When Pinnacle Treatment Centers acquired California-based Aegis Treatment Centers this year, it gained 10,000 patients and 36 opioid treatment programs (OTPs) in its expansion. This move meant Pinnacle, based in New Jersey, now had a presence on the West Coast. Unbeknownst to staff and patients, of course, was that the transition would be accompanied by the coronavirus pandemic which drastically altered service delivery nationwide.
“We took a very aggressive and forward-thinking process” for the pandemic, Pinnacle CEO Joe Pritchard told AT Forum. “We formed an executive-level task force, we worked with regulators to make sure our procedures provided for better accessibility, including expanded take-homes,” said Pritchard. Some stimulus funds (CARES Act) were also made available for PPE, including making sure the shipments would get through quickly. “We created a PPE supply chain within our organization,” said Mr. Pritchard. “Right now we have warehouses where at any time we have six months’ worth of PPE for our entire network.”
Pinnacle also instituted a daily communication call, and has a weekly town hall with all staff. And it established a “self-care” program for all employees who want it.
For patients, 85% of counseling was moved to remote, so Pinnacle bought more computers, he said. “IT teams made sure the infrastructure” for counseling was in place. Counseling hours have been maintained, and in some cases, increased. Most counseling is provided remotely, from counselor’s homes.
Some patients, based on their stage of induction, do have to come into the clinic, said Mr. Pritchard. “We stabilize new patients for at least 30 days,” he said. “They might get one day of take-homes.” If patients aren’t stable enough for even one day, Pinnacle arranges to treat them, even though some clinics are closed on Sunday.
Pinnacle also monitors patient and staff COVID cases within its network.
There was only one disruption of care – a residential program in Indiana, around the end of March, for one week. Residential programs operate 24 hours a day, 7 days a week, with staff, nursing, and all clinical support, except for that one occasion.
Pinnacle, which now provides treatment to 30,000 patients, 29,000 of whom are in OTPs, is also expanding its sober housing programs, with additional beds in Indiana, Virginia, Ohio, and Kentucky.
How does Pinnacle decide whether a patient is stable enough to get 30 days of take-homes, or falls into SAMHSA’s vague “less than stable” category which would allot the patient 14 days, or needs to come in more often? “It’s simple – we look at what’s in the best interest of the patient,” said Mr. Pritchard. “We have specific guidelines for take-homes,” he said. “The patient has to be medically stable, and it takes a long time for someone to get to two weeks” of take-homes. The point of more take-homes was treatment access without jeopardizing the safety of the patient, but patient safety relates to methadone too, said Pritchard. “The federal guidelines have given us the ability to work within a broader framework, but it’s always our responsibility to treat the patient first.”
As for whether a patient gets methadone or buprenorphine – or naltrexone, for that matter – COVID hasn’t changed Pinnacle’s decision-making, said Pritchard. “All the FDA-approved medications are excellent, but you have to look at the individual, the history, the support network they have, and make the decision based on all those elements.” Having more access to buprenorphine, for example, is good, but “that doesn’t mean buprenorphine is best for all patients.”
In fact, some patients have come to Pinnacle clinics since COVID started because the office-based opioid treatment (OBOT) program – most likely a private physician’s office – closed. Another reason is overdoses and problems with drug supply. “We’ve had more than 600 new patients in our census since the pandemic started,” said Pritchard. “We can relate that directly to changes caused by the pandemic – people are unable to maintain their active addiction on the street because they can’t get the drugs, pain management patients are ending up in treatment because they can’t get medications and are withdrawing, people are overdosing and relapsing,” he said, adding he has heard similar stories from other OTP providers.
Acquisition + COVID = “Perfect storm”
The transition for Aegis patients and staff to Pinnacle management took place at the same time COVID hit. “You can imagine that perfect storm,” said Pritchard. Alex Dodd is staying with company, as is senior staff, and clinics will still bear the Aegis name, which always helps during a transition. “Aegis is a well established well regarded program,” he said. “They had a platform in place that allowed them to stay focused on their primary mission” before the acquisition.
“We’re fortunate because our philosophies are very much aligned,” said Pritchard. “We were very engaged in cross-functional activities, such as integrating day-to-day employee management as well as patient management,” he said. “Those activities were well under way before the pandemic,” he said.
“Many of us have gone through other crises – 9/11, Katrina, earthquakes, floods, fires” he added. “We’re on top of this.”