Recovery Centers Of America Presented to: Evan Allen and David :33; I The Addiction Epidemic is Exploding • Over 200 million opioid prescriptions were filled by U.S. pharmacies in each of the past 5 years • In 2015, substance use disorders (SUDs) killed almost 90,000 Americans and contributed to many more deaths due to comorbidities, car accidents, gang and domestic violence, and suicides • Drug overdoses are now the leading cause of death among Americans under 50, increasing 19% year-over-year from 2015 to 2016 • Fentanyl related deaths increased 72% from 2014 to 2015 • According to the Surgeon General, the total societal cost of drug & alcohol misuse in America exceeds $440 billion − Alcohol misuse alone costs society an estimated $249 billion annually, which includes lost workplace productivity, medical expenses, criminal justice costs, and car accidents − The same issues related to illicit drug use cost society an additional $193 billion annually. In particular, opioid abuse is estimated to result in over $72 billion in medical costs each year 2 Statistically Significant Drug Overdose Death Rate Increases from 2014 to 2015 by State 10.5% 26.2% 35.3% 20.4% 13.3% 7.6% 20.1% 25.6% 21.5% 16.9% 21.1% 14.5% 20.1% 13.8% 30.9% 16.4% 12.4% 20.5% 22.7% Note: Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug-poisoning deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Age-adjusted death rates were calculated as deaths per 100,000 population using the direct method and the 2000 standard population Source: CDC/NCHS, National Vital Statistics System, Mortality 3 Drug Overdose Death Rate Increases from 2014 to 2015 by State Source: CDC/NCHS, National Vital Statistics System, Mortality Top 20 Drug Overdose Death Rate Trending Changes by State 2014 to 2015 # State Percent Change 1 ND 36.5% 2 MA 35.3% 3 DC 31.0% 4 NH 30.9% 5 ME 26.2% 6 CT 25.6% 7 FL 22.7% 8 OH 21.5% 9 KY 21.1% 10 RI 20.5% 11 NY 20.4% 12 MD 20.1% 13 PA 20.1% 14 VT 20.1% 15 IA 17.0% 16 WV 16.9% 17 NJ 16.4% 18 NC 14.5% 19 TN 13.8% 20 MI 13.3% 4 The United States Has an Immense Addiction Treatment Gap • In 2015, an estimated 21.7 million Americans (8.1% of total population) needed treatment for a problem related to drugs or alcohol, but only about 2.3 million people (11%) received treatment at a specialty facility • 66 million people (20% of all Americans) engage in risky use of drugs and alcohol • 58 million people (17% of all Americans) reside in RCA’s primary marketplace • Therefore, RCA has between approximately 4 and 12 million potential patients in its primary marketplace • If 100% of RCA’s facilities were 100% occupied and all of RCA’s colleagues were also 100% occupied, RCA could only treat 20,000 patients, or 0.5% to 0.2% of patients potentially needing treatment 21,700,000 66,000,000 5 :33; I According to the Boston Globe… • Massachusetts’ overdose rate is more than twice the national average • Heroin usage is increasing and having deadly consequences − In 2014, half of all opioid deaths in Massachusetts involved heroin vs. in 2010, heroin was implicated in less than 20% of opioid deaths • Ages 25-34 have the highest incidence of deaths related to prescription opioids and heroin in Massachusetts • Between 1999 and 2010, Massachusetts saw a six-fold increase in deaths from such prescription opioids • Beginning in 2010, the state has outpaced national trends. • Between 2013 and 2014, prescription opioid overdoses have increased by over 90 percent Source: bostonglobe.com- Heroin, prescription opioids form especially toxic mix in Mass. 7 Death Rates Increasing at a Staggering Pace • From 2000 to 2016, there has been a 446% increase in annual opioid-related deaths, and a 41%, 32%, and 15% year-over-year increase from 2013 to 2016 • New England is the epicenter for heroin and opioid related deaths − Massachusetts, New Hampshire, Rhode Island, Vermont and Connecticut all place in the top ten worst-hit states in the nation for heroin and opioid-related deaths • Heroin and Opioid-related deaths per state in 2015: Massachusetts (1,724), New Hampshire (422), Rhode Island (310), Vermont (99), Connecticut (800) Source: http://www.mass.gov/, https://www.nytimes.com, bostonglobe.com- Heroin, prescription opioids form especially toxic mix in Mass. 8 Source: http://www.mass.gov/eohhs/docs/dph/stop-addiction/current-statistics/overdose-deaths-by-county-including-map-may-2017.pdf 9 Addiction Demographics in Massachusetts • There is a population of 6.9 million people in the Commonwealth of Massachusetts • Based on the national average of 8.1% needing treatment, there are approximately 558,000 residents suffering from a substance use disorder • There are 1,496 beds serving patients in Massachusetts • The Boston Center for Addiction Treatment will have 207 beds and RCA at Westminster will have 90 beds • Assuming all available beds are 100% full for the entire year and two treatment cycles per month are