How PursueCare’s Virtual Addiction Services Integrate with Healthcare Infrastructure

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Our healthcare ecosystem acknowledges that people with chronic conditions account for a majority of costs. Organizations have reacted to this by dedicating more funding to treat these individuals. However, behavioral health conditions have not yet been entirely included in this group. People with substance use disorders (SUD) are searching for care in hospitals and health systems that are not properly equipped to treat their conditions. Nick Mercadante, CEO of PursueCare, an online addiction and mental health counseling provider, is sharing more on this issue and what options like PursueCare can do to help.

How and why does PursueCare partner with hospitals and health systems?

Starting with the why for better context of the crisis we are facing is really important. 

Most health care starts locally to the individual experiencing either an acute or chronic health condition. That usually means a health system, hospital, or community health provider is the reference point for most individuals needing any sort of help, physical or otherwise. 

Recent studies have shown that roughly 10% of patients account for 70% of total healthcare costs. 57% of the highest cost group of patients have SUD and behavioral health diagnoses. Yet SUD and behavioral health treatment only represents 4% of the total spend in that high-cost group. Unfortunately, most hospitals and health systems have historically been set up in every respect to tackle health issues for the physically sick as a primary concern. 

Let’s face it, healthcare is a business. Primary care is often a loss leader itself, but it’s a gateway for other more lucrative services – surgeries, specialty care, and chronic care for the physically ill. Financial incentives to refer and then treat SUD remain paltry in comparison to other areas of medicine that systems specialize in. Preventive SUD care is virtually non-existent. To make matters worse, populations experiencing social determinants of health suffer disproportionately from SUD. That often means Medicaid, which in most states reimburses very poorly for first-line treatment like therapy and prescribing medication for opioid use disorder (“OUD”).

So health systems, and the treatment teams that make them tick, are often only minimally set up to help patients with SUD directly. They mostly just do their best to send the patient somewhere outside their four walls. In rural regions – the options are lacking. But treatment availability, and quality, outside of the health systems and hospitals that drive most community care, is a problem almost everywhere at this point.

The result of all this is that local healthcare almost entirely misses the progression of SUD from mild, to moderate, to falling out of all healthcare infrastructure. They usually rediscover the individual in the emergency room when a crisis occurs. Opioid-related overdoses and emergencies have pushed physiological aspects of substance use disorder to the doorstep with more regularity. EDs, medical-surgical units, and other settings are facing daily crises. But they still regularly lack integrated resources or even clear next steps for care after stabilizing patients.

PursueCare is a Joint Commission-accredited virtual clinic that treats SUD and behavioral health. PursueCare’s mission is to make comprehensive services accessible to everyone, everywhere, by removing traditional obstacles to treatment that patients frequently encounter. Critically, PursueCare treats not only patients that have SUD, but also patients that exhibit symptoms of possible dependence, require deprescribing from pain management medications, or may be at risk for SUD. PursueCare also treats patients with co-occurring mental and behavioral health disorders, or those in need of therapy or psychiatric medication management, forming a holistic solution for what patients might face.

Predominantly all care is initiated through assessment and/or referral by a collaborating healthcare facility on-site. Partners are trained to successfully conduct basic screenings, brief interventions, and referral to treatment (“SBIRT”). Intervention is frequently driven by PursueCare’s partner portal and help from field patient access specialists. Opportunities for preventive care at primary care and specialty care offices come from the confidence in knowing that there’s a full virtual suite of specialists ready to collaborate. Thereafter, ongoing longitudinal treatment continues at home through PursueCare’s patient-centric app experience. 

What’s unique about what PursueCare offers to patients and partnering organizations?

Maybe as a result of the COVID-19 pandemic, or the inherent complexity of mental health and SUD, or competitive walls being put up within the health care industry, a lot of virtual health is fairly siloed to being a direct-to-consumer single-point solution. Consumers can and should have choices when it comes to how they engage with care, and the plethora of services out there help to bring those choices right into the palm of our hands. But often times patients, particularly chronic care patients, have fairly complex and multi-faceted physical and mental health needs. Furthermore, I have a growing concern that the siloed nature of various solutions leads to what I like to call “digital whiplash.” Going to four different places to handle your six or seven health issues is hard.

