Co-creating Patient Treatment Models Beyond Feedback with Dr. Lauren Grawert

Speaker A: You're listening to Health Innovators, a podcast and video show about the leaders, influencers and early adopters who are shaping the future of healthcare. I'm your host, Dr. Roxy Mooney. Welcome back to the show Health Innovators. On today's episode, I'm sitting down with Lauren Grorett, who is the chief medical officer at Aware Recovery Care. Welcome to the show, Lauren.

Speaker B: Thanks, Roxy. Thanks for having me.

Speaker A: It is good to have you here. So start off by telling our listeners a little bit about your background and what you've been innovating these days.

Speaker B: Um, yeah, so I am a physician by training and background. I'm actually an addiction psychiatrist. Um, so I did four years of medical school, followed by a psychiatry residency, um, and then followed by an addiction fellowship. Um, after that I served as the chief of psychiatry for Kaiser Permanente of the Mid Atlantic, um, for about eight years or so. And then last year came to become the chief medical officer at Aware Recovery Care, um, which is an organization that does in home addiction treatment. Hmm.

Speaker A: So what does that look like? I don't think I've heard of that before.

Speaker B: Yeah, so if you imagine in healthcare there are other fields where, um, providers will go into the home to provide more individualized, comprehensive care. Um, so we've kind of taken that idea and applied it to the addiction field, um, really to try to address addiction treatment from a whole person perspective, um, and also address family as well. So, you know, we know that addiction is a, it's a brain disease with behavioral manifestations, but it also affects everybody around the person who is suffering from the disorder. So we send a multidisciplinary team into the home. And when I say home, sometimes folks will choose to meet us at a bowling alley, at a skating rink, at a Starbucks, wherever they want to meet. And, uh, work on, um, relapse prevention skills, recurrence prevention skills. We give folks a case manager, a therapist, a family therapist. We have a medication component as well, and really just a holistic approach to addiction treatment.

Speaker A: So I'm just curious, um, is that help overcome. I don't know if I would say stigma, but I'm just going to say stigma, ah, around going to a treatment center and kind of being more inpatient. Um, is this to kind of like be able to capture some of that audience that might not go to an inpatient facility?

Speaker B: Yeah, I mean, that's one of many reasons. And actually, I think the word stigma is the correct one to use here. You know, unfortunately, in our society there's still so much stigma uh, around addiction treatment. And honestly, a lot of misunderstanding. Um, we know that only about 10% of folks who have a substance use disorder end up seeking treatment. And that's for a lot of reasons. But some of it is, um, uh, anonymity, you know, wanting to have more anonymous treatment. Some of it's wanting more personalized, individualized treatment. Some of it's financial reasons. You know, inpatient facilities can, um, be pretty costly and sometimes out of financial reach of most people. Um, and I would say the other reason probably is that, um, you know, lots of people cannot go inpatient for family reasons or employer reasons. Um, and so this allows people to have treatment m who might not otherwise be able to because of other life responsibilities.

Speaker A: Yep. Okay, so one of the things that we do on this show is we talk about, you know, not necessarily the sexy tech, um, although that's part of it that comes up sometimes, or you know, the tools and the solutions that are being innovated. But, ah, we really like to dig deep into that commercialization journey. So that way, you know, from founder to founder, leader to leader, you're sharing. Um, you know, how do you build something out of nothing in today's market, um, especially going through the complexities of, you know, the healthcare ecosystem. Uh, so let's just talk a little bit about the origin story and um, where you are today.

Speaker B: Yeah, great, great question. So Aware was actually founded in 2012 and I can't take credit for it. Our founder, um, was a really, really smart guy who had been working in the pharmaceutical industry, who was in recovery himself from alcohol and, and had asked some painters to come over to his house to paint. And so the painters were there and the painters incidentally were also in recovery as well. And so our founder, super nice chatty guy, they started talking and he started saying, you know, um, in the painting industry, you guys come to me, um, why can't that be the same in the addiction treatment industry? Why can't we have people come to the person? We always say in medicine we meet people where they're at, but, uh, we don't really physically meet them where they're at. And so they got to talk and they were like, yeah, why does that exist? Well, it should exist. Um, which is where the idea was kind of born with these painters and this, um, really smart, funny guy in recovery himself. Um, so he started talking to others, got the idea off the ground. We have a value based care arrangement with payers, um, which is really nice because, um, you know, it's not chopped up with A fee for service type schedule. Uh, but that was the genesis of it was, hey, why doesn't the addiction industry have something that every other, um, sector really has where people come to you? Um, it kind of took off from there.