authorized by payers, 43,000 patients could be served or 7.7% of those needing treatment • If payers approve the recommended 30 day treatment cycle, then 21,500 patients per year or 3.85% of those needing treatment could be served • Both assumptions assume that colleagues accept MassHealth and in-network insurance, which most do not • This total number includes Florida method operators and other substandard treatment facilities 10 National Drug Use Data - Millennials • Millennials between the ages of 18 and 20 account for the highest rate of current illicit drug use, with 22.7 percent of that population reporting illegal drug use in the past month • The next highest rate is among 21–25-year-olds, with 21.5 percent reporting past-month use • The American Council on Science and Health reports that millennials between the ages of 25 and 34 are the most likely age group to die of an opioid overdose • In 2010, the overdose rate for opioids for this age group was 2.2 per 100,000. By 2015, it had more than quadrupled to 9.7 per 100,000 • Between 2013 and 2014, the rate of overdose for millennials increased by more than 10 percent, from 12,716 opioid overdose deaths in 2013 to 13,962 in 2014, according to the Centers for Disease Control and Prevention • All told, more than one out of every 12 deaths among millennials between the ages of 25 and 34 is due to an opioid overdose IE 12 Rmn'c? The RCA Challenge • The behavioral health treatment industry, is a highly regulated industry that is misunderstood by the public, the media and government • Behavioral health patients are the most discriminated human beings in America today • While every family and neighborhood are gravely affected by the disease of addiction, most neighborhoods go out of their way to prevent the construction and location of behavioral health facilities in flagrant violation of the law • Despite The Mental Health Parity and Addiction Equity Act, insurers, Medicaid, Medicare and government health insurance programs (including those for veterans and members of the armed services benefits) do not adequately cover addiction treatment in flagrant violation of the law, due to exceptions and loopholes • Those less fortunate are most affected 13 The RCA Challenge • The size of this epidemic is expanding rapidly • RCA wants to change the way addiction is treated, therefore, we need to do it on a massive scale • In order for RCA to achieve its mission, vision and goals, it needs to work collaboratively with its colleagues in the industry • Massive legislative changes at the state and federal level need to be implemented • The cost of zoning, legal, legislative change, regulatory compliance, clinical excellence, hiring top talent and construction of world-class facilities is massive • Not moving quickly and on a massive scale will result in millions of lives unnecessarily lost 14 The RCA Action Plan • RCA has assembled the finest management team in the industry • RCA is forcing neighborhoods to allow the construction of treatment facilities by utilizing the legal system where necessary • RCA legal victories are making it easier for others to open treatment facilities • RCA has designed a sophisticated, complex hiring and retention system enabling RCA to attract the thousands of employees it needs to operate • RCA has sponsored legislation successfully on the state level and is currently sponsoring legislation on the federal level which will make treatment available for all Americans regardless of financial means 15 The RCA Action Plan • RCA is building a series of world-class inpatient facilities in the Northeastern United States to attack the addiction crisis on a massive scale and set a new bar for the industry • RCA is also opening outpatient and medication assisted treatment facilities nationally • RCA is sharing its knowledge, legislation and experience as well as referring its patients to its colleagues • RCA is developing a massive technology platform to automate the treatment, medical record, payer interaction, hiring and retention process • RCA has developed a 24/7, 365 days per year mission center which answers over 13,000 calls per month within 5 seconds or less • RCA has developed a transportation network of owned vehicles and hired drivers to provide transportation 24/7, 365 days per year • RCA created the “Second Chance Program” which hires members of the recovery community despite their backgrounds and legal challenges 16 The RCA Action Plan • RCA has created a complex digital and media platform which combines multiple software capabilities to reach thousands of people and families suffering from addiction every day • RCA executives make multiple presentations and write over 700 posts and articles per year and appear frequently on radio and TV to educate the public on addiction treatment and recovery • RCA believes that patients should receive treatment whether it’s with RCA or other