Speaker 1: 0:00

It's been estimated that 8% of employees have a moderate to severe addiction to alcohol and drugs, and that an addicted employee can cost their employer $25,000. What could make that problem even worse and what can be done to help resolve those issues? We'll find out on this episode of Shift Shapers.

Speaker 2: 0:20

Change either energizes or paralyzes. The choice is yours. This is the Shift Shapers podcast, bringing the employee benefits industry interviews with individuals and companies who are shaping the industry shifts. And now here's your host, david Saltzman.

Speaker 1: 0:42

And to help us answer that question, we've invited Joanna Conte. She is the founder and chairman of the board at Conquer Addiction. Welcome, Joanna. Thanks for being here.

Speaker 3: 0:51

Well, thank you, david, it's a pleasure.

Speaker 1: 0:53

Pleasure is completely and totally all ours. So let's start out with a great starting point. Like a number of our guests over the years, you ended up doing what you're doing because of a personal story that happened. Would you be willing to share that with us?

Speaker 3: 1:07

Yes, I would. So I had a teenage daughter who developed a really severe alcoholism and she would drink night after night to levels that could potentially kill her. She would just guzzle vodka until she would pass out or whatever. When we realized how severe it was, it was after a couple of car accidents and airlifts to shock trauma and so forth. It started a six-year journey for us to try and find her effective treatment and during those six years she was in and out of different treatment programs.

Speaker 3: 1:51

I kept finding myself in a crisis situation where I would have to make basically a life and death decision about where to send Karina for treatment, and I wasn't able to make it on the basis of hard data, saying this treatment center was particularly effective and this one wasn't. Each time I was forced to make this decision on the basis of how nice somebody was on the phone. We were incredibly lucky and after six years we usually found effective treatment and, as a result, my daughter has now been in recovery for 13 years and has completely turned her life around, is actually in the next couple of weeks expecting her fourth little girl and has a wonderful career traveling the country and so forth. So we've been incredibly blessed, traveling the country and so forth. So we've been incredibly blessed. But when the worst was behind me, I said there's got to be a way for the families coming behind us to find effective treatment. The system is broken.

Speaker 1: 2:58

So let's forward that into the employer arena, which is where most of our audience lives. They're mostly folks who are client-facing and help employers make decisions and deal with risks just like this. That $25,000 before an employee goes to treatment is a stat that you and I talked about in our pre-interview. Where does that come from? What drives those costs?

Speaker 3: 3:27

that come from? What drives those costs? So, first of all, this is all of the research that my company has created. I've spent the last 10 years monitoring over 100,000 patients during addiction treatment across the US and also following up post-treatment, through the post-treatment year, with over 40,000 patients who were in treatment for addiction to see how they're doing one, six and 12 months later. And what we found through following up with those patients, monitoring them during treatment and following up with them them afterwards, is that in the year before they come to treatment, the average patient will have ER visits and unplanned hospital stays and detox treatments that will total, on average, about $25,000 in that pre-treatment year.

Speaker 1: 4:21

That's before you factor in absenteeism, treatment year. That's before you factor in absenteeism, presenteeism and all the other isms that are kind of soft costs. Let's call them right.

Speaker 3: 4:31

Well, and there's one other really large cost, and that is that other research has shown not ours, but other research has shown that if you have a patient that also has a mental health disorder and an addiction, it'll cost three to four times as much to treat any of their other physical conditions. So we already know diabetes is very expensive for employers. If you have an employee with diabetes that also has a substance use disorder, it's going to cost you three to four times more on average to treat them than if they didn't have either.

Speaker 1: 5:07

So, going back to something that you said, and we kind of trace your journey a little bit, choosing a provider based on how nice the person who answered the phone happened to be on that given day, on that given moment, on that given phone call, is probably not the best way. Were there no other assets available to you, and what have you been working on since?

Speaker 3: 5:31

Well, what was so frustrating was I would ask the salespeople. I'd say well, what is your success rate? And I invariably got one of two answers Either they told me it was simply impossible to measure how effective treatment was, or they made up some number. They would say oh, 80%, 85% of our patients are in recovery one year later, which, as much as we would all like to believe that it's absolute nonsense, addiction is a chronic disease. Our research shows that only about 36% of patients will be not using drugs or alcohol one year later. It's very difficult to recover from addiction, and so you know, there was no real information out there that I could use to make a decision and unfortunately, 20 years later, not much has changed. I guess it has been quite. It's been about 17 years and the situation is the same.

Speaker 1: 6:33

So what are you to do, whether you're a parent or a caregiver or a paternalistic employer or just somebody who is a friend and wants to help? What options are out there? Has anything gotten better? Is there any more information about quality and outcomes and all of that stuff available?

