovery space. So again, very excited about this topic today. Going to dive right in because we got a lot to cover in a short period of time. However, before we start, I just want to share a personal story recently of dealing with addiction and just talk about that a little bit and get your thoughts and reactions, Kendra. I think I mentioned on a previous podcast, I've got a good friend's brother that suffered from addiction his whole life. You know, he's he's in his mid to late 50s now. He got hooked on opioids when he was in his early 20s from a football injury. And he literally is what you see as a typical, like Dr. Sue said on a previous call, that addiction is a chronic condition. And he has dealt with addiction his whole life. And recently, about a little over a month ago, he decided he was getting into some of his, he's been sober for a bit, but he decided he was getting into some of his bad patterns of behavior. And he proactively decided to check himself into a sober living facility where he stayed a month. And I had the wonderful opportunity when he called, he didn't have transportation home, so I said, I'll come out there and get you with my friends. We went out there not too far from where we were to go pick him up one Saturday morning. And, you know, got to pick him up in the morning. And I I can just tell you uh two things about it is came out of that uh addiction, that sober living facility, was so feeling so good after being there for a month. So good about what you know he went through, the medication he was on, the the psychotherapy he was getting, the group meetings. He told a lot of stories about people there and just the relationships he built in just 30 days there and talked to him about some of the people and how good it was for him. And he came out of there so enthusiastic about where he was at and he was looking for. They'd hooked him up with a therapist, so he was going to continue to meet with the therapist on a periodic basis, to continue to work through his recovery every single day. As I asked him, I said, you know, how how what is it like to deal with um addiction recovery? And he said, sometimes it's day-to-day, sometimes it's minute to minute. But I so there was so much positivity, but also he got an opportunity to share with me, Kendra, some of the stories of the people that are at that facility. Tough, tough stories.

SPEAKER_00 3:59

Tough ones, right?

SPEAKER_02 4:00

Of people and what they were dealing with. A woman who was a grandmother and a husband, kids, grandkids dealing with alcohol addiction, who came from another state out there, and just he said the withdrawals from alcohol addiction, he said, it is brutal, brutal. And she came in there and it was going to she had to go, you know, no alcohol, obviously, going through that patrols those first several days were there. He said, You can't believe how brutal that is. And so, you know, it's just the tough, the good and the bad of dealing with that and just hearing that stories, but continue to give me inspiration about what we're doing. So I just wanted to share that with you and get your perspective. I know you've been in this space for so long and helping people with addiction recovery. And so, you know, is that typical? I mean, uh just curious. Have you probably been to a ton of these facilities in your career?

SPEAKER_00 4:47

Yeah, we we had a lot of them for a long time, you know, uh, a partner of mine and myself. And I would say that's highly unusual, number one, for him to have the cognizance to say, I need to go do this, and for such a short stay, I think that's amazing that he has that ability to do that because so many people don't. And, you know, I wish some of the people in my life that that I've loved and loved and lost could could have done that, right? But it it's just not. And maybe it's just because he's that far in his recovery. So although he may feel bad that he had to take whatever time out and kind of go recenter himself. And if you think of our daily lives, I mean, how often could we go and do that? You know, it's just so hard, right? So good for him. And and I'm so glad that he is able to find that. And yeah, alcohol, we often see more failures with alcohol addiction than we do opiate addiction. It's just so number one, it's socially acceptable. So it's everywhere. It's everything, you know, it's it's with dinner, it's every holiday party, it's every, it's it's social in American life and many other, you know, um, I guess, countries, you know, it's but it's very, very prevalent here. So it's hard. I think that's I think that in a lot of ways, alcohol is harder than opiates for people. Um but you know, it all goes hand in hand, right? The the whole there's happy people don't do drugs. So we have to heal ourselves um from the pain that we're trying to numb. And if we don't do that, we're never gonna get out from underneath it. Now, like your your friend's brother, he he obviously hurt himself in football, but there's a a radical cycle of depression and anxiety that comes from that, and then there's the shame cycle, and then there's the guilt cycle, which leads to more depression, which leads to more anxiety. So it's a snake eating his tail, right? So if you can't forgive yourself and you can't work through those things, I mean, and sometimes even when you do, it it crops up. I mean, stress of life is stress of life, right? So, um, but kudos to him. And I'm so glad there was a place that could fit him in and make it work. One of our bigger problems is that we just don't have enough providers and facilities and payment coverage, honestly. Money is one of the biggest barriers to treatment that there is. And if they can't get insurance coverage for it, a lot of people just do not have the resources to financially step out of life and into treatment.