Speaker A: Wow. 2012. It's kind of before the home health movement. Really.

Speaker B: Yeah, yeah, it really, I mean, yes, it really kind of predated that. I would say the infancy. Um, we really saw a huge growth during COVID Um, I think that was a great time to be an in home, uh, organization because it was the first time in medical history where there were real legitimate reasons that most people could not do in person or, um, inpatient treatment. Um, and so we were really able to reach a lot of folks during that time. Um, and we're still able to reach folks who are looking for a personalized, comprehensive, um, addiction treatment journey. Um, that is chronic. You know, that's the other thing we know that addiction, it's a chronic disease. Um, it's different from getting pneumonia. Where you get pneumonia, you go in, you get a medicine, you're better, you leave. It really does require lifelong care. And so we really embrace that model and help folks along the way for a journey. And as they finish our program, we also get them ready to uh, be connected to community resources so that they have that support when they leave our program as well.

Speaker A: Yeah, there's a lot of innovation happening in this space. Um, so what are some of those commercialization milestones that you can think of that the company's achieved over the last 12, 14 years?

Speaker B: Yeah, I would say, um, probably getting our first major payer contract was a huge, um, milestone. Uh, we work very closely with, um, Anthem, um, also known as Carillon. Um, they've been a great supporter. So that was huge. That really helped to take us to the next level. Um, ah, so that was probably the first major one, I would say, um, expanding to other states was really big for us as well. The founder, um, is from Connecticut, um, Wallingford, Connecticut. And so as we got this um, large national payer contract, we were able to strategically reach out to states that have large, um, uh, Anthem members, um, and had a partner among others to kind of help us, guide us to where kind of those folks were. So yeah, I'd say the payer contract was big, um, the expansion into other states. We went from four states to 12 states and in about two years time. Um, so those were some of that, I would say the big things.

Speaker A: Um, how long did it take you to get your first payer contract?

Speaker B: Oh, gosh you know that's a great question that predates me

Speaker A: in healthcare, right?

Speaker B: Yes, yes. I would say if I'm guesstimating probably two years or so. Um, so the challenge I think is um, as you said there's a lot of choices in the addiction treatment industry. So there's a lot of um, I guess vendors for more or less that payers can choose from. But the other thing is I would say um, to healthcare innovators probably well know that um, negotiating a value based care contract um, is very challenging. It's like the unicorn of healthcare. We all talk about how it's the way healthcare should go and it's the right thing for the patient and all that's true. But it is so much more challenging to um, negotiate that rather than a standard fee for service where you know there's CPT codes that are already there. But I think it really shows our commitment to um, approaching addiction treatment in a way that truly is best for the patient. It's way more work on the front end. Um, but it really is um, the best kind of treatment for the patient. Um, so, so that's I would say one of the. Coming into the role, one of the most challenging things that I underestimated was just the complexity of a value based care agreement and the time it takes and the individualization. You know, again like there's no CPT codes for that. So you have to kind of come up with that and work with large payers kind of in a way that's going to be synchronous.

Speaker A: And would you say that, you know um, in my experience developing that contract is there's a huge finish line when you finish um, that right when you get everything signed and ready to go. But in many ways it's also the start line and there's a lot of management um, right. Um, to make sure that everybody's getting the value in the ROI out of the program as well.

Speaker B: 100%. Yes. I think you phrased it perfectly. It is the starting, it is the finish line and the starting line, um, particularly um, in healthcare as we move more towards measurement based outcomes and measurement based care, um, which I also am really excited about. I think it's high time we move that way. Um, it helps keep uh, treatment providers um, accountable but it also involves another lift in terms of the technology and the departments for an organization to have to be able to produce um, that kind of data on a mass scale. So um, that I think is a good way healthcare is going. Measurement based outcomes, um, and at the same time also is something that takes more time, you know, internally to develop.