Speaker 3: 6:51

There is some. That's what I've spent the last 10 years focusing on. My research company, as I said, has monitored over 100,000 patients during treatment and followed up with over 40,000 of them afterwards, and what we have found is that there's a tremendous variation in the effectiveness of different rehabs. While the average is that 36% of patients will be doing well one year later, it goes all the way from over 50% at some rehabs of their patients are doing well a year later to less than 15% at other rehabs, and the problem is you can't tell which is which by looking at the pretty pictures on the website. And so what my daughter and I have done is create a nonprofit called Conquer Addiction, where our goal is to help the families and employers to find more effective treatment, and so what we've done is treatment centers who have proven that at least 40% or more of their patients are in recovery one year after treatment. They are on the Conquer Addiction website with a five-star rating. Their actual research results are there so that people can see for themselves the impact that attending that treatment center has had on patients through a third-party independent research company, and they can contact that treatment center if they're interested in considering going there and then that's been there for about five years.

Speaker 3: 8:27

Most recently, we took it to the next level and created a market of truly effective treatment centers where we asked treatment centers that could prove that a high percentage of their patients were in recovery one year later. We asked them to create an all-inclusive bundled rate payment bundled rate payment for an episode of care and you know everything would be included. There would be no surprises. But what is so cool about what we've done with this market is we've also required to be part of the market that if a patient completes treatment at one of these treatment centers and they relapse within the 90 days after they complete treatment, that the center agrees to take them back into treatment for at least 20, 21 days on their own dime. So we've aligned the incentives. Everyone the patient, the payer, the rehab are all aligned identically, with the focus being on how do we help this patient recover.

Speaker 1: 9:42

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Speaker 3: 11:30

Yes, well, as I said, only 36% of patients are in recovery one year later, as defined as meeting their drug and alcohol treatment goals, and of the patients that are not in recovery, the majority of them will probably relapse in the first 30 days.

Speaker 1: 11:49

Wow.

Speaker 3: 11:51

Yeah, it's scary. This is a terrible disease.

Speaker 1: 11:55

Well, and it's multivariate. So I was going to go back to when you started looking into the problem and you started trying to quantify these results. There's so many variables. Are you at the point, even with 100,000 cases that you've looked at, are you at the point where you can make any kind of conclusions about what makes one program successful and another program maybe less so?

Speaker 3: 12:22

We can definitely say a number of things in very general terms.

Speaker 3: 12:26

I mean, there is some truth that addiction is an art.

Speaker 3: 12:30

It is partly science, I'm sure, but it is also an art.

Speaker 3: 12:33

How well does the therapist connect with the patient, help them resolve whatever the issues that are making them drink or drug to oblivion? You know that takes a very special person to be able to do that, but in general what we can say is the longer a patient is in treatment, the higher the likelihood is that they're going to be doing well one year later. So, for example, if a patient spends 90 days or longer in treatment, which might start out in a detox and then go to a residential treatment center for a while and then end up going into what's called intensive outpatient and outpatient therapy, if they're on a continuum where they go from very controlled to more and more real-world therapy over the course of 90 days, about 50% of those patients will be doing well one year later. If they only spend 20 days in treatment, only half of that will be in treatment one year later. So the difference between 20 days and 90 days in some sort of you know helpful therapy will double the likelihood that an individual is doing well one year later.

Speaker 1: 13:59

Is there an easy way for folks who are interested to access this data, this information about these centers?

Speaker 3: 14:06

Yes, if they go to Conquer Addiction, which is conquer-addictionorg, they can search for treatment centers in the US that meet their criteria. They can say you know, I wanted to be in California, I wanted to serve women only, I wanted to be this or that, and they can pull up a list of treatment centers, with those with the best independently verified outcomes at the top of the list. But here's the challenge it is still well less than 1% of all treatment centers who are doing any kind of accurate post-treatment follow-up, and so there aren't that many centers yet that we can point to. And so that's what we're trying to do with Conquer Addiction as our next step.

Speaker 1: 14:52

Well, you talked about aligning incentives. I wonder if you've given any thought in your plan, down the road, to maybe bringing this information to some of the major carriers, the major health insurance carriers or some of the other folks who are building a la carte plans, which is more and more the thing for employers and saying, look, we can drive more business to the appropriate centers and therefore there's an incentive, there are more people on the platform, there's an incentive for the carriers or whoever it is to start looking at. Gee, maybe we need to be tracking this stuff, we need to watch more carefully and see what our outcomes are and do follow up. Or and to be crass about it, for a lot of these centers is it just a money game.

Speaker 3: 15:37

You know there's a few out there, of course, that are bad actors. There used to be more. There's been a lot of cleanup in this industry since. You know all the horrible things you heard five or 10 years ago. You know any business, any industry is going to attract some people who are in it for the money. But most of the people that I talk to every day really care very deeply about their clients and helping them recover, because most of the people who start addiction treatment centers are in recovery themselves. They know how difficult it is.

