Telehealth: Making Treatment a Virtual Reality for More People

0:00:13 William Moyers
Here we are another interview in our Let's Talk podcast series. Thanks for joining us. I'm your host, William C. Moyers. These podcasts feature experts on the gamut of issues that matter to Hazelden Betty Ford. The same issues that matter to you, our audience. From substance use prevention to cutting-edge research, treatment of addiction, and recovery from it. These conversations have become quite popular the past two years. And if you've tuned in previously for today you'll note that things look a little bit different around here. No wonder. We're recording in the midst of the pandemic that has affected all of us. Hazelden Betty Ford takes seriously the need to do everything possible to prevent the spread of coronavirus among our patients and our employees. Even here in the studio, we're following public health guidelines. As a result, I can take off my mask for the interview because the production crew, the Executive Producer, and yes, even my guest, Robert Poznanovich, are elsewhere in the building. The fundamentals of social distancing 101. It's a real treat to have Bob Poznanovich with me today because a long time ago, before he went to work at Hazelden, before he became the Vice President of Business Development for this organization, Bob and I met in the community of recovery in St. Paul. Bob, it was in about 1980—'95 when you and I would get in the car together and drive to Center City. Certainly a lot has happened in our lives personally and professionally. Just share with our audience today your personal connection to the organization.

0:01:45 Bob Poznanovich
Sure hi William. It was February 13th of 1995 when I had reached my bottom. When I was using cocaine, a really high amount, in Chicago. I had just lost my job as a senior executive in a technology company and kind of lost my relationships and kind of like everybody else I reached that point that I ran out of options and fortunately I found the Hazelden Foundation. I went to treatment like I said in February and stayed in Center City until March. And then I went to Fellowship Club where I met you and other members of the community. Some point at the end of March we started volunteering. And every Saturday a group of us would go to Center City and share our strength, experience, and hope with patients. And I think that became a big secret to, you know, my recovery is that volunteering and giving back. And having some fun and you know filling that void that the drugs and alcohol had that was now being filled with recovery. And then I think that's one of the promises. And one of the gifts. Is to have really true friendships like yourselves and others throughout the years. So it's nice to see you and it's nice to be here in the same capacity with you, being able to kind of carry—put a face on recovery and carry the message of hope.

0:02:55 William Moyers
Who'd have ever imagined it, right? Way back then? [Bob laughs heartily] You know you talk about how much you lost but we're so glad that you've gained so much. And we're so glad that you continue to hold onto really the expertise that has put you into the role now as the Vice President of Business Development for this organization. At really a critical time. Not only in our growth but as we, you know, address the pandemic of coronavirus. And you're in charge of a lot of that effort. Can you take us through the process of developing and launching Hazelden Betty Ford's telehealth strategy?

0:03:26 Bob Poznanovich
Sure. So because my background has always been in technology, I was looking ahead and trying to predict kind of where the industry was going to go as you're looking at technology and health care in general. I think it was pretty clear that technology utilization in behavioral health was really lagging and particularly even more so in substance use. I mean a lot of organizations didn't even have electronic medical records. And you looked at the industry, you started to look at the industry problems, patient problems and care delivery problems, back in 2018. When I happened to have seen a demo of some software that one of our Payer partners was developing. And it clicked on me that this technology could be used to deliver care differently. So it was in 2018 we started to talk about how could we use video, and live video between patients, not just in a one-on-one environment, which was kinda being done, you know, for telehealth for years. But how could it be done in a group environment? Because the problem we were looking to solve was access. And as we're working with a lot of our partners around the country and communities, academic health centers and other state organizations, you know, health care to rural patients is a real challenge. So, you know, could it help provide care and improve access to rural markets? Would the convenience of being able to get care wherever you're at improve engagement? You know, if you live in downtown L.A., Chicago, or New York, you know the catch mitt area is really small. Big cities 'cause people don't wanna fight the traffic after work to get to care. So could convenience improve engagement?