SPEAKER_02 7:36

Yeah, absolutely. Absolutely no. Well, and I want to dive into that. Thank you for sharing that with us. Um, you know, I want to dive into our topic today, what we talked about, and that is the practice of addiction opioid treatment programs and some of the challenges they're facing. God bless all these people like yourself and Dr. Sue that have spent a lifetime of helping people with addiction recovery. You know, these people are angels to go in this to try to help people in their struggles. But also, they have to be business people too, right? There is the economics of just what you're saying, of dealing with you know, managing and running an opioid treatment program and the challenges of that, just like you said, and and concerns about Medicaid crunches and things like this. So that's what we're talking about today. I want to I want to dive right in. One of the things that I've heard you talk about in the past is staffing shortages and burnout that's going on at these opioid treatment programs, right? Driven by labor-intensive processes, whether it's you know, observed dosing and daily monitoring of all these things. Tell me about that. What'd you talk about that a little bit? What do you see of these challenges with these opiate treatment programs in terms of labor?

SPEAKER_00 8:43

That we could talk about this all day. So in certain, there's just number one, we know we have a nurse student shortage, we've had a nursing shortage forever. Um luckily, I think some things have changed in our education community. We have a lot of RN certificate programs now. We have a lot more online school, we have lots of young men and women who are going through nursing programs, and we're starting to see a small shift in that. Um, so that is awesome. And I hope we can continue on that path. So if you are a young person and you are a nurse or trying to be a nurse, I I the world needs you. Go do it. It's whether it's a stepping stone, there's a practical nurse, which it's not very common anymore, but it's a certificate program. It's like nine months. We still need you, you know. Um, and if you're trying to do your RN, it's it's typically a one 18-month, 20-month program, and you get an associate degree and you have your nursing license. So we need you. And in some states, like Florida, they actually have a state mandated plan to try to end the treatment provider shortage to cover addiction services and mental health services very specifically. And they have budget lines and student loan forgiveness, and they're trying to do everything they can to retain providers in that state, as well as encourage people to move there and be providers. And they've relaxed their telehealth laws, which we've seen a huge relax in that since 2020. So that's helped. Um, but yeah, we we have a problem. And the the worst part about nursing, I think, is you get into nursing or to be a doctor because you want to help people and you want to heal people. The hardest part is much like, you know, following a baseball team, right? The cubs will break your heart, is what you always hear, right? It's kind of like that, right? So when you're first out of nursing school, there's there's mostly two jobs available to you before you can ever go to a hospital or, you know, make decent money anywhere. And that is addiction treatment or nursing home services. That's kind of like your first, you know, where you cut your teeth. And those are the hearts, those are the jobs that kind of break your heart because, you know, it's it's the elderly. So regardless who they were in their former life in a nursing home, these people are frail and they're kind, and you know, they ring their little call bell and Mildred wants her blanket, and then one day Mildred passes away and it's horrible, you know. Um but in addiction treatment, it's actually worse because we see we see Ben coming every day, Ben's making progress, he's clean, he's sober, he's doing great, he's visiting his kids, his family's talking to him, and then all of a sudden Ben disappears. And then bad things for Ben, right? And then sometimes you see Ben again, sometimes you see that Ben has passed away or someone tells you, and that's heartbreaking because it could have been prevented, you know. So I think that care for our staff is some of the the most kind things we can do, and it also will keep our staff with us is and it doesn't necessarily have to involve money. I mean, people to have a two-hour lunch break or to, you know, have a raffle for noticing that Ben was gone, you know. Those those kind of care type of things for your staff to let them know that they're doing a great job is paramount.

