A quest for addiction treatment that works, and the data to prove it
First in an occasional series on breaking the grip of opioid addiction.
Colin Beatty and his family did everything they could to help his sister during her years of addiction to prescription opioids. Again and again, they sent her to top-dollar rehabs around the country.
She would get sober and come back home. Then she would start using again. In 2011, at age 44, Beatty’s sister took drugs one last time. The postmortem found five illegal substances in her system.
Seven years later, Beatty vividly recalls the fury and bafflement that accompanied his grief. How could this have happened? Especially, how could this have happened to the sister of one Colin Beatty, a health care consultant to some of Boston’s top hospitals?
And — most critically — what was he going to do about it?
Beatty’s answer to that last question was to create Column Health, a small but fast-growing company that aims to challenge the traditions of addiction treatment. Column opened its first outpatient clinic in Arlington in July 2015. Within two years, three more clinics sprang up in Brighton, Somerville, and Lawrence, and four more are in the works.
Column’s motto: “Addiction treatment that doesn’t suck.”
If ultimately successful, this scrappy start-up — whose business “cards” are shaped like poker chips — may have lessons to teach as Massachusetts continues to confront the opioid crisis.
Wearing his signature baseball cap and oversized horn-rims, the 46-year-old Beatty ticks off the ways he believes traditional addiction treatment falls short: Too often, addiction is managed as if a single course of treatment will solve it, when it’s actually a chronic disease. Too often, treatment centers are dirty, scary places where patients get kicked out if they “slip,” then resume drug use. Too often, there are no services close to where people live.
Beatty saw the state of Massachusetts, much like his stricken family in Ohio, pouring money into inpatient treatment in a system that seems to reward failure, as patients relapse after completing a program, then return for repeated, costly rounds of treatment. And he saw little accountability, no standardized methods for measuring results, not even agreement on the meaning of the word “relapse.”
Column Health joins a shift in emphasis in Massachusetts toward outpatient care and the use of medication in treating addiction. This year, for example, the state funded eight new programs in doctor’s offices to expand access to such care. Spectrum Health Systems, the largest treatment provider, recently added two outpatient centers, bringing its total to 13.
But Beatty has pushed ahead of the rest in this: He deploys electronic health records to hold his clinics accountable, with detailed tracking of how patients fare, and contracts with insurers that have financial consequences for his company if patients don’t fare well.
That experiment comes as specialists and policy makers are starting to talk about setting higher standards in addiction care.
For the longest time, “success” for a patient meant simply completing a treatment program, not staying sober afterward, said Susan Sered, a Suffolk University sociology professor who for the past decade has been following 47 women struggling with substance use. Sered saw the women time and again celebrated for “graduating” from a program, even as they soon returned to the streets and drug use. For years, she said, the talk at conferences was all about the need for more beds, with no discussion of whether the occupants of such beds get treatment that actually works.
“That’s starting to change,” Sered said.
Governor Charlie Baker, for example, has proposed legislation requiring treatment programs to show they can provide effective care as a condition of licensure. A group of addiction specialists, writing in the journal Health Affairs in January, called for “report cards” to guide consumers in choosing treatment that works.
After Beatty’s sister died, his family agonized over what had gone wrong. They had had every advantage. Colin’s brother was a Medicaid official in Ohio, his mother a psychotherapist. Colin had advised hospitals on finances, strategy, and technology. There was no shortage of money or savvy. His conclusion: The system was broken.
A key shortfall, he believed, was the idea that addicted individuals could be sent away for a month in rehab, often far from home, to have their condition fixed.
“You don’t usually relapse while you’re sitting by the pool in Malibu for 28 days,” Beatty said. “You relapse on day 29 when you’re discharged to your abusive husband, discharged to the house that was two doors down from the dealer. You struggle when you get back to the community where you struggled in the first place.”
Beatty dreamed of a program that would embrace patients as they returned to their community. He teamed up with Dr. Daniel R. Karlin, a psychiatrist he had befriended when consulting for Tufts Medical Center, and raised money from about 20 private investors, mostly friends and family.
In 2014, they bought a three-story house in Arlington, in those days painted green outside and smelling of chocolate inside. The building had served as a testing lab for an organic chocolate maker. Now it would become a different sort of laboratory, testing Beatty’s concepts on how to treat addiction. Column Health opened its doors in July 2015.
