East Tennessee State University

Reinvestment from Expanded System to Treat OUD: Reclaiming the Epicenter Highly Ranked

Addiction services

RESTORE establishes a new, scaled network of non-profit opioid addiction treatment clinics that reinvest clinic revenue into prevention services in highest need Central Appalachian communities.

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Project Summary

Alongside the urgent need for treatment clinics, systems to prevent and mitigate Appalachia’s escalation of addiction are broken. States disburse prevention funding based on federal/state priorities; not local priorities. Per recent Washington Post reports, the regional scale of decades-long opioid overprescribing, dependence and addiction, is jarring. The epidemic persisted for years before government agencies prioritized money for opioid-focused prevention in our region. Appalachia needs sustainable, scalable revenue to support effective and timely prevention services. Using social franchising as a route to simultaneously scale and impact both treatment and prevention, RESTORE will establish a network of 35 branded revenue-generating, non-profit office-based outpatient treatment (OBOT) clinics. Clinics will provide revenue for rapid reinvestment into local prevention agencies.RESTORE will determine the highest-need communities, assess treatment/prevention readiness, streamline complexities and expedite clinic set up, applying quality control standards, and increased access, serving up to 2.7 million people in Appalachia’s highest-need, historically underserved areas.

Problem Statement

The US is amidst an OUD and overdose crisis, with exponential growth in overdose deaths for three decades. Central Appalachia is the crisis epicenter, with the nation’s highest overdose death rates. Why didn’t our public health systems prevent this crisis? In short, there was nothing standing in the way. Systems designed to prevent such problems failed because they are fragmented with no mechanisms for timely, locally relevant, and sustainable resource generation. Local prevention agencies struggle to address emerging or resulting local health issues because national/state agencies, from which they receive funds, do not prioritize local or regional problems. This is an intractable problem. Appalachia urgently needs this paradigm-shifting solution.As a case in point, until the federal government prioritized the opioid problem three years ago, one of the region’s most effective prevention agencies had a grant-funded portfolio restricted to topics other than opioids. There were no resources for OUD prevention, until federal agencies finally prioritized the crisis, fully 20 years after the first documented spike in overdoses. Resulting desperation and loss has exacerbated inter-generational poverty, accelerated economic decline, and led to significant increases in crime and poor health status. The crisis has eroded much of the sturdy cultural identities of self-reliance and grit for which the region has been historically known. But such strong identities will never be fully eroded. Not waiting on government responses that have repeatedly failed them, local communities are banding together, creating alternative solutions, like RESTORE. However, funding for these local solutions remains a significant barrier.

Solution Overview

RESTORE is grounded in non-profit social franchising: taking a tested solution (i.e., Overmountain) from one community and spreading it to another, using commercial franchising principles to promote social benefit rather than private gain. This model will streamline complexities that communities face in standing-up treatment clinics, expanding access to high-quality MAT services to millions.Expert teams will identify high-need communities using precision data science, geographic risk-assessment and readiness algorithms. Established partner networks will facilitate entrée to communities. RESTORE’s OBOT model is evidence-based, easily set up as new, or integrated into existing treatment programs. High-impact social franchising tools increase likelihood of scaling RESTORE regionally. ‘Franchise packages’ with network branding, training, and standardized business/clinical operations will be established where OBOTs are needed most and where demand supports costs. RESTORE will establish fitted mobile clinics (vans) for areas of low population density. Simultaneously, we will purchase for-profit clinics with high market-share, converting to RESTORE’s non-profit model. Working with each state’s designated prevention authority and network, RESTORE will reinvest clinical revenue into each clinic’s pre-selected, aligned local prevention organization. Revenues will vary by clinic size but the business model is strong. For every 100 patients, we conservatively estimate that $300K will be generated in revenue ($200K will cover costs), with $100K available for reinvestment. We expect that: 1) RESTORE communities overdose mortality will decrease significantly as adoption of MAT increases, 2) sustainable revenue will strengthen and broaden locally relevant prevention programming, and 3) the RESTORE model will facilitate standardized operations suitable for other emergent crises.

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Project Funders

  • Ballad Health

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