An Interview with Stephanie Strong, Founder & CEO, Boulder Care

Stephanie Strong is the Founder and CEO of Boulder Care, a value-based provider of medical treatment and long-term support for patients overcoming substance use disorders. Dedicated care teams collaborate across medical, behavioral, and psychosocial dimensions to deliver evidence-based telehealthcare, helping patients work toward their unique recovery goals. Millions of people have access to Boulder Care through leading health plans and employers.We originally sat down with Stephanie six years ago, near the beginning of her journey. Having accomplished so much since then, we thought it was time for an update…

Tim Gordon: The last time we sat together was the beginning of 2018, about six years ago. A lot has changed since then in theworld and at Boulder Care. How has the intervening period shaped the company to today?

Stephanie Strong: The world has almost entirely changed. Unfortunately, the opioid crisis, which was already a defining public health emergency in 2017, has only worsened since then. And we lost over a hundred thousand people last year.There’s 50 million people in America with substance use disorder, and afterCOVID, we’ve seen an escalation in mental health conditions and in social needs, like people losing their homes and jobs, and experiencing isolation. So, in many ways, the problems that Boulder was established to solve have only become more pressing.

The good news is COVID created widespread adoption of novel solutions like telemedicine. We need to take radical steps or risk losing an entire generation of Americans to addiction: and this outcome is  preventable. This represents an incredible opportunity for our mission at Boulder.

We were able to, in 2020, jump in and start seeing patients who were struggling int he wake of the COVID-19 pandemic and build trust and community at that critical time.

And by partnering with their health plans, including Medicaid plans, and being a safety net provider, that’s enabled Boulder to grow with partners who understand the outcomes and associated value that we provide — and increasingly, reimburse us for outsized impact.

We’ve treated over 12,000 patients. Our outcomes are three times better than the standard of care, despite treating some of the most vulnerable and sickest patients covered by Medicaid. And as of now, we are operating in three markets with incredible partnerships and care delivery outcomes, we’re excited to scale to our next several states and bring the solution to more people who need it.

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TG: Boulder has touched so many lives already, and the outcomes data that you have is really impressive. So can you talk a little bit about that impact and the difference you all are making?

SS: We've led with outcomes from the beginning. You remember having these conversations when we were building the care model, how much time and attention went into bringing the right clinical leaders, research, and peers with lived experience to develop a program that's truly evidence-based. And that's why we're so excited to see it pay off longitudinally. We have retention in care more than three times better than the industry quality benchmark and success on a host of quality of life metrics. We're seeing that patients are more engaged, they're happier and healthier and are reporting recovery progress greater than 98% of the time.

And we are also seeing the results translate into outcomes that payers care a lot about, like reductions in hospitalizations and emergency department utilization and in overdose and mortality. So supported by our research that we've now been proudly publishing and working toward, and by our partners and their claims data, we’re really heartened to see these pretty rigorously vetted outcomes metrics to let us know that we're doing the right thing for patients.

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TG: Obviously that data is compelling and clearly caught the eye of investors as evidenced by the recent closure of your Series C. But I'm sure not without some ups and downs in light of the market. What was unique about this funding cycle, which also is your third institutional raise?

SS: Actually, this is perfectly linked to your previous question. There was a focus on outcomes in this round that we didn't necessarily hear from investors in the past. I think the industry has flocked toward quality, recognizing that grow this not necessarily the most important metric when you're trying to create sustainable long-term value. Pairing growth with a real clinical model that has proven success is really key. That's been key to Boulder's story: to lead with quality and compliance and outcomes. And the market is now rewarding that. We had a very rigorous due diligence process that looked through all of our data and analytics, had customer references, looked at patient charts and claims data. And so to be able to pass that bar and be seen as a category leading company is something that our clinical and operations teams are really proud of.

It was also a round that let us seek investors who shared our vision and mission-alignment in serving a Medicaid population.90 million Americans are underserved, and there are really compelling trends inManaged Medicaid innovation. As you know, more and more health plans are responsible for patient health outcomes and keeping people well. But it's been a space that's been rather neglected by private investors. And I think there has never been more interest from the venture community and supporting companies that are tackling Medicaid problems.

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TG: You started to talk a little bit about the effect of COVID earlier. For a time, this epidemic was raging in the shadows and overshadowed by a global pandemic, which I'm sure created some additional challenges. What are some of the biggest challenges faced by the business over the last couple of years if not because of COVID, but in the postCOVID world?

SS: In a post-COVID world, there are a lot of regulatory changes needed to keep pace with the innovation that has been made possible by technology in healthcare. So there is, again, widespread adoption and acceptance of telehealth as an evidence-based way of delivering this care. But a lot of updates that need to be made are at a local and federal level to be able to support that. Boulder has been really active in helping to advocate for patients in bringing research and insights to the highest leaders at the DEA, for example, and to state and federal policy makers about the value of telehealth and suggested guardrails for how it can be done safely and effectively at scale. But this period of tumultuous change is one where there's a lot of uncertainty and it'svery dynamic. It leads us to be selective when we enter a new state and go one state at a time to ensure that there's no disruption to care. We put deep roots down in the community and get to know the provider landscape and other community resources and become part of a state's existing infrastructure. We are also very closely following the reimbursement environment and some of the other changes that are coming along with this new way of delivering telemedicine care.