SPEAKER_02 12:28

Yeah. Yeah. No, I love that. So it is because it is a challenge. These are, you know, it's tough for this in addiction recovery for nursing and stuff. So certainly showing that is so important. How about the the type of activities that these clinicians are focused on? Do you see a lot where you know they're end up performing administrative tasks or sort of lower value tasks than what they were trained for, to be a clinician, right? And provide clinical care to a patient. Do you see a lot of that going on in OTPs today?

SPEAKER_00 12:58

I think that is, I think if there's a dollar for every complaint, that would be it, right? We we are constantly hammering our clinicians to finish their notes as they do them. And before software was allowing AI in their software to take the note for them while they're doing the session and summarize it, um, this was a huge problem. We were behind weeks and weeks and weeks and weeks in notes, and there's there's uh it just feels like you can never catch up. But when you have back-to-back appointments and the person in front of you is really spilling out their heart, it's really hard to say, oh, I'm sorry, our time's up. You know, meanwhile, she's crying on your couch, right? Like, how do you do that? So we have to um we have to acknowledge that things are getting better in that space, that clinicians are doing better in the administrative task area, that that AI has really changed that dynamic. Not that we want AI to diagnose people, but also it takes those notes for us. And that also helps us not have so many takebacks and inconsistencies during audit. I think that's been amazing. Um, so if your software doesn't have that, 100% check it out. Um, even if you just do something like chat GPT um healthcare subscription, it'll make a it'll make a night and day difference in a clinician's life. Um but also for physicians, it's the same problem. Um, but I think it's worse for practice owners because it's typically a provider practice owner. And so now they have to worry about billing, not just the notes, and they have to worry about staffing, and they have to worry about if she's sick or someone leaves, and then we have a whole caseload that we have to redistribute and we can't find someone in time. What are the telehealth laws? Did their insurance expire? Did their license expire? I mean, there's an endless line of things that we have to look for. Um but yeah, I think I think things are getting better on that front from an administrative standpoint, but we still have a long way to go in getting paid on time and not having to fight for payment. I've I've worked in healthcare and mental health, and mental and behavioral health, especially for addiction and inpatient mental health, is some of the hardest claims to get paid. And I don't think a lot of people understand that because to get paid for a medical claim, it's very um objective. You know, you have the flu, there's a diagnostic formula for that, you get, you see the visit and it's clean cut and you get paid. Mental health is more subjective. So you have someone interpreting a feeling and you have someone interpreting life events, and and so the clinician is saying it's this level of care, and the insurance is saying, well, maybe not, because you didn't check this box. And the next thing you know, a person's at a facility and the facility's having to discharge because the insurance company doesn't think they meet criteria. So that person is back out, you know, in the cold. And I think I think that's horrible. You know, you finally get someone to care. And then to actually have if they don't have someone to fight for it or that knows how to fight for it, or that patient could hurt themselves in a lot of ways.

SPEAKER_02 16:16

Yeah. So absolutely, absolutely. No, certainly, no, that's one of the challenges. I want to shift a little bit in, you know, so we in the on the clinical side, right? The clinical care side. So, you know, in those such, you know, obviously the practice has got a lot of work on in making sure staff can be focused on those high-value clinical care. But um, talk to me about, you know, in delivering that clinical care about visibility into patient behavior and adherence and outcomes. Talk to me about some of the challenges today that opioid treatment programs are dealing with, you know, in these outpatient settings with patient engagement and intelligence and what's going on with patients.