PursueCare’s integration with health system and community health ensures continuity and success both in engagement with the patient and long-term outcomes. Ongoing collaboration with health partners and health insurance plans ensures continuity and success both in engagement with the patient and long-term outcomes. In some cases, such as with primary care, pain management, and obstetric care, the treatment is also preventative in nature.

This form of collaboration is what is known as Behavioral Health Integration (“BHI”), and more specifically, the Collaborative Care Model advanced by the American Psychiatric Association. In this model, psychiatry, mental health, and other resource professionals are integrated into primary and specialty care settings to form a collaborative care team. This brings both physical and mental health care through frequent and familiar front doors for populations suffering from mental health and SUD, often resulting in a better holistic health experience, destigmatizing seeking help, and improving patient outcomes. The Collaborative Care Model has the most evidence among integration models to demonstrate its efficacy and efficiency in terms of controlling costs, improving door-to-treatment time, improving clinical outcomes, and increasing patient satisfaction.

From there, PursueCare aims to be as comprehensive as possible as a virtual clinic. Services include medical care with medications like buprenorphine for reducing withdrawal and cravings, counseling and therapy, psychiatric treatment, treatment with FDA-approved digital therapeutics. Patients can access 1-to-1 care with members of their treatment team, but PursueCare also specializes in virtual group therapy combined with breakout 1-to-1 medical and psychiatric services. The efficiency mimics an outpatient clinic but without the travel, time off work, and long wait times. Patients can obtain medications directly and discretely from the in-house pharmacy. Whether or not they do, all patients have access to a pharmacist for pharmacological consultations that is either covered by insurance or free.

Targeted case management helps tie treatment and partnerships together. Patients have one-to-one support for the treatment journey. They can conduct toxicology screens from home. Case Managers promote access and support for social and other needs patients with SUD often have. The comprehensive approach helps reduce treatment gaps, coordinate other aspects of patient health, such as primary care, and increase engagement.

Lastly, treatment is affordable. It is frequently covered by insurance, and PursueCare is in-network with Medicare, Medicaid, managed care, and commercial insurances. The goal is to never let cost be a determining factor in whether or not a patient can access and stick with a treatment program. Because PursueCare works with insurance directly, health partners also do not have to support the cost of care, instead experiencing a significant ROI for their collaboration: meeting critical health access and quality metrics without increasing their own costs.

Why is it important to offer full mental health as well as addiction treatment?

Forming a more cohesive team-driven approach to care not only helps to address more of the underlying and intrinsically intertwined causes and symptoms of SUD, but it also helps reduce the complexity experienced by collaborating physical health providers who need to refer a patient, and the patients themselves.

Most SUD can be considered a chronic condition, and treatment requires a longitudinal approach. Additionally, studies show 43% of people in treatment for substance use disorder have a dual diagnosis of mental health disorders. As many as 70% of individuals experience trauma. The “front door” settings that PursueCare collaborates with, on their own, frequently lack those comprehensive resources at their points-of-care, or even at their fingertips when it is time to refer. Treaters may not have confidence in solving for the multi-faceted nature of SUD and mental health, which requires treatment planning between a number of often disparate specialists, with conditions that require different treatment plans and goals. and medications that may have contraindications.

Forming a more cohesive team-driven approach to care not only helps to address more of the underlying and intrinsically intertwined causes and symptoms of SUD, but it also helps reduce the complexity experienced by collaborating physical health providers who need to refer a patient, and the patients themselves. It can improve patient education and understanding of their own conditions and the benefits of all clinically-indicated treatments for those conditions. It can also improve safety, particularly when SUD and psychiatric medications are controlled substances or have contraindications. 

Finally, team-based care ensures that the patient is receiving access to the care they need, and that the specialized treaters themselves are communicating around the patient.

Article written by Nicholas Mercadante , Founder & CEO, PursueCare