[00:00:00] Nicole Belles: Welcome back to Healthcare on the Rocks, Employee Benefits with a Twist. I'm Nicole Belles, the SVP of Product at Springbuk, and I'm here with my co-host, David Pittman, our senior Director of Marketing. Today we have a wonderful guest with us, Deb Adler, the CEO of Navigator Healthcare.
Deb has more than 25 years of experience in executive healthcare roles, including leading quality initiatives and provider network strategies at leading national insurance plans. Her Vast experience letter to Create Navigator, an organization that opens doors for people seeking substance use disorder services with rapid access to the right care. Navigator's mission is to provide effective treatment, empowering individuals to make informed treatment decisions, and receive ongoing recovery support with the assistance of a 24 by seven clinical care navigator. Deb, welcome to the show.
[00:01:03] Deb Adler: Thank you. Happy to be here.
[00:01:08] David Pittman: Deb, Nicole gave us a small look at your career at Navigator. We'll get into more of that in just a second, but I'd like to know first, what else occupies your time? What do you enjoy doing when you're not leading Navigator?
[00:01:21] Deb Adler: Well, I enjoy playing with grandkids. I have four and they're all five and under, so I am gotta stay in shape and so I can get up and down on my knees. I play a lot of Legos but when I'm not playing with grandkids, I'm also a pretty avid runner. You know, go to Orange Theory several times a week.
So, try to, try to stay somewhat physically fit so I can keep pace with two to three toddlers and a 5-year-old. So that's what occupies a lot of my downtime. My “downtime”!
[00:01:55] David Pittman: Four under five. That is definitely a handful.
[00:01:58] Deb Adler: Yes. Yeah.
[00:01:59] David Pittman: I used to be a big Orange Theory person myself. It's great workout, isn't it?
[00:02:04] Deb Adler: It is, it is. Yeah, I enjoy it a lot. Yeah, mostly the treadmill. Not, not so much the other pieces, but I do them all. It is a requirement.
[00:02:15] David Pittman: Yeah. Yeah. The rower can be a bit much, sometimes.
[00:02:18] Nicole Belles: Oh
[00:02:18] Deb Adler: Yes.
[00:02:19] Nicole Belles: That's a torture device. The rowing machine.
[00:02:21] David Pittman: Yeah. Yeah. When they do that 2000 meter test, I'm like, oh, boy!
[00:02:27] Deb Adler: Oh yeah. I know a lot of people check ahead of time to see what's up for the day. I don't do that, or I would not go if it was the 2000 meter rower, I would suddenly not be able to show up!
[00:02:40] David Pittman: Yeah, I feel your pain.
[00:02:41] Deb Adler: Cool.
[00:02:42] David Pittman: All right. Well, tell us a little bit more about Navigator and what led you to launch it and how has the journey been?
[00:02:50] Deb Adler: Well, I launched Navigator in 2019, so it's been around a while and I'm kind of late in life to do a startup. But it really was started as a result of my own experience with seeing individuals struggle with getting access and engagement. And for individuals that need help with substance use disorder, it's a very complex condition.
And it is not only the individual with substance use disorder that suffers. The entire family is often impacted as well. And what I learned in my roles at payers was you can build a wonderful evidence-based provider network. But that doesn't mean individuals are gonna access the right care at the right time.
So you have to solve for both access to care, to make it easy to access and quick to access, as well as solve for engagement. Because often, you know, individuals just don't know what is the right thing to do, right? You see TV shows. I rewatched “The Sopranos” not long ago, and you know, they talk about, you know, going away for four weeks to a very resort-style program, but most individuals don't know the value of getting care close to home and one that also uses the evidence base, which is medication-assisted treatment. So I launched Navigator to really offer individuals that type of guidance that's needed to help individuals not only understand their options for treatment, but also how to best leverage their insurance benefits because many insurance companies will incentivize right care, but if you don't know about it, you're not going to to access it. So that's what really propelled me in late 2019 to launch Navigator.
