Continuum is a virtual-first SUD/OUD treatment company. We deliver medication-assisted treatment via the permanent DEA telehealth prescribing pathway, assign a named navigator who stays with each member from intake through step-down, and measure outcomes against the employer's own claims baseline.
This is not a digital wellness app. This is treatment delivery. Buprenorphine induction. IOP sessions. Relapse management. Return-to-work coordination. Every touchpoint tracked, every outcome measured, every consent documented under 42 CFR Part 2.
90-day measurement window. Minimum 25 referred members. Claims-verified outcomes at days 30, 60, and 90. Performance guarantees active from first member.
Employees and dependents with SUD/OUD diagnosis, injury-to-opioid pipeline referrals, EAP escalations, and self-referrals. Workers' comp coordination where injury is origin.
70%+ treatment retention at 90 days. 80%+ MAT adherence. 40%+ reduction in SUD-related ED visits. Measurable return-to-work improvement.
25 referred members over 90 days for meaningful measurement. Below that threshold, the data is anecdotal -- but we still treat every member who shows up. If volume is under 25, we extend the measurement window to 120 or 150 days rather than force a premature scorecard. Above 50, we can run subgroup analysis (injury-origin vs. non-injury, buprenorphine vs. non-MAT, IOP intensity levels). At 100+, we can model actuarial projections for full deployment.
Employees or dependents with existing substance use disorder diagnosis (ICD-10 F10-F19). Currently in treatment, between episodes, or untreated.
Workers' comp or medical claims showing workplace injury followed by opioid prescription. The most predictable pathway to OUD in physical-labor workforces. Often invisible until dependency is established.
Members whose substance use exceeds what 6 EAP sessions can address. EAP counselors identify these early but have nowhere to escalate that includes MAT, IOP, and longitudinal navigation.
Members who contact Continuum directly through the benefits portal or a dedicated intake line. Confidential. No employer notification. 42 CFR Part 2 protections apply.
EAP counselor identifies SUD beyond session scope. Warm transfer to Continuum intake with member consent. No gap in care. Navigator assigned within 24 hours.
HR identifies performance issues potentially linked to substance use. Refers to Continuum as a treatment resource. Voluntary participation. No employer access to treatment records under 42 CFR Part 2.
Member contacts Continuum through benefits portal listing, dedicated phone line, or website. Fully confidential. Employer receives aggregate utilization data only.
For injury-origin OUD: coordination with workers' comp TPA. Treatment records remain Part 2 protected. Claims coordination handled by Continuum's compliance team. Separate consent required.
Define how members reach Continuum. EAP warm handoff protocol, HR referral process, self-referral channel (benefits portal listing or dedicated line). We provide template language for each pathway. Typical setup: 1–2 weeks.
12 months of baseline BH/SUD utilization data. De-identified acceptable for baseline analysis. This is for measurement, not for treatment. We need to know your starting point to prove we moved the numbers. Standard 837/835 or TPA extract.
Benefits portal listing for self-referral access. EAP warm handoff protocol documentation. Optional: internal benefits communication to HR/managers about the program. We provide all template materials.
Standard HIPAA BAA between employer (or employer's TPA) and Continuum. We provide our template or execute yours. Required before any PHI exchange. Typical execution: 1–2 weeks with legal review.
ASAM criteria assessment within 48 hours of referral. Determines level of care (outpatient, IOP, residential referral). COWS (Clinical Opiate Withdrawal Scale) for opioid-dependent members. SDOH screening at intake. 42 CFR Part 2 consent obtained and logged.
Virtual, physician-supervised. Member at home with telehealth connection to prescribing clinician. COWS score verified before induction (score 12+ required). First dose observed via video. Follow-up within 24 hours. PDMP checked in KY (KASPER) or OH (OARRS) before every prescription. Naloxone co-prescribed at induction per SAMHSA guidelines. Urine drug screen (UDS) at intake and random thereafter.