0:05:17 Bob Poznanovich
And the other was would stigma—could we help overcome some of the stigma by not making people physically have to show up in a building, kinda put a label on themselves, kinda come out much more in a public sense. And could we engage them earlier by having them feel it's safer as well as convenient to start that way. So we had started in 2018 down the path saying could we accomplish all kind of the goals of health care? Which is improve access, improve outcomes, improve patient satisfaction. And lower costs. In 2019, we started a pilot along with a couple Payer partners. One of the primary ones was Anthem. Out of California. And we ran groups where we took our patients with our counselors using a technology platform to deliver the same type of care we were doing virtually. And we piloted that for about nine months. During that nine-month period, we really worked on developing the right protocols for patient safety. For confidentiality. For workflows, for integration, tweaking clinical content, developing and understanding what counselor skills had to be developed. You know that bedside versus web-side manner is just something that we really are focusing on. And we learned a lot of that.

0:06:44 Bob Poznanovich
[continued]
And our plan was to launch our virtual outpatient services at the end of March and then roll it out one state at a time—

0:06:53 William Moyers
Mmm-hmm.

0:06:53 Bob Poznanovich
—Throughout this year. And then because of the epidemic and because of our really number one focus which was to make our patients and staff safe, we transitioned all of our outpatient patients across seven states into virtual care services over a couple weeks. And we moved something like 1300 patients successfully.

0:07:13 William Moyers
Wow.

0:07:13 Bob Poznanovich
Over that period of time. Between our intensive outpatient, outpatient, and day treatment programs. And those numbers are even higher today than they were—the number of patients we're treating today are even higher than they were when we transitioned the initial group out.

0:07:25 William Moyers
So you had the plan to roll it out in the spring of 2020, you never anticipated the pandemic, what is the pandemic of coronavirus as a relates to virtual care? What have you learned so far?

0:07:40 Bob Poznanovich
Number one that it appears to work, that virtual care seems to work. If you look at a couple of indicators. Staff satisfaction and confidence in the delivery system. If you think of—if the counselors don't think that the product and the service and the patient engagement is working, that would be a very—a big obstacle. The second one is the surveys that we've have from patient satisfaction.

0:08:02 William Moyers
Mmm-hmm. 

0:08:03 Bob Poznanovich
You know some have said they would never think about going back to brick and mortar and that was not universal but it's a high percentage are very, very comfortable with that delivery vehicle. And we're looking at early data outcomes. On engagement. Meaning, that our patients today are averaging more sessions and have significantly less no-show rates. Which we believe, when you improve that level of engagement, and consistency, that we will improve outcomes. And we are starting to study, you know, the outcomes that we'll know in a few months. If outcomes are at least the same if not better using some virtual. [Moyers nods] In fact I think we'll know over time too as we do some stratification about which patients would fit better in a facility versus brick and mortar facility. And I think we'll know that over time as well as what skills counselors have to develop. And what are the outcomes by counselor and is there some skills that we could learn to create that better therapeutic alliance.

0:08:59 William Moyers
And those outcomes, the efficacy of virtual care is being gauged through the Butler Center for Research.

0:09:08 Bob Poznanovich
Right.

0:09:09 William Moyers
So Bob, so you disclosed at the beginning of our podcast here you know your own personal journey. You know as well as I do that addiction is an illness of isolation. And the antidote to it is community. Virtual does bring people together but is it—is it the best answer for what we used to experience when we're on the units, when we're sitting in a group of chairs in a circle down at St. Paul?

0:09:34 Bob Poznanovich
Yeah. I think it's gonna be different. I mean, at some point I think that there's gonna have to be that—that one-on-one contact. You know isolation is a concern. I think that that's one of the areas that we could measure, it's one of the apps and some of the things that we're looking at for future product developments is how do we measure and how do we intervene. On isolation. Because it is kind of the diagnosis of the disease or consequence of the disease. You know but today's day and age, we're gonna have to rely on some social separation. We're seeing really good participation and acceptance of virtual meetings. You know we've got the daily pledge.org which is our run site. Which is seeing record numbers of patients. Some of the online AA meetings. And NA meetings. And other Twelve Step meetings have seen record numbers of people. I know that there was a meeting in my old hometown which used to draw a hundred or so people physically, who had over a thousand people attend a speaker meeting virtually. [Moyers nods] You know I've been able to attend meetings with friends in Chicago that I never would have done—

0:10:40 William Moyers
Right. [nods]

0:10:41 Bob Poznanovich
—Pre you know COVID because I wouldn't have been in Chicago or I wouldn't have been in their area where they're going to meetings. So, I think it's gonna be a change. I think it—I think it can't completely replace the face-to-face, I think there'll still be some of that connection, maybe that connection with a sponsor. So that there is some additional accountability. But I think for those who have transitioned into recovery virtual will be able to complement it really well. And then we—but we've also looked at what we've got in our continuum of care, William, too.