[00:04:50] Nicole Belles: Can you talk a little bit about how Navigator works, maybe from the patient journey perspective?
[00:04:56] Deb Adler: Sure. We, we tried to build something that was really simple and easy, so we're a simple phone call away for anyone needing help. So we have a toll free number that's dedicated for each of the employers that we work with. And so we're a simple call. We operate a 24x7 resource center that's staffed with independently licensed clinicians.
They're all trained in motivational interviewing and have deep experience in substance use disorder. And the value behind motivational interviewing is it helps people commit and engage in treatment. So we will talk to the person on the phone and help guide them to right care. We built a proprietary platform that allows us to see into the open appointment schedules of high-performing substance use providers in all 50 states.
So while our care Navigator is talking to the individual on the phone about their current situation and needs, they're able to look into the platform and identify treatment options for that individual that are close to home and meet their preferences. So we have providers that offer virtual care as well as in-person care and in some cases in-home care.
And I know we're all familiar with how COVID has increased the use of telehealth. I will tell you, we see the pendulum swinging back. Where more individuals, at least our callers, are requesting in-person options. So there is a gravitational pull towards more in-person, but it's a very simple program from the member or consumer experience standpoint.
We're a phone call away. We help you get into an appointment same day, next day for a full comprehensive evaluation. And then we work as your guide and care navigator. Throughout your journey throughout the year to help you stay connected to right care at the right time, which will change over time, right?
What I need today may not be the same as what I'll need in 60 days or 90 days, but we work with that individual along their recovery journey to help them stay the course, so to speak.
[00:07:18] Nicole Belles: I'm curious about that shift more to in-person care. Do you think that's maybe someone's desire just to get out of the existing environment a bit?
[00:07:35] Deb Adler: So more people want to go into a program and have a face-to-face, a literal face-to-face, not like this experience, not a shift to inpatient care. There are, you know, often though individuals may believe they need an inpatient level of care because they may not understand that, you know, withdrawal management, many services can be offered at an outpatient or other level of care.
And the interesting thing about substance use is it's a continuum of care from outpatient, you know, it could be a phone call like this with a licensed clinician on the other end, of course to an intensive outpatient experience, which is three hours, three times a week, typically partial hospitalization, five hours, five days a week, typically to, to a residential setting where you actually are spending the night or even a medically managed detox program. So we work with individuals that need help across that full continuum of care.
[00:08:45] Nicole Belles: How do you measure the impact of Navigator? What are the typical outcomes you track for not only the employee independence, but the employers as well?
[00:08:57] Deb Adler: We, we have a number of key metrics that we monitor. First and foremost, we're all about the consumer, the member's experience, right? So we do track a net promoter score, which is pretty common in the industry, right? It's that single question of how likely would you recommend Navigator to a friend, family, or other.
So we collect that at each transaction with the consumer, the individual, to understand, you know, their experience with us. And we score over 80 consistently, which is a world-class rating based on the developers of the net promoter score. We also track something called the CAP score.
It's an industry standard score that really gauges the individual's results their progress as a result of treatment. It's a simple question, right? As a result of working with the treating provider the Navigator connected you with, are you much better or worse? It's a five-point scale and five being much better, and we're scoring about a 4.79.
So that tells us that the individuals we're connecting them to the right programs, that they're actually succeeding, right? They're progressing and feeling better as a result of treatment. The other thing we measure is our actual performance guarantee, which is within 48 hours of the call to us, we will have you connected into same day, next day appointment.
So we're running about 85% of the time with that appointment same day, and then the rest of the time is within 48 hours. We also look at financial return on investment as well. So with our employer customers, we typically see at least a three-to-one return on investment. Meaning once you bake in our cost, we're able to save the employers healthcare dollars, healthcare cost savings because we're helping individuals get to, in-network services at the right level of care at the right time, and that that helps avoid, you know, other challenges like emergency room costs and high cost of residential settings. On occasion when they're not necessary, sometimes they are necessary. So we are also able to show that financial return on investment as well. So those are some of the things we typically measure.