SPEAKER_00 16:58

Yeah, there's nothing. It's it's pretty much a black box. So um we see a patient, they come in, uh, we talk to them, they self-report. Most oftentimes, because of that guilt-shame cycle that we all have, regardless of what we're doing in our life, sometimes they omit things, sometimes they straight out lie, and sometimes they tell the truth. But I would say the vast majority fueled by that shame and guilt cycle often don't self-report a hundred percent accurately. And so as a provider, what happens is the provider can't tell, do they need a bridge dose? Can we tell if this person needs more medication or less medication? You know, it's it's the same thing for you. If you go to the doctor and you have a high blood pressure and you typically forget to take your medication or you're just not really 100% on board with taking a medication every day, the doctor says, so have you been taking your medication? Because your blood pressure is a little high. Typically you're gonna say, Yeah, or more or less, you know. So we're not any better, right? Like it doesn't matter the diagnosis, right? So whether it's mental health or medical, um, as a whole society, I think we are bad at consistently taking medication um for whatever reason. You know, I I mean, I personally can come up with a ridiculous justification for not taking blood pressure medication on time or daily, right? So um yeah. So I think that in the addiction and mental health world, um, when you see those providers, you have a whole different level of guilt and shame tied to it because bad things happen when you don't take those medications. And the second thing we often hear is it makes me dull. I don't like to take it because it makes me dull. Because typically we have a mental health medication that's trying to address the underlying issues of bipolar or depression or whatever it is. And then we have the addiction resulting from the underlying condition, right? So if the person takes their buprenorphine, for example, to control their cravings, but they are not taking their antidepressant, it's only half as effective as life could be, right? Um, but the the biggest reason people don't take their, besides they mention I just what I just mentioned is that we're just bad at taking medication, I think. But um, you know, they they say, well, it makes me feel dull. And I had an interesting conversation with a patient not too long ago, and I said, explain to me what you mean. And they said, Well, when I don't take my medication, I just feel sharper and I feel happier, and I feel all the highs and all the lows. And I'm like, okay, so every day's not a bungee jump for me, right? Like, I am never way happy all day long or way sad all day long. Like there's a lot of days where it's just flat for everybody. You just do the day, and there's happy moments and sad moments and stressful moments, but to have that crazy elevation all day long, that's gotta be exhausting. But see, that's their normal, right? You know, and so if that is your normal, and then suddenly that normal's gone, they have no comparison to, so they make so they feel like it's dull. And um, you know, we have another patient who was doing great. He he was before he got hooked on prescription pain medication, he was an operating room technician. And he went to work every day and he got hooked on some pain medication, and from that he had a shoulder surgery, and from that he ended up using um street drugs, and from that it ended up going to heroin. And sadly enough, um, his wife got involved in somehow and she died, and he just, you know, completely did his life just went completely sideways, the guilt from it, right? So he had made pretty much a full recovery. He'd, you know, he'd he got his addiction under control and he was really just trying to heal himself, and he had gotten his operating technician reinstated, and he would start back to I don't know, resolving his life and being a dad. And he started breaking into cars. And we're like, what do you what are you doing? And why are you taking change? I mean, you make you know thirty dollars an hour. Why are you taking change? And he lived in one of our sober living homes and he says, Well, I just I just need that. I need that adrenaline rush. Like, but let's find a sport. Like, what what are you doing? You know, um Yeah, but you know, sadly, you know, um life didn't go his h in his way and he just couldn't recover. And and we ended up losing him. But you know, those are the things that break your heart, right? Like um Absolutely. You just there's no resolution for that person, and it just it's hard to watch.

SPEAKER_02 22:12

I bet. And and that it kind of doves it up to the next question I want to ask you too about too is in in your story about relapse. You know, you hear statistics in the industry about high, how high patient churn is, as they call it, right? Loss of patients that are coming into these opiate treatment programs and getting involved with addiction recovery and then just disappear, right? And relapse. You know, what tell me what's driving that? I mean, you gave me some examples. What do you think are some of the biggest problems? Why we have such high churn in these addiction recovery programs? And what does that mean for these clinics to be able to survive, right? When they're losing so many patients.

