Digital substance use management platform Pelago announced it launched an inpatient Centers of Excellence network focused on increasing access to care, treatment completion, and cost reduction.
Pelago will use its substance use disorder (SUD)-focused digital front door to identify members in need of a higher level of care.
The company also employs a proprietary clinical vetting process to match members with the best inpatient facility for them, providing a transition to the facility. Upon discharge, the company provides offerings to continue to support the member to help ensure treatment success.
“With a proper clinical referral and care management pathway ensuring the right level of care, employers can realize higher rates of successful SUD treatment completion,” Dr. Yusuf Sherwani, cofounder and CEO of Pelago, told MobiHealthNews in an email.
Pelago works with its partners to drive in-network utilization through its insurance plan coverage to address the high cost of out-of-network SUD admissions.
“The goal is to ensure members receive the right level of care at the right time, and when a higher level of care is called for, refer them to thoroughly pre-vetted, high-quality centers of excellence,” Sherwani said.
Pelago vets each network partner using an assessment process to ensure the organization can deliver the appropriate care. This includes passing a proprietary outcomes and performance evaluation, meeting specific levels of accreditation, licensure, clinical results, and training and achieving best practices in quality metrics reporting and data sharing.
Pelago’s four assessment categories for network partners include care outcome and performance measurement, organizational accreditations and clinician qualifications, evidence-based treatment programs and data sharing and technology commitment.
Pelago uses its multidimensional assessment (MDA) approach combined with Prioritization, Assessment, Categorization, and Triage (PACT) to streamline the care pathway.
Assessment includes determining SUD diagnosis and severity, suicidality risk and current mental health and physical health.
“Our white-glove service that transitions the member to the facility includes, expedited access to care, access to Pelago’s concierge travel service, personal, secure release of information and documentation to the facility and care coordination with the patient’s primary care provider,” Sherwani said.
He explained that Pelago uses this personal approach to understand members and collect key details about the substance(s) they are struggling with and their stage of change.
“It helps in creating a person-centered treatment plan, care pathway, and upon discharge, continues to support the member to prevent relapse and readmission,” he said.
THE LARGER TREND
In the U.S., nearly 2 million people aged 12 and over are admitted to rehabilitation centers annually, with almost 600,000 of these individuals receiving residential and detox services.
However, a SAMHSA report found that 45% of those undergoing inpatient treatment do not complete their programs, raising concerns about the effectiveness of current referral and support systems.
Earlier this year, Pelago scored $58 million in Series C funding, which the company said it would use to conduct clinical research and expand its care capabilities. The round brought the company’s total raise to $151 million.
Pelago, formerly known as Quit Genius, is one of several digital therapeutics and SUD providers.
Bicycle Health is a virtual opioid use treatment company located in Boston, and Michigan-based Workit Health offers a virtual addiction treatment platform for substance use disorder and other addiction care.
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