A few months later, a man named Jeff Gannon made his way to the house at 339 Massachusetts Ave. At first, he was flummoxed, looking for a typical clinic with glass double doors, surprised by a place that “looked like a family home.”
Gannon previously had gone for treatment at a crowded, graffiti-scrawled building where the staff seemed always in a hurry to get rid of him. They gave him a prescription but he hated going back every week to renew it. The place scared him.
After a relapse and a stint in detox, Gannon learned of Column Health through an online search. Inside, Gannon found a pleasant lobby with hardwood floors and a smiling receptionist who offered him a bottle of water. He started meeting with a counselor who over time uncovered his childhood traumas and diagnosed the anxiety and depression that underlay his addiction.
To aid his recovery, Gannon took a monthly shot of Vivitrol, a drug that prevented him from getting high on opioids. He continued that for a year. Today, Gannon, who is 38 and lives in Cambridge, takes an antidepressant, sees his therapist at Column once a week, and also participates in a weekly art therapy group there. He is working as a crossing guard and personal care attendant.
“Column Health is the only place that makes you feel like you’re human,” Gannon said.
Although Gannon opted for Vivitrol, most Column Health patients receive buprenorphine (best known by the brand name Suboxone). But Column is emphatically not a “Suboxone clinic.”
“You can’t come to us and just get a Suboxone prescription,” Beatty said. “The base of our program is psychotherapeutic. Sure, for some patients, medication-assisted treatment reduces the cravings. That does not do anything for the psychological aspects of the disease, for the trauma that almost always is underpinning the addiction.”
Kurt Isaacson, CEO of Spectrum Health Systems, said his agency frequently refers departing patients to Column. He appreciates that Column integrates all services under one roof; many other programs provide the medication but send patients elsewhere for counseling.
Virtually every Column patient has undergone detox or treatment somewhere else; Column is the next step toward staying sober long-term. The company now has about 1,000 patients, nearly half on Medicaid. (By comparison, Spectrum has more than 5,100.)
In addition to offering treatment known to work — combining medication and therapy — Beatty is trying other, smaller ways to create a healing environment, such as hanging original artwork on the walls and offering water bottles to everyone.
“The look of the place is very different than other treatment programs. It’s very welcoming,” said Mary Kowalczuk, manager of substance abuse prevention programs for the Cambridge Public Health Department. “They’re willing to engage people in treatment and keep them in treatment, and it’s done in a very respectful way.”
Arguably the biggest innovation at Column Health is one that can’t be seen — the role of data. Column tracks whether patients keep appointments, take their medications, progress through the phases of treatment, and report improvements in quality of life. And by working with insurers, it is able to find out whether patients run into trouble after leaving.
Column entered into a contract with Beacon Health Options, the company that manages behavioral health care for MassHealth, the state’s Medicaid program, under which Column has the potential to make or lose money if it exceeds or falls below target percentages on certain measures, such as adherence with treatment.
Such arrangements, known as “value-based contracts,” are common in other areas of health care, but not in addiction treatment. Column Health is the only addiction treatment provider in the country that has a value-based contract with Beacon, which manages the care of 1 million patients in Massachusetts and more than 30 million nationwide.
Jeremy Hastings, Beacon’s regional chief operating officer for the Northeast, said that Column is better than any other provider in the eastern third of the country at offering the critical aspects of treatment — medication, counseling, and life supports — “in a cohesive and organized way.”
And Hastings said he is happy with the results so far. From May through the end of November last year, he said, 145 patients were enrolled in the value-based program with Column. Of those, 138 continued to progress in their treatment.
Although some may start using drugs again, the company keeps them in treatment and works with them to get them back on track. Only three needed a higher level of care, such as inpatient treatment or intensive outpatient care. (The remaining four are no longer covered by Beacon and it’s unknown how they’re doing.)
Hastings acknowledged that the 145 initial patients are not necessarily representative of all people with addiction, but he said they are not pre-selected to succeed. These are just the first few to be tracked in a new system. Column said it continues to see only 2 percent to 3 percent of its patients take a severe turn for the worse. In contrast, the typical estimates of relapse rates six months after addiction treatment range from 40 percent to 60 percent.
Meanwhile, Column’s data accumulate. And, as the company grows, Beatty envisions that someday the data will answer deeper questions about which therapies work for specific groups of people. What type of psychotherapy proves effective for people whose addiction originated in childhood trauma, and what type for those who started with postsurgical painkillers? What works best for women or men, young or old?
“That’s where it becomes potentially very powerful,” Beatty said.