As Interventionism Becomes Big Business, Some Worry That the Client May Become Lost in the ShuffleAbout 20 years ago, Chris Crosby, now CEO of thriving South Florida-based Watershed Treatment Programs, was working at Boca Ratonbased Anon Anew as an interventionist. Crosby was one of many such interventionists throughout the nation who then mostly worked as quasi in-house marketing agents at treatment centers around the country.
Trained at the Johnson Institute, which was founded by the famed Vernon Johnson, who is credited by many of today’s interventionist as the founder of the interventions profession, Crosby says he and his colleagues would visit places like emergency rooms looking for appropriate treatment candidates. “Some saw us as kind of like ambulance chasers,” says Crosby. “But I didn’t see it that way at all. We did a lot of good and got a lot of people into treatment, where they got the help they needed.”
Of course, a lot has changed since Crosby was working in-house at Anon Anew, the principal changes being a massive shift in the payor mix of the private side of the treatment business over the last twenty years, as well as the related rise of the Internet as an increasingly important channel of patient acquisition for the treatment industry.
Both these changes have had a key impact on the development of contemporary interventionism and have been critical in helping shape the profession as it exists today.
Back when Crosby was at Anon Anew, it made a lot of sense for centers to employ interventionists, and at that time most interventionists were indeed employed by treatment centers, or at least closely affiliated with providers. In the mid-1980s, almost 40 percent of all treatment industry revenues came from commercial payors, so there was every reasonable expectation that clients who had the ability to pay for treatment could be found by randomly visiting places like emergency rooms and courts. 20 years later, the payor mix of the private side of the treatment business has changed drastically, with only a little more than 10 percent of the industry’s revenues coming from insurance carriers. There now rarely exists the expectation that people have coverages that will pay for anything other than minimal inpatient stays as insurance carriers have moved increasingly toward supporting outpatient care.
How this has impacted the interventions profession is that, increasingly, interventionists have become private practitioners who are now an ever growing and potent source of treatment industry private pay clientele, upon which residential and inpatient private treatment providers have become very reliant in recent years. Based on growth patterns prevailing in the 1990s, Treatment Magazine estimates that private pay in 2006 accounted for at least $1.7 billion in revenue for the treatment industry, up 70 percent since the advent of managed care fifteen years ago. Private pay now likely accounts for at least 40 percent of private – non government – payments into the $25B a year treatment business, compared to just slightly more than 20 percent in the early 1990s.
As these percentages include outpatient providers, which are now 90 percent of the treatment industry and get the lion share of their payments from the dwindling pool of commercial insurance substance abuse dollars – thus most insurance dollars go to outpatient – it is clear that private pay is now very likely the most important part of the payor mix for private residential and inpatient addiction treatment providers.
And the new independent operator interventionists are becoming more and more a critical part of the private pay referral gathering mechanism for the private side of the residenttial treatment industry, with the rise of the Internet increasingly contributing to the success of these private interventionist practitioners.
“In the past, interventionists were almost exclusively reliant on treatment centers as the source for their interventions candidates,” says Jim Emmert, among the nation’s most respected interventionists and a partner at Delray Beach-based Open Door Interventions, a private interventions practice. “But now the Internet has opened up a way for interventionists to reach clients directly [a “direct-to-consumer channel” in marketing parlance] through their own online marketing efforts.”
Now, to be sure, much, if not most, of clients handled by interventionists still come from treatment centers themselves, with the Caron Foundation being a case in point. COO Mike Early says that in the vast majority of cases it is Caron that is referring out to interventionists, but he says that in recent years referrals coming in from interventionists have been increasing. So much so, that he now estimates as much as 5 percent of Caron’s revenues now come from interventionists who are referring private pay clients themselves to the center, independent of an initial intervention referral from the Caron Foundation itself.
As interventions have become big business in the treatment industry, accounting for what has likely been between $100 million and $200 million of independent private pay referrals to treatment centers in 2006 – private interventionists are typically paid fees of around $3,000 per intervention, usually by the family – independent interventionists have become increasingly courted by private pay centers.
That this is true became evident this year from a couple of conferences aimed at interventionists put on by Foundation Associates in partnership with the ubiquitous interventionist John Southworth, whose Southworth Associates is probably the nation’s largest and most successful interventions firm.
Dubbed “The Moment of Change,” and held early in the year in Santa Monica and again later on in Palm Beach, the conferences were among the most successful on the treatment conference circuit in 2006, with hundreds of attendees at each event. And each conference was packed with private pay treatment exhibitors who paid up to $6,000 per booth, many times the typical booth rate at industry conferences, to gain access to the scores of interventionist registrants.
“What I see occurring, to some extent, is that interventionism is moving away from being a profession and more toward being a business,’ says Jim Emmert. “I worry sometimes that the client’s interests, which should always be paramount, might get lost in the shuffle” Other long time, respected independent interventionists, like Ed Storti, are also concerned.” try to stay out of that side of things,”he says. “But interventions are becoming quite a booming business these days.”
Emmert sees potential troubling parallels between the interventions business today and the development of the EAP field, which has its roots in efforts by employers to help alcoholics found within the ranks of their employees.
“With EAP, in the beginning, it was a profession whose genesis came from a meeting Bill Wilson had in the 1940s with a member of the Dupont chemicals family about how to help alcoholics among his employees,” says Emmert, adding that since that time EAP has expanded to include providing many other services as the field has grown into a multi-billion dollar business with hundreds of firms offering services to corporations nationwide.
Inevitably, the business pressures began to intrude on the EAP profession as it grew, explains Emmert. “There were eventually some very serious ethical problems that developed, which left a taint on the EAP profession and business,” says Emmert. “A number of treatment centers were caught making illegal payments to union EAP officials in exchange for patient referrals. This type of thing cannot be allowed to occur with interventions as it would seriously damage the field as well as the treatment industry, which cannot afford another scandal of this type.”
(Editorial Note: Treatment Magazine has unconvered direct, incontravertible documentary evidence that one of the nation’s most prominent – arguably the most prominent – interventionist has received large ongoing six figure payments from treatment providers, payments that where nowhere disclosed on the firm’s website or any other documents, which always prominently highlighted the firm’s “idependence” and sole loyalty and obligation to the clients seeking interventionist services. Obviously, regular six figure payoiuts by treatment providers to this interventionist might create a dual obligation on the part of this interventionist and such payments are highly ethically, if not legally, suspect.)
For players like Ed Storti, there is no question that the interventions field has changed drastically over the past fifteen years or so. “After managed care hit, this was a dying profession for a few years as the treatment centers cut back hiring interventionists,” he says. “It really was a profession that seemed to be going nowhere in the early 1990s.”
More than anything, what was breathed new life into interventionism over the last 10 years has been the rise of the Internet, according to Storti. “The Internet has really exploded this,” he says, adding that it used to take years to build a reputation as an interventionist. “It took me five years to become known and build a book of business, a process that can now take just a few months if you have the right kind of Internet marketing behind you.”
And Storti says that, 20 years ago, he was totally dependent on treatment centers for interventions referrals, which is no longer the case. “I get at most 15 percent of my interventions from treatment centers now,” he says. This means that Storti, and the growing ranks of independent interventionists like him, are now rising, powerful and often highly courted new referral players on the addiction treatment scene. TJ