0:11:10 William Moyers
Mmm-hmm.

0:11:10 Bob Poznanovich
So even though we started at Hazelden, you know, 2018 looking at virtual care, and then 2019 piloting it, we've really looked—if you think about telehealth is the overall big environment, which includes not only virtual services which means delivering care live via video. But it's also digital resources, digital health—

0:11:32 William Moyers
Mmm-hmm.

0:11:33 Bob Poznanovich
—Solutions, content that's driven just one way on demand as opposed to bidirectional through live access. So you know since '09, 2009, you know, we've been moving—we moved digital content you know from—from our books and other literature—

0:11:52 William Moyers
Mmm-hmm.

0:11:52 Bob Poznanovich
—To the web. That was kind of early on. And then we moved all that content into an application called MORE.

0:11:58 William Moyers
Right.

0:11:59 Bob Poznanovich
You know which is an evidence-based continuing care recovery management tool that provided telephonic support as well. You know and we moved and integrated all of that into our electronic health. So first to the web and then into a stand-alone product and then into our electronic health system. And then we complemented that with apps.

0:12:18 William Moyers
Mmm-hmm. [nods]

0:12:18 Bob Poznanovich
—That we did as 27 different mobile apps that are available on the android and IOS platforms to support people.

0:12:25 William Moyers
Right.

0:12:27 Bob Poznanovich
And then there's thousands of hours and pages of content that's available through books, our bookstores, and it's available to consumers and not to mention things like our daily mediation and all the other resources that we provide free on our website. [Moyers nods] So, if you think about the complete continuum of care for telehealth, you know it's—it was a lot of digital resources that were available to individuals and families and communities via our web. A lot of it was available to our patients via now their electronic health record and other services. Some of that was just digital some of it was digital and telephonic. And now we've expanded all of those under a product family called RecoveryGo which is our organization's product family for our telehealth which is digital and virtual product solutions. For families, individuals, and the communities that we serve. Or, to support the providers that we also support. As they provide solutions to their families. So, if you think about the complete continuum to complement the lack of that face-to-face environment, you know we are now expanding not only into virtual addiction treatment but we are launching virtual mental health. So people will be able to get individual and group mental health services in all of our states and that will follow the states that we expand to.

0:13:43 Bob Poznanovich
[continued]
So, people could start if they needed to with mental health services to kind of figure out what's going on. That might be the beginning and the end of their road.

0:13:49 William Moyers
Right.

0:13:50 Bob Poznanovich
They might find that mental health transitions to a core issue which is substance use and they may transition into substance programs for, you know, virtually. They may transition back after substance use back into ongoing mental health support if that's needed. So we've got a complete continuum virtually for mental health before, during, and after treatment. And we're providing family support too now virtually. There is four or five groups a week that are offered free by Hazelden. In our Family Program to anybody in the community. Any community. Who wants to get education about the disease of addiction, how it impacts them, how it affects their loved ones, how they can support those recovering—

0:14:30 William Moyers
Mmm.

0:14:31 Bob Poznanovich
—And how they could also take care of themselves to make sure they get healthy. And that's been a great resource and that's another indication of success. Every week we are seeing record numbers of people attend those programs virtually. And far exceed the number of people that would have attended our brick and mortar programs.

0:14:45 William Moyers
Right. Right.

0:14:46 Bob Poznanovich
So I think we're able to help more people in more markets differently as a result.

0:14:50 William Moyers
And Bob what's been the Payer response? When I say Payer, I'm talking about the private insurance companies that people often times use their insurance to access our system of care. What's been the Payer response to virtual?

0:15:01 Bob Poznanovich
So early on, prior to the COVID, we had had Payer—some Payer acceptance and willingness early on. There were some that were hesitant. With COVID however, every one of our Payers has made policy changes that supported both intensive outpatient as well as partial hospitalization.

0:15:24 William Moyers
Mmm.

0:15:26 Bob Poznanovich
I would expect all of those to continue with that platform going forward for intensive outpatient. I think the other levels of care will be determined.