SPEAKER_00 22:51

Yeah, it's hard. It's hard to stay in business for sure. First of all, it's a low margin business. So our biggest overhead is personnel. And um good personnel isn't cheap. And the rent isn't cheap. And, you know, there's lots of licensing and insurance. Oh my God, the insurance. So I think the biggest financial barrier to or not financial barrier, the biggest patient churn reason actually is financial. That's our number one complaint of when you talk to, hey Matt, what happened to you? Um, well, I lost my insurance because I lost my job and now I have to cash pay and I can't choose between food and cash pay. So that's the number one reason. The number two reason is transportation, 100% transportation. Wow. So um a lot of these, a lot of these folks have lost their license or do not have the ability to have enough money for transportation, you know, insurance, car insurance, the cost of the car, whatever. Um, or they only have one car and the someone else has to take it to to do whatever. Um so that's the second the second biggest reason is transportation. Um and if you think about it, I don't know if you've ever taken a public bus, but a public bus takes you hours to go anywhere. I mean, especially if it's across town, right? So unless the clinic's within walking distance of you, um, and you have to take a bus and you have to make sure you're typically these are are people who have children. I would say 80% of my patients have children, 20 do not. Um, so you have to get kids to school, then you have to get to the clinic, and then you have to get to work, and doing all of that by nine o'clock is incredibly hard. Now, a lot of these clinics open up at 4:30, 5 o'clock in the morning. Um, some buses don't start running that early, or even if you do that, let's say you go and you're on a five o'clock bus so that you can get your kids to school by seven. So you get up at four, you're on the five o'clock bus. It's probably an hour ride between stops. You get there at six, you take your medication for 10 minutes, now on your way home, you're on the hustle to get your kids. And then, you know, then you have to do that. Anybody with kids knows it's a song and dance.

SPEAKER_02 25:08

And every day. Yeah, every day.

SPEAKER_00 25:12

And it doesn't matter how old they are. And then um from there, you got to get yourself to work and then not be in trouble for being late. And so trying to do that on the daily, um, or even if you're trying to do it three times a week, uh, even once a week, I mean, how do you maintain that level of in energy to even accomplish that? I mean, you have to be so motivated. Um you know, it's I just don't you have to be very, very motivated. And I think that motivation can, you know, wane because uh you get tired and you get depressed and you get you lose faith it's gonna work or that you can keep it up.

SPEAKER_01 25:52

Yeah.

SPEAKER_00 25:52

So I think if we can solve these problems, then we can solve big problems for patients at clinics, you know?

SPEAKER_02 26:00

Yeah. How much in in just that churn? So you mentioned cost as a big driver, transportation, getting the clinic's a big driver. How much is, you know, a lack of visibility from the practice group from being up to being proactive? I know you've said in the past, today these practices it's reactive, not proactive. How much do you think that matters? Getting somebody to relapse where the practice groups aren't being proactive or don't have the ability to understand when they can be proactive, such that they're reactive. So patients just aren't getting the support they constantly need to be able to stay in a program.

