Groups Recover Together is a national healthcare company for individuals with opioid use disorder. It's based in Burlington, Massachusetts.

THE PROBLEM

Addiction is a disease of isolation. The success of Groups Recover Together's care model relies heavily on building a supportive community for its members.

Before COVID-19, this was in the form of weekly, in-person group therapy. In March 2020, Groups Recover Together closed its physical locations, stood up a telehealth platform and transitioned to 100% virtual care. It completed the transition in just four days – no small feat considering it served more than 5,000 members across six states at the time.

Staff did all this with great uncertainty about what the future might look like. Their "keep us up at night" questions were:

●        Will members have sufficient technology or broadband access?

●        Will staff be able to perform their jobs at a high level?

●        Will members continue to engage in treatment?

●        How will members do in a virtual setting?

●        Will staff see a degradation of outcomes?

"At the time, we had no way to know how long the restrictions related to the pandemic would last, and it was difficult to predict the impact it would have on the disease state we treat," said Colleen Nicewicz, CEO of Groups Recover Together. "We now know that 2020 was the worst year ever recorded by the CDC for drug overdoses.

"Four of the 10 most common diagnoses treated via telehealth in the second half of 2020 were psychiatric or behavioral conditions – highlighting the urgency of our mission to establish continuity of care for patients with opioid use disorder," she continued. 

"Our top priorities throughout the process were the safety of our staff and members, and we committed to a deeply held belief that a telehealth model would maintain the same standards of care and clinical outcomes for our members."

PROPOSAL

In November 2018, Groups Recover Together's clinic operations in Northern California were forced to shift to virtual care as the Camp Fire wildfires in Butte County displaced most members and staff.

"The speed of the wildfires left no time for evaluating commercial telehealth platforms," Nicewicz said. "The only option was to leverage the existing telephony solution, EHR and e-sign platform with 'swivel-chair' integration.

"It wasn't perfect, but the solution kept our members engaged in weekly group therapy and making progress on their recovery. In hindsight, this developed the playbook for executing a rapid shift from in-person care to virtual care that proved vital in March 2020."

In response to the COVID-19 shutdown, Groups Recover Together scaled the same solution it stood up in California 18 months prior and began a search for an integrated platform that could support its delivery model.

What it found was a limited set of options, and none that were designed to effectively manage a group telehealth encounter. This drove the decision to build a solution that could meet a specific set of criteria.

"First, we had to continue to deliver industry-leading outcomes: retention in treatment, abstinence from illicit opioids and attendance to weekly group therapy," Nicewicz explained. "It had to support multiple modalities of care – group and 1-on-1 meetings – and had to be easy enough for members to navigate.

"Beyond the technology solution, we had to revamp many of our operational processes – such as the script for our call center, our clinical intake flow, our protocol for toxicology screens and onboarding paperwork for members."

Even before the pandemic, individuals struggling with opioid use disorder often faced significant barriers to care. Only one in five people struggling with addiction to heroin or pain pills engage in any form of treatment.

So, the telehealth solution needed to support easy access to care by mitigating the most common obstacles for receiving treatment, such as lack of transportation, schedule inflexibility or fear/stigma associated with addiction treatment. In addition, it had to comply with pandemic restrictions and mitigate the spread of COVID-19 among members.

MARKETPLACE

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MEETING THE CHALLENGE

The previous solution offered a fragmented member experience at best. The field teams were communicating with members via multiple platforms, which required significant training and enablement of both members and staff.

"But the one key feature that allowed us to deliver impact was virtual group counseling," Nicewicz said. "Every one of our more than 5,000 members across six states retained access to their weekly group counseling and their monthly group physician encounter via Ring Central, our video conferencing application.

"New member intakes were supported by HelloSign to adjudicate all the required consents and releases of information," she continued. "We used Keap to manage outreach campaigns to continue to engage members, and our eClinicalWorks EHR supported our daily SMS messaging to our members. Since the COVID-19 shutdown began, our outcomes have remained consistent with our in-person model pre-pandemic – a testament to the value of community in addiction treatment."

RESULTS

Early on, Groups Recover Together emphasized the importance of measuring success. That's why it took a baseline measurement of data at the onset of the pandemic and rigorously tracked outcomes measures against it after transitioning to telehealth.

"We also surveyed our members to capture qualitative feedback," Nicewicz noted. "Our first checkpoint came three months in, when we took a pre/post measurement and received survey data from our members, as well. We were pleasantly surprised by the findings."

The first success metric: 87% of members said they felt as supported or more supported in a virtual care model.

"Telehealth is bringing back the benefits of the house call," she said. "By meeting with patients virtually while they're at home, physicians can gather crucial information about social determinants of health that may affect the patient's disease state and ability to recover from addiction.

"For example, the physician can perform a 'fridge check' and see what foods they have or if food insecurity might be an issue. They can see the patient's living conditions by asking for a tour of their home. Often patients feel like the physician is going the extra mile in offering quality care when they make those asks."

Telehealth also makes it much easier for family members and health advocates to join appointments and ask questions on the spot. That support network is a crucial component to recovery.

"Lack of access to the Internet or teleconferencing devices was not a significant barrier to care, as 87% of members joined their weekly groups via smartphone," Nicewicz noted. "We also saw no change in our attendance rates, maintaining an 83% attendance rate for weekly group meetings."

Access to care is an ongoing issue in addiction therapy as the opioid epidemic has heavily impacted rural areas of the country where resources for in-person treatment are scarcer than in urban areas. By making telehealth more broadly available, Groups Recover Together can reach more patients who live outside the range of a reasonable drive to one of its brick-and-mortar clinics and address the opioid crisis in those communities that are hard to reach.

"Prior to the pandemic, it was rare for us to serve members who lived more than 50 miles away from one of our physical locations," Nicewicz reported. "But today, 29% of all of our members live in a county where we don't even have a physical clinic. This is a major reason why our membership has grown by 45% since the start of the pandemic.

"Anecdotally, we heard stories about members who had been reserved and finally opened up in their group therapy sessions, likely resulting from a feeling of less pressure than the room full of people in an in-person setting. We also read numerous reviews about members who greatly enjoy the flexibility of telehealth."

Beyond the three months of data, the healthcare organization has partnered with UCLA to co-author a long-term study on the impact of telehealth on its clinical outcomes. The paper currently is in peer review, but the findings will validate much of what the organization already knows – that it saw no degradation in member outcomes in the post-pandemic virtual care environment. That paper is scheduled to publish in late 2021.

ADVICE FOR OTHERS

"First, providers should accept that telehealth has a permanent place in the healthcare ecosystem," Nicewicz advised. "Likely, most of your staff enjoy the added flexibility and lower risk of treating patients via telehealth, and patients have grown to expect access to telehealth. Providers who fail to accept those realities are less likely to retain patients.

"Second, listen to your members/patients. Ask them how they want to access their healthcare and what feature or functionality they'd like to see in a virtual platform – even beyond teleconferencing. At Groups, early recovery from opioids is fickle and requires an immense effort from the member."

Members are waging the battle of their lives, she added. That's why it's so important for Groups to meet members where they are, and the organization believes the added flexibility and convenience of telehealth is translating into a greater likelihood of success for them. The organization came to that understanding by listening to member feedback.

"Lastly, provider organizations must advocate for federal support for telehealth," she concluded. "Without the backing of CMS and clear policy that mandates public and private insurers reimburse fully for telehealth services, providers will have no choice but to discontinue using it as a treatment modality."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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