Speaker A: You touched on something that I think is really interesting is just the power of networking. I think often that is something that's overlooked, maybe perceived as kind of a nice to have in the commercialization journey and not necessarily a must have. Especially when I'm working with technologists who are very much product focused, um, who maybe aren't active on social media at all. Like that blows my mind, right? Like I don't even have an account or I have an account but I haven't touched it in 10 years, you know, um, and aren't thinking about how they need to be building that community and that network just as much as they're building in new features and functionality to the product. Um, because it's a lot harder. I mean if you are trying to do that only when you need something desperately.

Speaker B: 100%. 100%. I mean I look at every as a, as a physician and a business person at the same time. Every opportunity as an opportunity to talk about aware. Um, I think a great example. I do a lot of medical writing, medical advocacy, um, addiction literacy, um, and I always think of that through the lens of helping with addiction literacy but also increasing brand awareness. Um, and so I think there's so many ways that you can do that and the more creative and non traditional you are, the better for sure.

Speaker A: Yeah, absolutely. Trying to break through the noise, right?

Speaker B: Yes.

Speaker A: Uh, um. So what would you say is the number one commercialization strategy that's um, been. That's led to the success of the company?

Speaker B: That's a great question. And um, I was thinking about this, you know this, it's this idea before we started talking. Um, I would say this is going to sound, at the risk of sounding inauthentic, um, authenticity, um, meaning that we really, I mean every single interaction that we have as an organization is really genuine and really, really, really patient focused to a degree that I don't think you see quite so much in traditional addiction treatment. Um, particularly, I mean, I'll give you a good example. This past two years we've really put a focus on harm reduction, um, approaches and moderation management. And so that means people whose goal is not necessarily to be sober, um, but they want to cut down their drinking, let's say. Um, and so we really try for our message to be authentic, um, to be what is best for the patient and from the patient's perspective. Um, so it's not like saying, you know, Dr. Lauren says this is best. We go out and talk to patients. We talk to our patients, we do surveys, we say what would be better, what should be different, what should addiction treatment look like? And then we try to be some of the first people to really start talking about that. Which I think has resonated with a lot of patients in a way that other traditional addiction treatment, um, doesn't necessarily talk about.

Speaker A: Yeah, um, that touches on something that we do talk about a lot on the show. Um, is this idea of kind of co creating the company and the solution, um, the experience with the customer and not doing that for a project. Um, like we're going to do that for the next 12 weeks and survey them and ask them what they want. But it's something that that feedback loop kind of becomes part of the DNA of company and we've woven into the fabric of the company. And it's just what you do where you're always staying in connection with the customer. Um, so that way you're able to anticipate and witness those shift in needs and desires way before the competition.

Speaker B: Yes, yes. And I always tell folks like, assume you never know enough about your customer or patient. It's impossible to know too much. Like I'm always searching for what are things that people are looking for in addiction treatment that we're not talking about yet, maybe that are taboo to talk about. Um, and so yes, I think going into your organization or your business with that perspective of uh, to be hungry to know more about the customer patient experience is so important. And also where I see people struggle, um, organizations struggle who um, are not listening to the patient perspective or who say they are. Um, but maybe the, the words uh, aren't matching the action, you know?

Speaker A: Yeah, yeah. You know those patient centric organizations that have never had one real conversation with their customer except for the business that's being done.

Speaker B: Hundred percent. Yes, yes. Yeah, yeah.

Speaker A: Um, or when they are, all they're looking to do is just validate their assumptions and biases. They're really not on that factory finding mission that you just described where you're truly seeking out of like, what can I learn new that I don't already know?

Speaker B: Right? Ah, yes, yes. That's super important as well. Like going into it, being humble enough to say if I find out some stuff that's helpful that that necessitates change, I'm willing to make that change versus continuing to search for the answer that I already believe and endorse. Yes, exactly.

Speaker A: So what's next for aware? Where are you guys going from here in 2024? And beyond.