SPEAKER_00 26:37

Yeah. Unless we have a peer support counselor assigned to a patient who they can text, like I'm really struggling, or they have a really great sponsor that they have a really great relationship with. Um, we have no, we have no visibility. Like we have no ability. So if you think of medicine, if you think um, you know, of of any medicine really, like primary care is reactive. You only go to the doctor when you're sick, typically. They try to get you for go for a checkup every year, but you probably don't. Most of all addiction care, 100%, it's just a higher stakes, is a reactive care model. So the person is only there because they're struggling. And then the only time that you can do anything to really change things for them or catch them before they fall is to have constant communication or the ability to have constant communication or watch signals. So we don't have that. We don't have any of those tools. So I only know someone relapses when I'm doing a drug test. And it's typically not because they tell me. I mean, I like I've mentioned before, uh poppy seed muffins, it's an epidemic in this country, I swear. It makes everybody fail their drug test, you know, which it's just silly. But you know, um but yeah, you know, uh if we had an ability to because we know what the signals are, right? Like we have tons and tons of evidence that tell us this leads to this, which leads to this, which leads to relapse. So if we could flag those, if we could go out and just monitor for those signals, then we could flag them. And we could flag those signals and reach out potentially before a relapse happens and and have some just-in-time support where we can help catch someone before it's too late. Because the consequences in primary care are that someone has a cold for too long and it turns into pneumonia. Okay, although it's a terrible situation, the chances of that patient surviving that and they're cognizant enough to take care of themselves is actually pretty good. You're probably not gonna lose a patient from that unless they're elderly or have some other condition, right? Are uh it's high stakes in addiction. It is literally life and death. Literally. Because if this person hasn't used illicit drugs for a certain period of time and then they go out and use the same amount they used to use, the chance of an overdose is super high. And the chance of death if no one finds them is also super high. So we have to change this. We have to move from a reactive model to a proactive care model and pay attention to those signals that evidence tells us we can watch for. We just have to find a methodology to watch for these signals.

SPEAKER_02 29:39

Yeah, gosh, that's powerful, Kendra. So thank you for sharing that. I agree, right? That lack of knowing what's going on with your patient all the time. Because, like my buddy said, you know, my I should say my friend's brother, become my friend, so I can call him a buddy, said, you know, sometimes it's day-to-day, sometimes it's minute to minute. Because if you're driving them back from the sober living celly home, he said that sometimes it's minute to minute dealing with my addiction. And so you're right. Without that support system, without the the clinician understanding what that person's going through at that particular second moment, right, where they can make an intervention, right? Pick up the phone, send a text, do something to tell it, talk that person off where they may be headed. Uh, you know, I agree. It's probably why we part of that reason why there's so high churn, in addition to some of the things you mentioned for, right? About cost of transportation is just not having enough inter care, proactive care to help these people when they need it most.

SPEAKER_00 30:39

Yeah, and I think that we also fall down in in alumni programs too. So many residential treatment programs have alumni um care programs to make sure that their patients, once they leave that residential tra residential care setting, that they have additional support and they can be connected to a community and still have um interaction that can be supportive before they relapse, right? So um talking to Windmill um treatment program in Texas just like two weeks ago, and we were talking about their alumni program and how how they're working on improving it and and the different things and different signals they're watching for, and they're doing some great work down there. But she was saying, I randomly just noticed we hadn't called this person in a year, and I I texted him, hey, this is Ashley over here at at Windmill, and I'm just seeing how you're doing. And he's like, Oh my God, I'm so glad that you reached out today. I'm having a terrible day. You know, so sometimes it's just by chance we can catch people, you know, but if they didn't have her who, and she is so dedicated to making sure her people, her people by her words, are are okay, right? Like um, it's really hard to find those dedicated programs that are are really trying to hold on to people and make sure they're okay afterwards. And there's some new technology they're working in, alumni programs. Maybe we can get them to come on and talk to us about some of the things they're doing. Because that is changing the model, right? Like, um, but yeah, we we really need to embrace uh follow-up in a whole new way. You know, but the thing is, is how do you pay for Ashley, right?

SPEAKER_02 32:32

Right. Yep.

SPEAKER_00 32:33

So unless your profit margin has something built in somewhere, you know, Ashley is barely reimbursable. And even then you have to have a mechanism to capture it, which most systems don't have. I mean, there are codes for it, right? But um most systems leave that on the table and they forget that they can do that.