[00:11:32] David Pittman: Those are some outstanding success metrics. And by the way, happy five-year anniversary. So you said you started in 2019. That's great that you've been around that long and you've got those those type of metrics for you. I think I have an understanding of where this next answer is going to go, but just in case I missed anything, what's the employer's reception been? How, how are they responding to the programs?
[00:12:00] Deb Adler: I think very positively based on those numbers. I think what's been interesting for me is most of our customers come to us because they want their employees’ independents to have a better experience, right? They're concerned about, you know, access experience and less about cost.
So the ROI has not been the driver. It's a nice byproduct, but just having that better experience and helps create a healthier, safer workforce. You know, it helps reduce stigma within the workforce. Because what we find with, I'll say innovative employers is they understand the importance of a recovery-ready, recovery-friendly workplace, and how much that can impact and improve things like absenteeism, turnover.
There's a lot of other costs outside of the medical costs for these services. There's those hidden costs, right? The missed days from work because of substance use disorder, and an individual with substance use disorder misses 50% more days than an individual that doesn't have substance use disorder.
So it's that, you know, a safer, healthier environment that seems to be, you know, a huge driver and that the experience of their employees’ independents.
[00:13:29] David Pittman: Well, it's an important service to offer to them. And you mentioned earlier that just having awareness of programs is one of the challenges. So how do employees and their dependents learn about the services that are available to them through Navigator?
[00:13:46] Deb Adler: It's a great point because, you know, individuals left on their own devices are going to try to Google, you know, where should I go for treatment? They're going to ask their friends maybe. This may be a topic they don't want to discuss with their friends. So I think what's really important is we're a safe, private, confidential service.
And what we typically do with the employers is we deploy a toll-free number that's dedicated to them. We also typically have a landing page that is available off of the employer's intranet site, but we work with the employer on what are the most effective channels to communicate.
And that's a wide range. It can be not only digital content, but I'm a real fan of print content as well, you know, a poster in the bathroom, a flyer in the break room. We also do our own podcast. We do lunch and learn activities. We participate in health fairs. And one of the programs that we think has been very effective is offering a substance use benefit card. Everyone has their insurance card right in their wallet, but it may not be specific to substance use. So having a card in your wallet that has our toll-free number for the employer and just, you know, constantly getting the word out in a safe way because there isn't anyone that isn't touched at today by substance use with the opioid epidemic.
Fentanyl is on the rise. If you don't have someone in your life that hasn't been touched with this, that would be very surprising. And you have to get the word out frequently because, you know, everything may be great today, but a week from now, your 17-year-old is struggling with cannabis use.
And I should mention that the top substance of choice is alcohol. That is the most frequent claimable service. We see it followed by opioids, but cannabis is on the rise as well. And the impact it can have if not managed well. So those are kind of the top three we see.
[00:16:00] Nicole Belles: Yeah, your point about cannabis is interesting. I'm pretty sure a week or two ago I saw an article that was highlighting that in terms of daily use, marijuana has surpassed alcohol now in the us.
[00:16:14] Deb Adler: That's right and now the death rate for substances, opioid wins, the opiates wins the prize, right? The mortality rate is very high. Alcohol is still the highest use. Yeah, you're right. Cannabis is taking over. But, you know, alcohol, there's so many other impacts, right?
Because that's the cause of a lot of the emergency room visits. You may be coming through with a broken leg, but it's a result of a DUI. So yeah, that's the impact to physical health and comorbid and co-occurring conditions is really significant.
[00:16:56] Nicole Belles: Does Navigator integrate or interface with other employer benefits like I'm thinking employee assistance program or other wellness programs?
[00:17:07] Deb Adler: We do. We like to call ourselves the universal plug. We try to integrate with the employer within their culture and their ecosystem. So we can be a great wraparound to the EAP. It's interesting to me that, you know, employee assistance programs when they were, back in the early days, substance use was a key focus, right?