Speaker B: Yeah, well, we've recently added virtual, um, products, um, virtual medication assisted treatment, um, virtual psychiatric med management. And what I'm most excited about because nobody else in addiction is doing this virtual detox. Um, so we do completely virtual detoxes for, um, mild to moderate alcohol use disorder, mild to moderate opioid use disorder. There are lots of folks in the, in the, this ecosystem that are doing opioid treatment. Um, but I don't know of a single organization that's doing alcohol, um, detox, virtual. And so, um, I'm really excited about that. It opens up, um, care to so many people. And what's that like? Yeah, so, yeah, somebody asked me, um, not too long ago, they said, you know Lauren, there must be a reason nobody else is doing it. Why is that? And I said, yeah, well, because medicine is not risk free. I mean alcohol withdrawal, we know can be life threatening, um, it can cause seizures, um, it can cause delirium tremens. Um, so most healthcare providers, if you're not really highly trained in addiction treatment, they're gonna err towards just admitting every single person. But the reality is that about 88% of patients who have physical withdrawal symptoms from alcohol can safely do an outpatient detox. Um, we ask that patients have a blood pressure cuff, um, you know, the kind you just like literally press the button so we're able to get vital signs. Um, there are standardized criteria that we use. Um, one's called a CIWA scale that measures the intensity of their withdrawal. And we do have a pretty comprehensive, um, screening process. So we do a 90 minute screener, um, upfront to make sure that they don't have medical conditions that really exclude them from, from this level of care. But, um, those are the basics. It's, it's a seven day program. Um, you meet with a nurse practitioner, um, who is specialized in psychiatry and addiction. On day one, um, we come up with a medication plan. Then we have ah, six more days in a row where we meet M, we're meeting on camera with the person to see how their withdrawal is going. We, we can tweak the medication, um, journey if we need to, um, and then on day seven, they complete that program and some people will continue on to just do outpatient med management with us. And other folks say, you know what, I'm good, I'm feeling better, I'm jumping back into work, see you later. And we also say that's okay too, um, which I think also makes us different. A lot of people would say, no, you have to stay in treatment, we really try to honor patient, um, autonomy and agency in this whole process, um, and kind of let them lead the journey while we're holding their hand along the way.

Speaker A: Yeah, I can think of so many personal stories that come to mind, and I wonder if, um, you hear that often, you know, in the work that you do, whether you're at, like, a cocktail party or, you know, a group dinner, you know, when people are just having that casual conversation of, well, what do you do for a living? And you start to tell them about aware and the work that you're doing. And, you know, I wonder if everybody has a story of, oh, I wish so and so would have access to this, um, or I know someone or someone's that need access to this.

Speaker B: Yes, 100%. It comes up all the time. You know, people saying, oh, my sister would benefit from that. She doesn't have the money to go inpatient. Or, um, gosh, my brother's been struggling with work because he's oversleeping and struggling with alcohol, but he can't miss work. Um, we had a great example, really lovely patient who, um, went inpatient for alcohol withdrawal, um, got, um, treated inpatient, but found out while she was there that she was pregnant. Um, and so she. When she was discharged, she was really struggling to find an outpatient provider who was going to assess her and be comfortable continuing medications for alcohol, um, and pregnancy, continue mood medications during pregnancy. But she absolutely had to have an outpatient provider because she needed to continue work to have health care benefits. Um, so, I mean, that's just one example. She was a perfect fit for our program and has been able to maintain sobriety during her pregnancy. She's on medications now for depression, which has also improved her stability with sobriety. And because we have family therapist, she has a much better relationship with her mother. Um, so we've had lots of sessions with the mother and the grown daughter and trying, um, to strengthen that relationship before this child comes into the picture. So, just like you said, there's so many examples of folks who need, um, addiction treatment and often really want. Want it, but can't for a variety of reasons. And we're just trying to break down as many of those barriers as as possible.

Speaker A: What's interesting is, I don't know if you'll agree or disagree with this statement, but it almost seems like it's more cool than ever to be sober. You know, you have Drew Barrymore, you have Katy Perry, you have all of these different celebrities that are coming out and speaking, um, about their Struggle and their position on sobriety. Um, you know, I Scroll on TikTok and there's people that are doing like, I don't even know what they call it, but like alcohol coaching, like coaching people into not drinking. Um, I mean, just, uh, alcohol buddies. Again, you're not somebody that you go drink with, but there's a better phrase for it. But, you know, like this organic kind of partnering of people to try to, you know, have a partner that's helping you in that. It just seems like it's a lot m mocktails that just seems like there's a lot of trends that make it not, um, easy, but easier, more cool or accepted to kind of move into this direction.