Speaker 1: 16:13

Back to the original question. I kind of went a little bit long there, sorry about that. I do that sometimes like days that end. And why? How do you create an incentive for more centers to do the kind of work they need to do so that they can evidence what you need to evidence to help send patients to them?

Speaker 3: 16:32

You know, one of the challenges in the addiction treatment space is that they're really stretched for cash. The health insurance companies have been continually squeezing them, making them, you know, kick people out of treatment earlier than is, you know, I think, appropriate, and so forth, and it's a very hard business to be in. Money is very tight in this, in this industry. Our goal was if we could start driving a lot more families or employers to using accurate data to identify the most effective treatment centers. Our goal is that this will drive a lot more business to the more effective treatment centers. Our goal is that this will drive a lot more business to the more effective treatment centers, and so that's what we really want to do.

Speaker 3: 17:18

So an employer today that's interested in using one of the centers on Conquer Addiction Marketplace they don't have to contact us directly. They can go directly to the treatment center. Say I want to take you up on your market offer. Tell their TPA to you know, set up the contract with the center. Say I want to take you up on your market offer. Tell their TPA to you know, set up the contract with the center directly and they can knowingly know that they are sending their employees and the employee's dependents to one of the best treatment centers out there, and a treatment center that's put their money where their mouth is to commit to confirm that they're really providing effective treatment.

Speaker 1: 17:55

I'm curious about something. You know our folks, our audience, deals a lot with all of the compliance issues that the government comes up with. Has the Mental Health Parity Addiction Equity Act? Has that done anything to help ease some of the pressures on the centers that you're talking about in terms of length of stay or compensation or whatever?

Speaker 3: 18:18

It's a wonderful concept. It has really not been enforced.

Speaker 1: 18:23

You know, meanwhile the problem is growing and the number of Apparently really good treatment centers is not getting big anytime soon. To be honest, I mean, what the heck do you do?

Speaker 3: 18:36

Well, what we've realized is that if we rely on treatment centers to cover the cost for outcomes research, we're never going to get there where we need to be. What we really need is to know nationally which rehabs are providing truly effective treatment and which ones are not, and so what we've decided to do as a nonprofit is to purchase aggregated claims data on, you know, a million or more patients who go to treatment in any given year and use that to calculate what is the effectiveness of different treatment centers across the board. So we're in the process of raising we need to raise a million seven five to produce that national claims registry. The first time, we're using VISTA's data, my research data that we know how 23,000 patients did one year post treatment, and we're using that to create a predictive model that we can use to identify what are the factors and claims data that tell us that somebody is likely to be in recovery a year later or not. So, for example, if somebody's back in the ER at 10 months with an overdose, they're probably not doing well at one year, but maybe at six months and eight months. If they're meeting with their doctor to deal with their hypertension, maybe that's a sign that they are doing really well. And so we're going to use VISTA's data on 23,000 patients that we know how they were doing one year. We're going to get the claims data for those same patients.

Speaker 3: 20:15

All of this de-identified through really cool technology that exists today, and then we'll develop a predictive model that we can roll out across the million plus patients who were in treatment during a given year and that will allow us to identify the effectiveness, to estimate the effectiveness of treatment centers across the entire US.

Speaker 3: 20:40

Then what we're going to do is we're going to share that information with the rehabs and also, by the way, with the payers, because we see a tremendous variation in effectiveness by different health insurance companies too, and we're not into shaming. We're not going to publish results that show that treatment center X or payer Y has horrible outcomes. We're going to say here's what we think your outcomes are, based on our research. If you would like to share those outcomes publicly, you can do so for basically free on Conquer Addiction's platform, and that will allow more and more people to get able to use that information to help them pick the best treatment centers, and as that becomes more of a resource for people, then I think that will drive the entire industry to more effective treatment, and because we've also been able to identify what type of treatment is most likely to be effective for a particular individual.

Speaker 1: 22:01

And that's a great place. Hopeful to end our conversation for today, joanna Conte, founder and chairman of the board at Conquer Addiction and we will put the link to your nonprofit in the show notes, so anybody who wants to reach out or wants to learn more or maybe make a capital investment can do so. Thanks so much for being here.

Speaker 3: 22:19

Thank you so much, David.

Speaker 1: 22:27

I want to give a quick shout out to our sponsor and our producer, hatcher Media. Hey, if you need podcast production or professional graphic design, josh Hatcher is the expert to contact For more information. Visit him at HatcherMedianet. That's H-A-T-C-H-E-R Media dot net.

Speaker 2: 22:45

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