Same person from intake through step-down. Licensed counselor (LCSW or LPCC). Minimum 3 touchpoints per week during IOP. Manages medication adherence tracking, session attendance, crisis response, return-to-work coordination. Not a call center. Not a rotating roster.
9 hours/week standard (ASAM Level 2.1): 3 group sessions (3 hrs each). 12 hours/week intensive: adds individual therapy session + medication management. Group sessions capped at 10 members. All sessions virtual with attendance tracking. Evidence-based modalities: cognitive behavioral therapy, motivational interviewing, contingency management. No proprietary curriculum. Standard clinical tools with measured outcomes.
9–12 hrs/week. Weeks 1–8 typical. Buprenorphine stabilization. Group + individual sessions. Navigator touchpoints 3x/week minimum.
3–5 hrs/week. Weeks 8–16 typical. Reduced group frequency. Individual therapy continues. Navigator touchpoints 2x/week. Buprenorphine dose stabilized or tapering.
Monthly medication management. Monthly navigator check-in. Ongoing PDMP monitoring. Duration: 6–12 months standard. No forced taper timeline.
Planned discharge with warm handoff to community resources. 90-day post-discharge navigator check-in. Re-entry pathway documented.
| Role | Qualification | Engagement | Cost | Pilot Scope |
|---|---|---|---|---|
| Prescribing Clinician | Psychiatrist or NP. DEA registration. Buprenorphine experience. Employed/contracted through Friendly PC (AODE holder). | Via Friendly PC | $150–200/hr | 4–8 hrs/week at pilot volume. Scales with member count. One clinician covers 40–60 active members. SB 227: NPs prescribe independently in KY. |
| Navigator | LCSW or LPCC. SUD treatment experience. State-licensed in KY and/or OH. | 1 W-2 to start | $55–70K/yr | Caseload: 15–20 active members. One navigator for pilot. Second at 20+ members. |
| Clinical Director | Licensed psychologist or psychiatrist. Program oversight. Quality assurance. | Part-time / 1099 | $100–150/hr | 4–6 hrs/week. Treatment plan review. Clinical supervision. Quality metrics. |
| Founder Oversight | Joe Nalley. Employer relationship. Scorecard delivery. Compliance oversight. | Direct | — | Hands-on through pilot. Scorecard preparation. Employer communication. No delegation during proof period. |
| Metric | Definition | Source | Methodology | Target |
|---|---|---|---|---|
| Treatment retention | Members still engaged in treatment at measurement point. National OUD average: ~45% at 90 days. | Continuum episode records | Active episode status at day 30/60/90. Denominator: all members who completed intake. | 70%+ at 90d |
| MAT adherence | Buprenorphine prescription fill rate among MAT-enrolled members | Rx claims + PDMP | Prescriptions filled / prescriptions written. Cross-referenced with KASPER/OARRS data. | 80%+ |
| ED utilization | SUD-related emergency department visits, treatment period vs. baseline | Employer claims data | ICD-10 F10-F19 ED claims during treatment vs. 12-month pre-pilot baseline for same members. | 40%+ reduction |
| Return to work | Members who return to active employment status during treatment | Employer HR data | Employment status at day 90 vs. status at intake. Employer provides aggregate confirmation. | Measured |
| Relapse rate | Return to active use requiring re-escalation to higher intensity | Continuum clinical records | Episode state transition to re-escalation / total active episodes. Relapse = clinical event, not discharge. | <30% |
| Navigator engagement | Touchpoints per member per week during active treatment | Continuum touchpoint records | Logged touchpoints (call, video, message) / active member-weeks. IOP minimum: 3/week. | 3+/week (IOP) |
| Cost per episode | Total Continuum charges per treated member over 90-day pilot | Continuum billing + employer claims | All Continuum charges per member compared against employer's 12-month pre-pilot SUD spend per episode (ED, inpatient, pharmacy, outpatient BH claims). | Below baseline |
| Same-navigator rate | Members who had the same navigator from intake through measurement point | Continuum assignment records | Members with zero navigator reassignment / total active members. | 95%+ |
| Component | Rate | Basis |
|---|---|---|
| Per-patient per-month | $750–950 | During active treatment |
| Maintenance phase | $200–350 | Monthly after step-down |
| Setup / implementation | $0 | No setup fee |
| Termination fee | $0 | Walk away anytime |
| Item | Monthly |
|---|---|
| Prescribing clinician (6 hrs/wk @ $175/hr avg) | $4,200 |
| Navigator (1 W-2 LCSW) | $5,000 |
| Clinical director (5 hrs/wk @ $125/hr avg) | $2,500 |
| Telehealth platform | $300 |
| E-prescribing + PDMP | $200 |
| Malpractice insurance (prorated) | $2,100 |
| Supabase infrastructure | $25 |
| Total monthly operating cost | $14,325 |
Average SUD-related ED visit: $3,500–$5,200. At 40% reduction for treated population, savings of $1,400–$2,080 per member per year in ED costs alone. For 50 treated members: $70K–$104K annually.
