Best Practices: Suntra Modern Recovery

The co-founders of Suntra Modern Recovery on offering modern and accessible addiction recovery care.

Jean-Luc Neptune, MD, and Adam Banks, CARC, met for the first time while indoor skydiving, but they soon bonded over their mutual interest in innovating around addiction recovery care. Their new venture, Suntra Modern Recovery, offers at-home and virtual-based care to those with substance use disorders. Read on to learn more about how they both found their way into the addiction recovery space and why they believe accessibility and human interaction are the keys to effective and scalable care, more so than ever in light COVID-19

Jean-Luc, you were one of the first few people to test positive for the COVID-19 in New York State. Can you share any insights from your personal journey, especially given your perspective as a physician?

Jean-Luc: The last few weeks have been quite an experience. I was exposed to someone with COVID-19 at a conference on March 7th and have spent the past several recovering from my illness. Oddly enough, the theme of that conference was “The Future of Telemedicine” and it’s amazing to me how important telemedicine has become in just the last month. Thirty days ago, we were talking about how difficult it’s been to offer telemedicine because of regulatory and reimbursement hurdles. In a matter of weeks, however, we’ve seen that change as telemedicine has become a necessity. Payors are now offering broad-based reimbursement for virtual care and the government is streamlining regulations to make telemedicine easier to access.

As a patient, I was required to interact with my own doctor virtually because I was in quarantine, and I found that I was able to access high-quality care via televisit. As a provider, for Suntra Modern Recovery, I found that even though I was stuck in the house and coughing non-stop I was able to work with Adam to provide support to our substance use disorder patients. In addition, because I’ve done so much research on the coronavirus, I’ve become something of an expert on the topic and have been able to share my knowledge with friends, family, and members of the Suntra Modern Recovery community.

The COVID-19 pandemic has been a really traumatic experience for many of us, but I think it’s opened our eyes to the different ways we can deliver care.

How did each of you end up working in addiction recovery?

Jean-Luc: I trained in internal medicine at Columbia Presbyterian Medical Center, during which time I saw the effects of the drug epidemic firsthand. This was right around the end of the crack cocaine epidemic here in the US, so as a resident I was exposed to the challenge of addiction and was able to learn about the societal and personal costs of substance use disorders. Unlike others in this space, I don’t have a personal history with substance use disorders, but my medical training in the Columbia University system opened my eyes to the challenges that we face in treating people with addiction and the reality that a lot of what we do as practitioners doesn’t actually work.

I’m drawn to addiction recovery because I think there’s a huge opportunity to apply more scientific rigor in how we treat patients and deliver care. There are many evidence-based treatments, like MAT (medication assisted treatment), that are not being widely used and that we can make more available. There’s also much we can do in terms of accessibility and affordability–using at-home and virtual care–that will allow us to reach the many, many people who are not in treatment now.

Adam: Unlike Jean-Luc, I’ve had a very personal journey with addiction recovery. I’m twelve years sober, went through a traditional 28-day residential treatment center, and continue to be dedicated to a 12-step program.

While residential treatment (“rehab”) and 12 steps worked well for me, I work with people in all different phases of recovery and hear their objections to traditional approaches. The most common objections that I hear involve time and money. Specifically, most people who want to access treatment simply can’t go away for four weeks because of their family and work commitments. In addition, the high cost of residential treatment (as much as $40,000 per month) can be a significant problem given that much of this spending is out-of-pocket. These barriers prevent people from starting care, and Suntra aims to be the easiest onramp to accessing addiction treatment.

I’ve thought a lot about how I can help the largest number of people and how I can help make recovery more accessible and affordable for everyone. This is an exciting time in that the treatment theories, science, and medications are rapidly changing, offering new solutions in this space.

How did you two meet?

Jean-Luc: I used to run the accelerator program at Blueprint Health, a digital health accelerator that was formed in 2011. Over the course of five years, we invested in dozens of digital health companies that were using technology to improve healthcare in some way, shape, or form.

Though my primary background is as a physician, I learned a lot in that role, both as an investor and as a technologist. I learned about how technology could be applied in a bunch of different ways, including addiction treatment. In fact, I’d argue that seeing what was possible in regard to technological innovation in the medical space at Blueprint rekindled my interest in addiction and how we can use technology to help people.

Adam was a member of Blueprint’s community of mentors and advisors, and soon enough, we were introduced to each other–skydiving, no less–and got to talking about things we liked. We realized that we had a lot of common interests and have been working together ever since.

How did you decide to start Suntra Modern Recovery?