It was any EAP provider had to have significant experience in substance use. And that's diluted over time, largely because of the shortage of providers. So we've found many employers find it valuable to insert our program alongside the EAP as a a means of, you know, again, really addressing this rise in both, both spend and challenge and outcomes.
So, yeah, we can integrate with EAPs. We also work with the employer to understand other healthcare providers that are typically used, whether that's health systems, PCPs, pain specialists, you know, there's certainly a lot of potential support that we can bring in in integrating with the employer's current structure. And EAP is one of the most common.
[00:18:25] Nicole Belles: Okay. What are some of the biggest challenges you've had to overcome while growing Navigator?
[00:18:34] Deb Adler: Hmm. I would say there is still stigma of course with substance use. When we launched in 2019, we focused on adults only. But we did a couple of years ago expand to supporting youth. So we do work with individuals 13 and up based on the age of consent. Typically, it's still talking to the parent, but you know, we do occasionally have a teen and you know, depending on the state they can consent to treatment.
And I think that was a challenge to broaden our services to youth because of not only the, you know, making sure we're aware of the regulatory requirements, the consent rules, but also making sure we have adequate resources to continue to offer that fast entry to care with that 48 hours.
So I would say that was something we did relatively methodically. We would've loved to start that way. But I think that was, you know, something that we had to do very intentionally and planfully to make sure it worked right.
[00:19:46] David Pittman: Well, Deb, over the five years of this wonderful type of program, I'm sure you've had some outstanding successes. Is there one maybe that comes to mind that you could share with us?
[00:19:57] Deb Adler: The one that I think about a lot was a teen. In this case the teen had an overdose, a fentanyl overdose, and the mom had attended one of our benefit fairs with the employer and had picked up that substance use benefit card and had it in her wallet. And when she was at the emergency room on a Saturday with her teenager, the emergency room physician said, “Well, your daughter can go home now.”
And the mother, you know, panicked. Her daughter was probably medically stable, but the family wasn't ready, right? There was not a thorough discharge plan. The mother, you know, it was still an urgent crisis situation for her.
She called my team, I guess it was Saturday afternoon. And, you know, we were able to help with getting a provider that would do an assessment telephonically during that afternoon on a Saturday. And we were able to work with the emergency room in the hospital to have that daughter admitted on Monday to a stellar youth-focused, substance use disorder program and helped coordinate the care challenge that was happening for the family, for the mom.
They're on the spot who, you know, didn't feel comfortable that, subsequent to this fentanyl overdose that her daughter could come home. So that one sticks in my mind a lot because fentanyl's on the rise and there's such a challenge in the youth market and, and I know the, the mom was very appreciative of having that type of support and, I would say unexpected support too.
I think we find that a lot because most people when they're calling us think we're gonna share some options for them and then hang up and, you know, they go on their way and “good luck.” And when they, right there on the call, get the support as well as an appointment that same day often, they're actually just astounded that this is the type of service that they're getting.
And then to know that we're here, ongoing. You can call us anytime, and then we usually check in with the individual within every 30 days. In fact in this case, I think it's been quite a while for this mom, but the daughter's doing well.
They're now home with a family. I believe there's some psychiatric support being offered, but in any event, it's a good news story all around because there was the support during the crisis as well as ongoing support because things just don't cure and get cleaned up in one phone call.
[00:23:07] Nicole Belles: Right.
[00:23:08] Deb Adler: Right. So that ongoing support is very critical as well.
[00:23:12] David Pittman: Yeah, that's nice. It's wonderful that you could be there, could be available to them. So do you have 24x7x365 support?
[00:23:21] Deb Adler: Yes. 24x7x365. We never close. And I’m also very proud of the fact that it's a very diverse team. We've been very focused on, you know, trying to meet the individuals where they are. I think 60% of the staff identify as persons of color, and we also have Spanish-speaking staff and use a language line if someone needs a language outside of English or Spanish.