Opioid-involved workers' comp claims cost 7x more than non-opioid claims. Median: $67,622 vs. $9,643. Early MAT intervention reduces claim duration and total cost.
Employees with untreated SUD miss 14.8 additional work days per year. At median wage, that represents $3,500–$6,000 per employee in lost productivity annually. Treatment reduces absenteeism by 40–60%.
Employer reviews final scorecard. All 8 metrics measured against agreed targets. ROI analysis delivered. Three options: continue at pilot terms, expand to full contract, or terminate with no penalty. The scorecard is the decision document.
12-month initial term with annual renewal. PEPM at pilot rates (or better, at volume). Performance guarantees formalized: retention, adherence, and ED utilization targets with PEPM adjustment if missed. Gain-sharing on ED savings above baseline.
Pilot proves on a defined segment. Full contract expands to all eligible members. Additional referral pathways opened. Workers' comp coordination formalized. Second navigator hired at 20+ active members. OH operations added if KY-only pilot.
After 12 months of claims-verified outcomes: shared savings model. Continuum shares in verified ED diversion and claims reduction above baseline. Performance guarantees tighten. PEPM adjusts based on demonstrated outcomes. Capital reserved against guarantees.
Monthly utilization report (aggregate). Quarterly scorecard with all 8 metrics. Annual claims-verified outcomes analysis. All reports delivered within 10 business days of period close. No self-reported outcomes. Everything verified against claims.
90-day notice for either party. No termination fee. Active members transitioned to alternative treatment with warm handoff. Treatment records provided to member (not employer) per 42 CFR Part 2. Navigator continuity maintained through transition period.
Consent requirements: Written consent required for any disclosure of SUD treatment records. Consent must specify: who may disclose, who receives, purpose, extent of information, expiration date, right to revoke. Separate consent for each recipient.
Re-disclosure restrictions: Every disclosure must include: "This information has been disclosed to you from records protected by federal confidentiality rules (42 CFR Part 2). The federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains."
Medical emergency exception: Part 2 permits disclosure without consent when a member's life is in immediate danger. Limited to information necessary to address the emergency. Documented in audit log within 72 hours.
2024 final rule: HHS aligned Part 2 with HIPAA for treatment, payment, and healthcare operations disclosures (effective Feb 2024). Consent still required for initial disclosure. Re-disclosure notice still mandatory. Our consent flow already reflects the updated rule.
Audit requirements: Audit trail on all PHI access. Breach notification within 60 days. Annual compliance review. Already built into Supabase schema.
42 CFR Part 2 → ecfr.gov/current/title-42/chapter-I/subchapter-A/part-2
DEA finalized permanent telehealth prescribing rules for Schedule III–V substances (2024). Buprenorphine (Schedule III) prescribable via telehealth without in-person visit. X-waiver eliminated by MATE Act (2023). Prescribers must complete 8-hour training (MATE Act requirement) for DEA registration or renewal. DEA registration required in each state of practice. Prescribing clinician must hold active medical license in the state where the member is physically located at time of visit. Electronic prescribing for controlled substances (EPCS) compliant system required.