Jean-Luc: In my heart, I believe addiction is the single biggest unsolved problem that we face in healthcare today. In terms of the costs associated with addiction–be they direct (medications, hospitalizations, etc.) or indirect (society, families, employers, etc.)–addiction is right up there with cancer, diabetes and heart disease. Despite this reality, we believe that addiction treatment is still very much a cottage industry with a highly fragmented universe of providers offering point solutions that often don’t even work.

Suntra Modern Recovery is a personalized recovery solution for people with substance use disorders featuring expert medical doctors, home-based and virtual visits, and research-proven recovery medications. Our service is designed to assist patients wherever they are in their recovery process. We can perform an intervention for patients who need help understanding that recovery is an option. For patients who need to be detoxed from a substance, our team of expert providers can help with an effective home-based program. After someone is stabilized, we can manage medications like Vivitrol and Suboxone to help sustain recovery. Finally, when someone is ready to return to work, we can support them with aftercare services, such as coaching and case management.

At the end of the day, our focus is on delivering a solution that can help people who are dealing with addiction to continue working and to also maintain their other responsibilities of life, including the family and the home. We want to help people who are often at their peak earning years to avoid missing even a single day of work, which obviously helps them and their family, as well as their employer who bears the economic cost of addiction through increased sick days, lowered productivity, etc.

Adam: The work that we are doing in recovery is by far the most rewarding work that I’ve ever done in my life. It’s no secret that we’re living in an era of serious crisis in regard to heroin and opiate addiction, but other substances like alcohol are a problem for even more people. Fortunately, there are a number of incredible medications available to help people recover. For example, we can take someone from full-blown opiate addiction and get them started on Suboxone in a matter of hours. To see the change in someone who’s been playing Russian roulette with street drugs just by starting medicated assisted treatment is astonishing. A person can go from seeking out illicit drugs every few hours to a new commitment to their family and work with a stabilized life.

Our approach to recovery is to literally meet people where they are physically, mentally and quite possibly, geographically. Addiction treatment has traditionally been very paternalistic. Someone tells you what to do, and you’re expected to do it. We realize that not everyone is on the same path–some people want full abstinence, while a lot of others are on a “sober-ish” path. There are ways to help anyone that wants to reduce their consumption.

The hardest part about recovery is making the first call–the proverbial call for help. At Suntra we have made it easy to begin treatment, just send us a text, and we will quickly help you develop a recovery plan.

Tell us more about why accessibility is a key component to providing effective addiction recovery care. How does Suntra Modern Recovery approach this?

Jean Luc: The 28-day residential treatment program is the “dominant design” in addiction treatment. This approach was pioneered in the 1950s at the Hazelden Clinic in Minnesota and there’s been relatively little innovation in this space. It is still very common for patients to seek out care hundreds of miles away from home, where they’re completely disconnected from their “real life” situation.

Our focus is on providing a solution that’s more convenient, more acceptable, lower cost, and more in context with the life of the patient. We’re seeing a huge movement toward home-based therapy, and we’re lucky to be a part of the vanguard of organizations working in this space. There’s also a big virtual component to our care at Suntra Modern Recovery. Both of these elements allow us to provide accessible care, regardless of the patient’s ability to come to the doctor’s office.

In addition, we’re very focused on using technology to deliver other parts of our service. We work with Capsule so that we can offer accessible medication without requiring patients to visit a pharmacy, where many things often go wrong, like receiving the wrong prescription, registering the prescription with the inaccurate co-pay, or waiting too long for the prescription to be filled.

We’re committed to providing outstanding clinical care and an amazing customer service experience, and we believe that the way you do that is by rethinking how care is delivered now and taking a different approach.

Adam: Using telemedicine has been a great answer to the accessibility problem. Telehealth enables us to provide services in non-traditional ways, particularly to people who can’t leave their homes or visit the doctor in person. Beyond mobility issues, there are also many people who do not seek out addiction services due to fear or shame, and telehealth gives them the opportunity to receive treatment from the privacy and comfort of their own home.

In addiction, there’s also a real need for human connection. In fact, the antidote to addiction is often connecting with other people, which is the magic of 12-step programs and community-based recovery programs. So solving this problem by trying to take out the human interaction would never be successful.

Jean-Luc: As a digital health investor, I see a lot of startups in the behavioral health space that are actively trying to use technology to eliminate care providers altogether in the services they offer. Maybe we’ll get to a point someday in the future where we don’t need doctors and nurses, but today it’s still extremely important to connect with other human beings in medicine, whether in-person or via telemedicine. We see technology as a way to better connect people, especially in addiction care, but in all types of medicine as well.

The COVID-19 pandemic has already had a massive impact on the healthcare system in general. How has COVID-19 changed the way you do business at Suntra Modern Recovery?

