How to Start a Psychedelic Clinic Part 3: Getting Paid
Access and Reimbursement are far from Guaranteed
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This is part 3 of our series on "How to Start a Psychedelic Clinic" which addresses access and reimbursement.
Though not necessary reading for this piece, here are links to Part 1 and Part 2,
Two quick points:
To be sure this is not intended to be an instruction manual, I am merely trying to answer the questions that I have about this emerging therapeutic model and industry as I encounter them.
Please offer critique, corrections, thoughts, opinions, feedback by replying directly to this dispatch or emailing TheTripReport@protonmail.com
Demand for psychedelic-assisted therapy could far outpace supply
Third-Party Reimbursement is far from guaranteed
Self-Pay and creative solutions will be required
The TOMS/Vipassana Model
How to Start a Psychedelic Clinic Part 3: Getting Paid
Access and Payment Uncertainty
There are two areas of uncertainty to address for anyone thinking about bootstrapping a psychedelic clinic:
How to meet the expected demand
How to get paid
The Access Problem
Demand for psychedelic-assisted therapy will surpass the supply.
There's no doubt that the media will have a field day with the idea of a "club drug" becoming a legal treatment for a condition that afflicts/creates society's most vulnerable.
Up until this point, I get the sense that trial participants have been self-selected and fall on one side of a predictable cultural/political divide.
With the announcement of Expanded Access and then FDA approval "all kinds of folks" suffering from PTSD and related conditions will flock to treatment centers and participants will represent more and more unrepresented groups as incredulity turns to caution, caution turns to curiosity and curiosity turns to action.
However, don't count on insurance companies to pay for it.
The Reimbursement Problem
There is an inherent tension between self-pay models and third-party payer models.
The assumption that third payers are required in order to ensure access to those with limited means is understandable but lacks imagination and rigor.
In the rollout of psychedelic medicine, MAPS, COMPASS and perhaps others are deeply involved in hashing out negotiations with third-party payers in the United States, Canada, and Europe to ensure patient access and provider reimbursement.
But for most of us, the question of third-party reimbursement is a black hole is a major unknown.
Brad Burge appeared on the Psychedelics Today Podcast in February of 2019 (his assessment begins at the 24-minute mark). In short, it is really hard to speculate about how the treatment will be coded and billed and how and if insurance companies will reimburse for this form of treatment.
In conversation with Psymoposia for an excellent piece on this very topic, Ekaterina Malievskaia, co-founder of Compass Pathways, the London-based pharma company ushering psilocybin through the regulatory process, noted:
“There are no mechanisms in place in mental health care to ensure the coverage of a drug-therapy combination...“ We will have to be innovative in how we develop these [mechanisms], working with all stakeholders, including insurers.”
Rick Doblin, in the same piece, noted,
“Our negotiations [with insurance companies] involve adding various measures of health care utilization and functionality to our Phase 3 designs including long-term follow-up...The purpose of these measures is to try to demonstrate in our research subjects that helping reduce PTSD symptoms also reduces other health care due to high levels of stress, emergency room visits, heart attacks, strokes, etc... Until this treatment is proven without a doubt to reduce long-term costs, many insurance companies do not have an incentive to cover MDMA-assisted psychotherapy.”
These quotes, however, are outdated and they might have more information to share. I am going back to recent podcasts with Rick to see if I can find a more recent take. (if readers have insight into this please share)
Even with insurance coverage, it would be prudent to have other plans in place to generate revenue, because, after all they are insurance companies and their incentives often diverge from 1. patient access 2. quality care and 3. provider reimbursement.
In fact, insurance companies are known for making all three extremely challenging.
This means the psychedelic industry/community needs to start thinking outside the box.
Drugs Sell Themselves
I have seen estimates of the cost of a full course of treatment to be between $5k-$15k.
The major concern among the psychedelic community is ensuring access to “those who need it the most". Unfortunately, across the healthcare landscape access to care most strongly correlates with income/wealth. However, the psychedelic medicine community has the desire to avoid this inevitability and close the health/wealth gap.
There is a model that can address this issue that I can't imagine working for conventional care models as they are currently incentivized but might work in psychedelic medicine.
The TOMS/Vipassana model
TOMS is a shoe company that donates a pair of shoes to an impoverished child for every pair purchased. Buy one give one. Everyone knows Toms.
Perhaps Trip Report readers are less familiar with the model that SN Goenka has created for a 10-day silent Vipassana retreats. These meditation retreats are popular because they are (mostly) free of dogma and other trappings that make most spiritual situations insufferable for many and they are donation-based, with no suggested amount.
The organization has hundreds of retreat centers around the world.
The scale and durability of this program are impressive.
The assumption is that median and modal contribution is not enough to fund such an enterprise, but occasionally someone of means has such a powerful and significant experience that they make a sizeable contribution that more than makes up for the high volume of modest donations.
When I completed my experience I noticed that the participant who made the donation before me in the ledger contributed 10x what I could then afford.
This could work for psychedelic medicine.
The impact of a psychedelic experience in a therapeutic environment is often rated as one of the most important experiences of one's life.
The heart-opening capacity of the psychedelic experience creates a feeling of love and desire for other travelers in this life.
When combined with means and the opportunity to support access to psychedelic medicine, I have no doubt that there will be people enthusiastically willing to pay above and beyond the cost of treatment so those of lesser means can participate.
To deliver Psychedelic Medicine in an ethical, responsible and accessible manner is the hope for most of us involved in this field.
I would love to hear feedback, thoughts, opinions.
We’re in the midst of a revolution in consciousness, medicine, and health.
The transition, already underway, from underground, illegal and sacred to commercialized, legal and profane is fascinating, scary, and hopeful.
If you’re as fascinated by this transition as we are, The Trip Report has you covered.
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