Corbin Petro, Eleanor Health, on building a peer-supported, tech-enabled, value-based substance use disorder treatment platform.

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While they remain an incredibly stigmatized group of patients, those suffering from substance use disorders (SUDs) are finally finding a new breed of treatment centers focused on whole-person care. Eleanor Health is at the forefront of this movement, working to scale an innovative, tech-enabled, and peer-supported platform that supports patients through their recovery by aligning incentives in a value-based payment model. Corbin Petro (WG ’09) is co-founder and CEO of Eleanor. In this episode, we explore Corbin’s path to Eleanor, the unique market forces at play in the substance use disorder market, and Corbin’s perspectives on leading effectively in the COVID-19 era.

Corbin’s early interest in healthcare and career path to Eleanor: (Start–5:30)

• Our guest today is Corbin Petro — CEO and co-founder of Eleanor Health
• After working at a small consulting company focused on mutual funds, re-centered her interest in healthcare, which led to her applying to Wharton (where she majored in Healthcare Management)
• Some key threads resonating across time throughout her career include focusing on vulnerable patient populations, creating unique payment models and delivery models, and integrating technology and dataReturned to NYC to work with Oxeon Ventures and co-founded a company called Empiric Health (tech-enabled service model to reduce surgical costs)
• Prior to Wharton, Corbin spent most of her time on the consulting side; after Wharton, she graduated into the Great Recession
• While she wanted to move into an operating role, she spent time consulting with Bain’s healthcare practice before taking a position as COO of the Massachusetts Medicaid program
• Moved on to launch and run a joint venture between a health insurance company and four hospital systems (running a state insurance market and launching a new business)
• Has been at Eleanor Health for a little over one year
• Grew up just outside Cleveland, Ohio as part of a family which valued public service; it has always been the service side of healthcare that attracted her
• One summer attended 75 of Ohio’s 88 county fairs, and spoke with a wide variety of folks with diverse backgrounds — she began to understand that healthcare is the ultimate equalizer, and the widely varying experiences people have while accessing the healthcare system

The competitive landscape of SUD treatment (5:45–10:10)

• Eleanor’s model is to provide evidence-based, whole person care at the outpatient level; the comprehensive approach includes clinic-based treatment, a virtual platform, and in-home teams
• For decades healthcare has viewed the brain to be separate from the body, and prioritized acute interventions over long-term care
• Addiction has been stigmatized as a moral failing, and many treatment models have existed without regulation or evidence; to the contrary, we should be thinking about addiction as a chronic disease that requires ongoing management just as type II diabetes or heart failure do
• SUD treatment is marred by significant inequity when it comes to access; it has in many ways been a cottage industry driven less by evidence and more by anecdotes
• When thinking about fighting stigma, Eleanor considers multiple potential angles including physical spaces, language used, treatment policies

Editor’s note #1: As a practicing physician specializing in addiction medicine, I myself come up against this stigma often. Many physicians, and oftentimes even psychiatrists, will refuse to care for patients diagnosed with substance use disorders. This often leaves patients struggling with addiction with nowhere to turn, and often leads to severe progression of disease until it leads to a hospitalization. It takes significant effort to change the attitudes of physicians (primary care and specialists alike) to show the value in caring for this extraordinarily vulnerable patient population.

Eleanor’s approach to treating SUD patients, and aligning incentives (10:15–16:10):

• The model includes medication-assisted treatment (MAT) via Suboxone (buprenorphine), addressing all co-occurring psychiatric conditions, psychotherapy, and recovery services (addressing the non-clinical barriers to recovery)
• The very popular ‘social determinants of health’ (SDoH) doesn’t encompass some of the non-clinical barriers SUD patients face; Eleanor wants to ensure it can address a sense of community as well as fostering a sense of meaning and purpose amongst its patients in addition to addressing SDoH such as housing instability and financial security
• A significant part of the Eleanor model is the community recovery partner; these are community health workers and peer advocates who are in recovery themselves and help support patients in the community and in their homes (the ‘glue’ to Eleanor’s model)
• It has been critical for Eleanor to be in a value-based payment model to be able to deliver all these components
• In each market it enters, Eleanor partners with a payer who agrees to incentivize and pay Eleanor via a model that incentivizes the retention of patients, creation of access (same-day availability), and reduction of total cost of care
• The goal is for a patient to stay with Eleanor for 5 years; this is when the risk of relapse for a patient with a SUD equalizes to the risk of addiction for a person with no history of SUD
• Most addiction treatment providers operate in a fee-for-service (FFS) model; the FFS model in healthcare can create the perverse financial incentive of worsening patient illness driving more visits and thus creating more financial gain for the treatment provider

Attraction, enrollment, and retention of patients in SUD treatment (16:10–21:50):