Adam: The pandemic has impacted basically everyone with a substance use disorder. Traditional paths to recovery have been altered, 12-step meetings have moved to Zoom, and everyone is isolated in their apartments, so we know that people are suffering. Traffic to our website is up 5–10x since New York State governor Andrew Cuomo implemented the state-wide “Stay At Home” order in mid-March.

On social media, we’re seeing anecdotal evidence of people drinking more because they’re isolated at home and they don’t know what else to do or they’re using substances to cope with the stress. Zoom meetings often don’t provide the same degree of social support as in-person 12-step meetings, so patients are relapsing. For our business, that’s meant a lot more phone calls to provide support, more interest in starting on medications like Suboxone through virtual care, and a lot more traffic to our online educational content.

Jean-Luc: Since the initiation of the “Stay At Home” order, we have also become a purely virtual service because the pandemic limits in-person interactions. As the social distancing restrictions are lifted we look forward to being able to get back to interfacing with patients in their homes as well.

Do you think that the COVID-19 pandemic will fundamentally change the way we deliver healthcare? If so, what do you think will drive that change?

Jean-Luc: Absolutely. For years, maybe decades, we’ve talked about telemedicine as a useful tool, but change has always come in fits and starts from the standpoint of reimbursement and regulation. The pandemic has exposed how important virtual care is and how useful it can be in situations where patients and providers can’t meet in person. COVID-19 is a massive forcing function that is going to drive coordinated reform efforts across payors and providers nationally.

Last month CMS (The Centers For Medicare and Medicaid Services) instituted the so-called 1135 waiver, in which Medicare will now pay for a range of digital health services for all Medicare recipients. Commercial payors generally follow what Medicare does, and having universal telemedicine payment coverage will help a lot. In response to the pandemic, CMS is also working to make it easier for doctors to practice across state lines. These changes will make it easier for us to help patients outside our home state without having to deal with onerous multi-state licensing requirements. It is going to be difficult to reverse many of these changes, especially if the crisis lasts for many months, and I think these reforms will end up being permanent.

Adam: As the COVID-19 crisis grinds on, more and more patients are going to be interacting with providers exclusively through virtual channels. As patients get used to the convenience and accessibility of telemedicine, we think they’ll be reluctant to go back to office-based care. We believe that our model of home-based and virtual care will fit nicely into this new shared mindset.

With substance use disorders on the rise, what innovations do you see playing the biggest role in the future of addiction recovery?

Jean-Luc: When people think about innovation, they often envision new and exciting things that have never existed before. But we believe that most of the innovations in addiction care are solutions that already exist but aren’t being employed enough. For example, the technology behind telemedicine already exists, but it isn’t used as often as it could be because the business and reimbursement models don’t exist yet.

But if you can figure out a way to innovate around how you get paid or if major payors start covering telemedicine more broadly as noted above, then all of a sudden, home-based telemedicine makes sense. Additionally, wonderfully effective medications, like Suboxone and Vivitrol, have been approved for many years, but the number of patients who actually have access to them is relatively low. So the innovation would be finding a way to more effectively deliver these medications. In other words, I don’t think we necessarily need to come up with the whole class of products. Rather, we can figure out how to deliver the existing ones more efficiently and effectively.

Adam: That being said, I don’t think addiction is ever going to be solved with one medication or one miracle treatment. There are just too many contextual elements that contribute to it, such as family dynamics, living situation, income, genetics, and trauma. This means that the more important innovation will be figuring out how to incorporate multiple modalities into treating each patient successfully.

Vital Signs

Your secret talent is…

Jean-Luc: I love writing code and have written all the markup for our website and worked on other web projects, too.

Adam: My best conversation starter is that I used to be an airline pilot.

Favorite getaway destination?

Jean-Luc: My wife is from Connecticut and introduced me to Block Island (off the coast of Rhode Island) early in our relationship and it’s still one of our favorite places to go.

Adam: I love to ski, so probably Colorado in the wintertime.

What’s one healthful habit you’d love to see patients adopt?

Jean-Luc: To see patients more engaged in their care and have a bigger sense of ownership in their healthcare.

In another lifetime, you’d be a…

Jean-Luc: I’m a hard-core night owl, so in another life, I think that would lend itself well to being a club owner or a restaurateur.

What’s the best advice you’ve ever received?

Jean-Luc: It’s a philosophy that I’ve adopted more as I’ve gotten older: “The only thing I know is that I know nothing.” — Socrates. In other words, the only way I can know anything is to go out and learn on my own, a core skill for any entrepreneur.

Adam: Don’t drink, and go to meetings.