SPEAKER_02 32:52

Yeah. Now that's so important. And and I know you've talked about these alumni programs before. You know, we're running short on time for the podcast, but I'd love I'd love with just maybe doing the let's get another session in the future to talk about alumni programs and what these, like the Ashleys of the world and the windmills and what they're doing, and how I think it'd be a great topic in the future. Bring them on, talk about what they're doing to follow up. And like you said, how do we make the economics work? You know, and how do we use technology? What are what are technologies we can use that may be being developed today? You know, we have so much technology out here today, right? With med tech and AI and digital health and all these things. How can we use technology better, right? To keep people connected constantly every single day. You know, that's so important. So I'd let's I think it's a great topic for another day. So knowing we're out of time, I'd just like to wrap it up. You know, this last just one more question with you, right? Is just maybe sort of a final thoughts, kind of big picture uh perspective of where this is heading, this industry is heading from your perspective. Opioid treatment programs with all these challenges they're dealing with, you talked about, right? With with challenges with labor and challenge with patient churn and the economics and reimbursement and travel and geography and all these other things, staying connected to patients. How do we stay connected to patients and engaged? You know, what's your sort of final thoughts on OPTPs, where it's headed, you know, advice to OTPs, you know, what they should be embracing going forward in the future to be successful in providing addiction recovery?

SPEAKER_00 34:24

Yeah, I that's that's you know a loaded question, right? And now a whole nother hour. But but here's a short version, right?

SPEAKER_02 34:31

We just got a couple minutes. Right?

SPEAKER_00 34:33

So the short version is this like I I think a lot of our colleagues within the industry, when we talk to them at conferences or whatever, are trying to embrace new technologies as fast as they can find it. This isn't an unknown problem, right? They they are trying to hug into anything they can that will improve their patient outcomes. It's important to every provider I know. And um, a lot of our providers have struggled with addiction themselves, and some of them are even doctors, right? Like, so it's their hearts in it and their souls in it, and and they really want to help people um get through the valley, right? So we just I think people are embracing the technology and and I don't think that addiction treatments going to shrink. I think it's gonna grow. We have some anytime that we start to have these um financial problems as you know, these big roller coasters, we see lots of people um have more addiction problems, right? So I think I think we'll see addiction censuses increase. Sadly. Uh even if even if we say the opiate uh epidemic is is we're working on it, and that's that's all true, but um we still have alcohol and we still have an opiate problem, we still have a fentanyl problem, and we have stuff that creeps up all the time. We have designer drugs that are still um huge problems. We have outbreaks of them like in Seattle, they have one that uh people are animal tranquilizers that they're taking that that actually put them in the emergency room and and they have necrotic properties too. So terrible stuff, right? Desperate people doing desperate things is what it is. So um we're here to help the desperate. We're here, we're here to help heal, we're here to work with patients and and help them and their families. And you know, I I think all everybody in the industry is feels that way or they wouldn't be doing this job because it's certainly not easy and it's it's certainly not getting people rich. It's just we're just trying to work through the roller coaster of problems.

SPEAKER_02 36:36

Yep, absolutely. Now, thank you. Uh thank you for everything you've done, Kendra, and your career for this addiction. It's an honor for me to be a part of this with you and this journey to try to help people with addiction recovery. So thank you so much. We're out of time, but I I love this topic. I think it's so important is is, you know, we obviously focused with the doctor and Dr. Sue in the past about patients and the struggles that they've got. But this business side of it, you know, so plays such an important role. And so I think I love the fact that we got to spend two episodes really talking deep about practices and what they're struggling with and how they continue to provide great care for people dealing with addiction recovery. So you're a tremendous wealth of knowledge. Thank you so much.

SPEAKER_01 37:14

Yeah.

SPEAKER_02 37:15

Um, thank you all so much, wherever you are, our listeners today. Thank you so much for taking your time on whatever platform you're listening on. Please follow us, subscribe us, like for us. You know, we've got a website set up you can go to to reach out to us. You can reach out to us. Kendra is an unbelievable wealth of knowledge. If you're in the OTP space, you're struggling as a business, and you want some ideas and thoughts and ways that you can help improve your business. Please reach out to us through uh through our podcast and our and our website. We'd be happy to connect with you to learn more. So very excited. Thank you so much. I'm Will Padratti. This is Kendra Allen. Thank you so much for joining us today. Tonight, everybody. On the Saving Dose.