This NYT article focuses on a trend in the “high end” segment of the treatment marketplace, towards transitional living residences where those who can afford it enjoy luxury in a recovery-positive atmosphere. The opening anecdote makes it plain what these customers are looking for: a program that’s discreet, serves a primarily professional clientele, and doesn’t interfere with the resident’s work obligations.

The article puts the cost between $10-17k a month. It’s often out of pocket. Silver Hill and Caron are mentioned, but they’re not alone.

Also mentioned are rehabs designed along the same lines that can charge $65-85K for a month or six weeks in residence. To most of us, that sounds out of line. But the usual rationale is, if you can afford it, why not?

In practice, high-priced treatment programs have been around for as long as I can remember. At one time, they were supposed to disappear with the advent of  managed care. Instead, many reorganized to succeed without insurance business, focusing on private self-pay clients. They prospered with a business model that was closer to the hotel and entertainment industry than traditional healthcare. No denying that the demand was real. As new competitors entered the arena (they always do), some programs adapted their business model to once again allow insurance patients.

The rehab field has always divided itself into low-, mid-, and high price ranges. Programs at the low end aim to serve customers who can’t or won’t pay more for treatment (including government). That’s  a big group, obviously, and the lower price dictates these programs depend on higher patient volumes. The midrange customer will be less restricted financially, and assumes that a slightly more expensive option will at least be more comfortable than its low-end counterpart. The high-end customer naturally expects more in the way of special care and treatment for the extra money.

It’s a market that I’ve seen compared to a neighborhood that includes fast food places, a popular family restaurant, and a luxury steakhouse. Not a bad analogy.

Over the years, I’ve both directed and consulted to a number of programs in all three categories. My conclusion: treatment itself is quite similar, regardless of the level. A quality low-cost program can, run properly, do much of what the higher-cost options do.

How could that be? Addiction treatment has matured over the decades.  Like other maturing industries, it’s become more standardized and quality-conscious. For example, any licensed inpatient rehab will adhere to the same Federal confidentiality rules, comply with a set of very similar State laws, and increasingly, maintain full accreditation with one of a few accrediting bodies. Now there’s a push to integrate medications into every clinical program. As far as patient education goes, you can purchase a fully formed, evidence-based treatment curriculum from one of a number of vendors. Then go hear one of a relatively small group of recognized experts present at conferences where you can sit and take notes alongside the staff from other programs.

A colleague of mine refers to this as the “homogenization” of the treatment experience. In healthcare, this generally regarded as a good thing. The goal is for patients to receive quality care regardless of where they happen to land in the treatment system.

How does one entrepreneurial provider establish themselves as superior to the competition? Well, they can be the lowest cost. Or, they can advertise themselves as having the most advanced, sexy, new treatment approach. Or, they can offer the most specialized, individualized range of services.

The marketplace is big enough to accommodate success in all three areas.

But those are really business and marketing considerations. Under the surface, where recovery lives,  what makes one program superior to its competitors will always be the people who work there. The good news is that genuine quality programs may be found at all price points. But you may have to do some work to locate it.


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