Speaker B: Yes. And that's how I would summarize it. Not easy, but way easier. Um, the, the Sober Curious movement, I think is one of the greatest things to come to addiction treatment. Um, you know, we know that, um, almost any level of alcohol, even if it's in what's considered, um, safe, which is, uh, less than three drinks a day for women. Um, less than four drinks a day for men. Even if you're in that category, it still has elevated risks of cancer. Um, it still has elevated risks of dementia. Um, it still has elevated risks of all kinds of things. And so, um, the Sober curious movement, I think has been great because it offers folks, um, an avenue to have their journey be whatever, be whatever they want it to look like. Um, the mocktails are great too. Um, um, I will say my. So, like, fair disclosure, I don't have a substance use disorder, but all this information that has come out about alcohol over just the past couple of years has really, like, made me rethink how much do I want to drink.

Speaker A: Right.

Speaker B: Particularly it increases, you know. Right. I mean, it increases the risk of breast cancer by 15%. Uh, I'm sorry, 15 times. And so being somebody who has like a mother and an aunt who's have breast cancer, I, um, have been searching for, for mocktails. And there's all kinds of great ones out there. Um, my favorite one, Free af. Ah, Free af. You can guess what the AF stands for. Um, it's a woman owned company. It's got really cute, um, bottling. They've got every flavor you could think of. And, um, that's my current favorite one. But there, as you said, there are so many out there. I think it is. That is one of the exciting things about addiction treatment now is there are,

Speaker A: as I read and study a lot about brain health, um, just personally, um, as well as longevity, like there's always this heightened, um, awareness and insight into, like you said, it might be normal, it might be very little. But I'm also reading and understanding how it affects my brain and my health span. And I'm like, maybe I don't want to have that glass of wine with dinner. You know, maybe I do, maybe I don't. You know, just. Yeah, exactly.

Speaker B: I will say too, like. So I just got back from the American Society of Addiction Medicine. They had their national conference, um, about two months ago. And, and there's a section where we go over all of the most, um, the most googled or the most read addiction research studies of the year. So in 2023, the most Googled and most read addiction study was one that was done in Europe, um, showing that with some pretty compelling evidence that that whole notion that like one, you know, one red wine a day is healthy actually is really a, ah, fallacy. And the health, the longer living, um, that was in those original studies was more so associated with socioeconomic class. Um, so people, if you think about it, let's just say like, women drinking red, one glass of red wine a day, tend to be in higher socioeconomic classes and that correlates with better health outcomes. Um, not necessarily the one glass of wine a day. And it was a huge news. Like, none of us, including me, knew that or realized it, but it makes a lot of sense when you think about it now. Um, yeah. So.

Speaker A: Yeah, well, menopause also has me rethinking it because it doesn't blend well with menopause.

Speaker B: Sure. Yeah.

Speaker A: It's like, you know, you don't want to necessarily have that glass of wine again because you're going to have hot flashes tonight and it's just going to make it worse.

Speaker B: Totally get it. Yes. Yes. Oh, my goodness.

Speaker A: So, Lauren, thank you so much for joining me. As we wrap up, is there anything else that you would want to share with fellow innovators out there that might be listening to this episode?

Speaker B: You know, I would just say, like, as an innovator, um, if you're a specialty in a subject matter and you're looking to develop, either develop or take your organization to the next level. Um, trust your gut. Trust your gut. That's my main advice. Because oftentimes, you know you're going to get noise from every single direction and every person has an opinion. It's just like, like a nose. Everybody has one. Um, but if you are in a field where you're a specialist and you've had a lot of experience in this field, and you're truly listening to all of the patients and consumers around you. Um, trust your gut because you can't go wrong, um, going. Going into a healthcare field with that perspective.

Speaker A: Yeah. Awesome. Um, thank you again. Uh, how do folks get ahold of you if they want to reach out to you after the show and learn more about awareness?

Speaker B: Yeah, so I'm on LinkedIn. Um, Lauren Grauert, you can find me there. Um, I have a weekly newsletter I put out that's just on general addiction topics. Um, so LinkedIn, our website, awarerecoverycare.com has more information about our organization and the addiction treatment services. Um, either one of those are the fastest way. And if you Google me, There's lots of YouTube videos of me talking about, um, addiction treatment, Suboxone, alcohol. So, um, yeah, we're out there.

Speaker A: Not difficult to find you, right?

Speaker B: That's right.

Speaker A: Uh, all right, well, thanks for joining me on the show today.

Speaker B: Thank you so much, Roxy. Have a great day.

Speaker A: Thank you so much for listening. See you on the next episode of Health Innovators.