[00:23:58] Nicole Belles: Deb, how do you see the future of healthcare services evolving around substance use disorder?
[00:24:07] Deb Adler: I mean the good news is there are a lot more options than there were, you know, 10, 20 years ago. Medication-assisted treatment is now available and can be very effective. And it's difficult, I think you know, in this space. The notion of just being absent has always been kind of the, what people understood to be true, right?
You just have to quit, and that's not really true anymore. You can take a harm-reduction focus, maybe. You just can't stop alcohol immediately. There are supports both medication therapy and other things that can help you move away from misuse of substances.
And I think we are starting to see a little bit of light at the end of the tunnel around stigma, but in the workplace, it's still very difficult, right? Who wants to raise their hand and say, “yeah, during COVID, I had a, you know, a liter of vodka under my desk, and now I've gotta go back to work and I'm not gonna be able to hide that liter of vodka very well.”
And I do think we're seeing employers recognize that they need to put in some changes to make it their workplace more recovery-ready and friendly. And it doesn't have to be the big Amazons. I mean, there's a lot of small companies, less than a thousand employees, that are instituting changes and that can be small changes. Things like, you know, maybe you don't have happy hour as the reward, right? Or if you have happy hour, you have choices, mocktail choices. It was kind of ironic when you introduced the podcast. I'm like, oh my goodness! You have a take on alcohol, right? On the Rocks and With a Twist.
I'm like, uh oh! There are things you can do to, you know, create an openness and a judgment-free zone for people. And one way of doing that is, you know, having this private, confidential line. We don't provide any individual data back to the employer. It is a confidential, free service under the employer's benefit plan.
And we provide aggregate information, but we certainly protect the individual's identity. That's key. So I do think we're seeing workplaces recognize that they can be part of the solution in terms of policies and openness and offering other services. I do see that changing, but it's going to take some time and to get there and that increased spend year over year in this area.
Certainly drawing some of that attention, but also just the human suffering, right? If the mom with a daughter with a fentanyl overdose, that's probably that same case is being repeated, you know, if you have a thousand employees, there's probably one parent out there that's facing this issue and just helping one person can make a meaningful difference.
[00:27:37] Nicole Belles: Deb, earlier you mentioned in your success story you're talking about access to psychiatry services as well, and then you talked just a little bit about the COVID pandemic, and it kind of reminds me of all the trends we're seeing and increasing mental health issues. Can you talk a little bit about how Navigator kind of wraps in some of that mental health or psychiatric services?
[00:28:00] Deb Adler: We work with individuals who the phrase typically used is co-occurring disorder, right? Someone that has both mental health and substance use needs and, and you know, it's usually not an “and/or,” it's usually you know, an “and,” right, because, you know, it's a chicken and egg issue. Is my cannabis use or my alcohol use impacting my depression, or is my depression risk causing my alcohol use? We do make sure that the providers on our platform can work with individuals, whether the substance use issue is primary or secondary. We do have providers that can not only work with individuals that have mental health and substance use needs, but also medical needs.
I mean, a lot of our cases have been quite complex individuals who may be on transplant lists, and you may not be aware of this, but you know, you can't stay on the transplant list if you're misusing alcohol. So those are very complex cases because there's other physical health conditions that have to be addressed.
So yeah, we do make sure that our community of providers, our network can meet those needs as well.
[00:29:20] David Pittman: Well, Deb, it's been an absolute pleasure having you on the show today. Thank you for sharing your insights and the amazing work you're doing with Navigator. If people want to connect with you or navigator to learn more, how can they do that? Where can they do that?
[00:29:35] Deb Adler: Well, we have, our website, navigator.health. You can go out there and request a demo or request an inquiry. That's probably the easiest.
[00:29:48] Nicole Belles: Thank you again so much, Deb, for your time today, and for being one of Springbuk's Activate partners. For our listeners who want to learn more about Navigate Healthcare, we'll include links in the show notes. But until next time, stay healthy and informed. Thank you everyone.