• Attracting, acquiring , and retaining patients is a notable challenge in healthcare (and is particularly unique in the SUD space)
• The way patients and families find Eleanor is incredibly omnichannel; acquisition strategies include partner payers highlighting Eleanor as a provider of SUD treatment, family, word of mouth, SEO, and paid social marketing
• Family is particularly important in the encouragement of folks to enter SUD treatment; word of mouth and reputation becomes increasingly important over time
• In retention, the comprehensive approach is critical; the consistency and frequency of outreach (particularly by community recovery partners) drives retention of patients

Eleanor and COVID-19 (22:00–27:45):

• As COVID-19 hit, the importance of supporting both internal teams and community members became evident
• There was an early struggle to stabilize the business, and ensuring team members felt safe going into the clinics (most members have been converted to virtual visits, but it has been important to keep the safe space of the clinic open for members who rely on it)
• Early on, 50–60% of staff was out either for medical reasons or family care duties; this created significant human capital and logistical challenges
• Internally, transparency has been an important tenet; Eleanor instituted daily emails from the Medical Director, as well as weekly all-hands meetings and a weekly CEO email as touchpoints between leadership and teams
• Eleanor has also implemented a 5-minute guided Zoom meditation three times daily, open for any team member to join
• As a result of these strategies Eleanor’s internal net promoter scores have skyrocketed during this time, proving that the strategies implemented have been successful

The transition to virtual models of care (27:50–32:30):

• Eleanor’s model was built with technology as a key component, with plans to provide 100% of ongoing care virtually
• Eleanor quickly introduced a virtual intake and induction process (enabled by the suspension of Ryan Haight Act); this added multiple components to the process (including mailing urine drug screen to patients and remotely monitoring patients’ heart rates)
• There is some limitation of the acuity of patients who are appropriate for a full virtual induction process; overall, Eleanor went from 10% of care delivered virtually to 90% delivered virtually (over the course of two weeks)

Editor’s note #2: The Centers for Medicare and Medicaid (CMS) and the Department of Health and Human Services (HHS) have issued two important notices that enabled the widespread provision of telemedicine services during the COVID-19 pandemic. CMS relaxed rules in three major categories: physical location of patients (no longer restricted to underserved areas, and includes the patient home as an acceptable originating site), eligible services provided (allowing a broader range of appointment types), and modality of telehealth service (in many cases, allowing audio-only interaction). HHS simultaneously released guidance indicating that the Office for Civil Rights (OCR) within HSS would ‘exercise its enforcement discretion’ and not seek penalties for violations of HIPAA encountered while providing services in good faith. These have empowered clinicians to deliver care via telemedicine without fear of non-payment or legal liability (if standards of care are met).

Routes through entrepreneurship, and the importance of family (32:45–34:35):

• Corbin is married and has two young children; keeping these priorities in balance and perspective has always been a priority, and has made her a better leader
• Power couple: Corbin’s wife is also a CEO (in the tech/sports space)

Identities: LGBTQ, wife, mother, Midwesterner, runner, Wharton Grad (34:35–37:15):

• It is important for folks to be visible when they represent underrepresented groups
• There is a natural tendency to look for people who look like us, and this has driven a dearth of diversity across many organizations
• Within Eleanor, Corbin is very conscious about making diversity of background and experience a priority
• Early in her career, Corbin attended the Reaching Out MBA Conference which inspired her to apply to and attend Wharton; Corbin is now on the board of the organization

Graduating into economic downturns (37:15–40:45):

• Both graduations from undergrad and business school were in challenging times; she graduated college in 2001 with her first job starting 9/4 (and 9/11 occurring just one week later), and graduated from Wharton in 2009 in the midst of the Great Recession
• Graduating into this environment came with lots of uncertainty, which was difficult to sit with after having invested a lot of money and time into herself; these same circumstances exist today
• Her advice: this too shall pass, and will evolve; continue to seek out unique experiences, and be cognizant of the fact that mental health is important, and it is important to take care of each other during these times
• Additionally, look to see where you are most needed; there is an opportunity for Wharton graduates to have real impacts during these challenging times, and this should drive how you think about potential careers

The ‘Second Wave’ of COVID-19 and Eleanor’s continued growth (40:45–47:15):

• Eleanor has changed some of the language it uses; shifting towards ‘using substances to cope’ to help folks understand how changes in alcohol and substance use patterns during COVID-19 times could be dangerous
• Mission-orientation is critical, and Eleanor specifically screens for the use of stigmatized language amongst candidates; intellectual curiosity, humility, and collaborative work are important qualitative skillsets in MBA hires
• For more information check out Eleanor’s website (www.eleanorhealth.com); there are several roles available in NC and NJ (which just opened last week) with national team members sitting in Boston (there is a particular need in building out marketing teams and capabilities)
• Can also email the team at either info[at]elearnorhealth[dot]com or corbin[at]elearnorhealth[dot]com