0:15:34 William Moyers
Mmm-hmm.

0:15:36 Bob Poznanovich
You know, we're in conversations with them. We just did a panel discussion a couple weeks ago. With our research analysts and some of our Payer partners to start talking about, you know, what does quality, legitimate, ethical care look like? And you know how—how do we bring the value-based conversation to virtual? 'Cause value-based really hasn't hit even outpatient, let alone virtual. I think we're gonna have the same opportunities here to show what good care looks like. And to help them define standards and measurements that'll continue to validate this. I also think that there's risk as we've seen in health care in general as well as the substance use industry for fraud and abuse.

0:16:17 William Moyers
Right.

0:16:17 Bob Poznanovich
And I know that the Medicaid, Medicare and others are already looking at how do we safeguard, how do we insure that we're getting legitimate care?

0:16:25 William Moyers
Mmm-hmm.

0:16:26 Bob Poznanovich
But we hope to be able to lead those conversations to kind of set a path. With the research that we're doing through the Butler Center of Research the relationships we have with our Payers. To continue to say this is what legitimate, high-quality, good outcome care looks like. How do we start building into discharge plans virtual as part of a continuing care plan post-COVID as well to say how do we continue to use the tools?

0:16:50 William Moyers
Right.

0:16:50 Bob Poznanovich
To continue to improve engagement. Which we know leads to better outcomes and I think we just have to show that. That it's working, patients like it, the outcomes at the same or better.

0:17:01 William Moyers
Mmm-hmm.

0:17:00 Bob Poznanovich
And I think we'll get Payer support. And I think we'll—the government support will also be interesting too. To see some of the restrictions that government has made both state and federal. To support this going forward. I know there's a lot of push right now to continue to make all of the concessions that were made permanent.

0:17:19 William Moyers
Mmm-hmm. [nods]

0:17:20 Bob Poznanovich
I think Congress is meeting this week to discuss what to do with it. I see the Governor of Idaho just identified that he's going, that they're going to continue indefinitely post-COVID all—removing all of the regulations that they had imposed. So we're hoping you know that that continues. I mean there's a tremendous upside—

0:17:39 William Moyers
Right.

0:17:39 Bob Poznanovich
—In this if they do.

0:17:41 William Moyers
We've got one minute. Last question. From your position as the Vice President of Business Development, the incredible work that you've done for a long time now to expand our mission into so many different markets, so many different audiences and demographics. From your position, since March of this year, and now we're into the end of June with the pandemic being what it is. What's been the biggest surprise in a positive way for you, you know from your perspective as the Vice President of Business Development?

0:18:15 Bob Poznanovich
I think there's two, William. It's a great question. Number one is how rapidly we were able to launch virtual services and how, you know, good we were at it. I think those previous months helped. But we really accelerated it and expanded what we had envisioned as a launch and how well our clinical teams did that. And how well that translated the patient engagement. And the fact that we've grown, consistently grown, our number of people that we're serving. We're ten percent higher, excuse me, twelve percent today.

0:18:42 William Moyers
Hmm.

0:18:43 Bob Poznanovich
Twelve percent more patients treated virtually in our outpatient programs than we had in our facility-based programs. I think that that's great. And the second one was the continued I think demand, value, of our brand for our residential programs. You know, we drew people from more states outside of the states that we're in, in May of 2020 than we did of April of 2019.

0:19:14 William Moyers
Wow.

0:19:14 Bob Poznanovich
So I guess the point is even despite the fear of travel and all of the consequences and all of the complications, people were still desperate for care and people really wanted good care. And they were more willing than ever to come to us. I think that really just showed the value of our reputation, brand, and our brand promise. And the hope that we provide people. And I don't think that would have predicted.

0:19:35 William Moyers
Well we've have to have you back on in six months or so and see where we are with telehealth and with our virtual care. Robert Poznanovich, the Vice President of Business Development, thanks for being with us today.

0:19:47 Bob Poznanovich
Thank you, William.

0:19:48 William Moyers
And thanks to all of you for joining us. Be sure to tune in again for another edition of our regular podcasts, Let's Talk. On behalf of our Executive Producer, Lisa Stangl, and our podcast team from Blue Moon Productions in the Twin Cities, we wanna remind you to stay safe and stay healthy in these times and all the time.