We're also seeing patients who are struggling with a lot of needs that we can helpmeet. We've always talked about social determinants of health as an industry, but we're seeing it viscerally as people are not able to pay rent and are losing their housing, or are struggling to find employment. So by working withMedicaid and commercial plans to ensure continuous coverage, we've been able to help with some of the social needs by deploying case managers and peers who can help address them.

We’ve also partnered with Medicaid plans through Medicaid redetermination as folks are losing coverage and risking disruptions to their care. Boulder can be a continued link in keeping people engaged as the world starts to normalize again.

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TG: What do people typically misunderstand about this population and, and how has that hindered our ability, generally speaking, to get our arms around the problem?

SS:Considering that substance use disorder has been consistent across all cultures and generations since the beginning of human time, you'd think we'd know a lot more about it than we do! But in many ways we're just starting to gather really good data about what works in addiction medicine and for whom, and how to make those recommendations to patients.

There are very proven medications, which are vastly under prescribed and underutilized. Boulder is making sure that those medications are available to more people. And then there are ideological perceptions about people who are using drugs that must evolve. If we frame the issue as something related to that person's willpower or as them committing a crime, we'll continue societally investing in solutions that are criminal justice oriented and punitive rather than public health and harm reduction approaches that follow the medical science.. Boulder is very focused on ensuring that people have access to care and that it's the type of care that they can maintain.

If we are able to do that, everyone wins. It's a pragmatic solution that also hasa great return on investment. We are seeing people get into care, stay in care for months or years, and over time continually improve, while still only spending a fraction of what traditional rehab or other addiction medicine programs cost. So it's both clinically and economically viable.

TG: So as we switch gears just a little bit, you've always been thoughtful and deliberate about your approach to people and culture for as long as I've known you. What has worked well in getting Boulder to be the kind of place that clearly attracts some of the smartest and most passionate problem solvers in healthcare?

SS: We certainly attract people who are focused on mission, recognizing this is one of the defining public health crises of our lifetimes, and that one in three people have a loved one who's struggling. So, many people come to Boulder with a story either their own or with someone that they care about, and bring that empathy and compassion to our work. It's also a place where we really value outcomes and analytics. We talked about the need for research and practices, so folks that are passionate not only about helping the people in front of us, but changing the systems and policies that will allow for a sea change for millions of people. And it's a place where we see our frontline workers, those who are delivering direct care services, answering the phones, touching patients in anyway, whether it's billing or clinical services or peer support, we see them as customers, too. So the entire company is oriented around how we can make it easier not just to receive this care, but to deliver it. And I think that's an ideal place to start culturally for a tech-enabled services company in healthcare.

TG: Knowing that Boulder itself isa unique business in both how it's been built, as well as who it serves, what are some people challenges that maybe are unique to the business that you're building?

SS: I think hiring people with lived experience in addiction is very core to our mission. And a peer recovery workforce is relatively new in the industry. It's unfortunate that this workforce is neglected in traditional healthcare and there's not really a path for career advancement or leadership roles. And that's been an important part of what we do at Boulder. We also look to hire people locally who have a familiarity with the market communities that we're serving, the culture of the patients there, despite being a digital health provider. Developing a model around all of those kinds of paradoxical things is challenging but deeply rewarding.

We also think about how we can bring the best practices of a product-driven company to a very services-oriented model. How do you scale something that, by design, is high touch and tailored to every individual? It's an exciting challenge, but it's new, and requires a reverence for the patient and provider. What needs to be very high-touch, and what things can be automated and taken off of their plate? How can best practices be taught and trained in a way that lets us have a consistent culture and expectations around the quality of the overall experience? This will only become more of a challenge as we scale and grow our care teams. But it's one that I think all digital health operators are really drawn to.

TG: As you turn an eye towards the future I know you've got big plans. Where do you see this going? How has the vision evolved for Boulder?

SS: In the 25 pages from our previous interview, you probably saw a lot of the same themes. We're focused on making our patients feel empowered to achieve their own recovery goals and building the teams and the tools that they need to do that at scale. We know that there are millions of people who need treatment, so being able to grow quickly, expanding from three states to 10, to becoming a national provider. Partnering with Medicaid plans to ensure that these services are affordable, even to those who are very low income. And as we were just talking about COVID, with a lot of very targeted interventions and supports, we saw that curve start to go down. That has not happened with addiction for decades. We are still on an exponential growth curve. So success for Boulder means we start to see that go down, we reduce the number of overdoses and keep people safe, and then we continue to expand our suite of recovery services and comprehensive of support to make sure that we're treating the folks who are the sickest and most underserved and being the most trusted name in addiction medicine.

TG: Thank you, Steph. It’s always a pleasure to chat with you.

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