reputable providers. RCA refers hundreds of patients to reputable providers each month and shares all of its findings with members of the recovery community The RCA Mission Statement LOGO: Recovery Centers of America PURPOSE: Get 1,000,000 patients into meaningful recovery, one neighborhood at a time MISSION: In our neighborhood based treatment facilities we strive to provide the best practices to diagnose and treat people and their families suffering from drug/alcohol disorders with the direct goal of decreasing morbidity and mortality rates by decreasing the relapse rates, and increasing the recovery rates. This will be accomplished by an integrated comprehensive treatment program for the patient and family with continuity of care from the detox phase, to residential care, to ongoing outpatient, and individual and family therapy, integrated with medication where appropriate, and participation in a 12 step program for a minimum of one year post discharge with continued follow up in the second year. CORPORATE VALUES: Passion Dignity Respect Integrity Excellence Advocacy Experience Innovation Compassion Expertise Inclusion PROMISE: Integrity of treatment: Every patient is treated with respect and dignity in our five star facilities which offer a community of recovery and restores the confidence they need to succeed. We provide the highest standard of clinical care and evidence-based practices to ensure men and women suffering from addiction are prepared in a safe and comfortable environment to transition into a full life of recovery where they live. 18 RCA History • RCA was founded in August of 2014 with 5 employees and seed financing provided by Brian O’Neill after performing an intervention with Jay Youtz and concluding that the drug and alcohol rehabilitation industry needed radical overhaul • The original RCA business plan called for the opening of 8 inpatient facilities and 14 outpatient facilities located between Maryland and Massachusetts • The RCA business plan includes a $14 million investment in platform technology, enabling the business to run on a fully automated basis with paperless connection between payers, electronic health records and patient files • RCA identified the top 5 managers in the behavioral health industry in the country and began recruiting in September of 2014, 100% accepted 19 RCA History • Without a single facility open, RCA recruited the following senior managers − Deni Carise, PhD, Deputy Chief Clinical Officer, for CRC, the largest behavioral health company in the world, adjunct professor at the University of Pennsylvania, historic advisor to the United Nations, Nigeria, Egypt, Singapore, Thailand, Iraq, Iran, The City of Nairobi, Brazil, Israel, China and The White House. − Kevin McClure, CFO of NHS Human Services, the largest non-profit community based, behavioral health company in the U.S. − Deanna Telese, VP, Corporate Controller of NHS Human Services − J.P. Christen, VP of Acute Finance of UHS, an $8 billion national chain of acute care and behavioral hospitals headquartered in King of Prussia, PA − Jay Youtz, Head of Intervention Services for the Malvern Institute in Malvern Pennsylvania • Each of these senior managers left senior level positions in successful and established companies to join RCA in its mission to change the way addiction is treated 20 RCA History • After $10 million of additional seed funding, RCA began presenting its business case and vision to private equity firms, banks and debt funds • RCA made over 25 presentations and received multiple term sheets • RCA entered into an agreement with Deerfield Management who invested $231.5 million of debt and equity into the company • Deerfield has subsequently invested an additional $100 million 21 RCA History • RCA acquired the following facilities: − Blackwood • 125 beds − BCAT • 207 beds − Bracebridge Hall • 39 beds, with build out to 111 beds − Billingsley • 140 beds • RCA acquired “Lighthouse” a 53 bed facility in Mays Landing, NJ in March of 2016. Lighthouse was the first facility to open and is currently being expanded to 135 beds • RCA acquired “Westminster” in April of 2016, a 48 bed facility in Westminster, MA. It is currently being expanded to 90 beds • RCA acquired “Devon” in December of 2016. Devon is opening this month with 62 beds and will ultimately have 248 beds 22 The RCA Difference • Our neighborhood model – We build world-class facilities in neighborhoods close to where our patients live and work. When patients recover in their own backyard, the love and support of their family and friends plays a crucial role in their recovery • Our five-star patient experience enables our patients and their families to open their hearts and minds to accept treatment and allows patients to stay well longer • World-Class Care – We treat the body, mind and spirit. We have medical professionals on site 24/7 and provide the best doctors available who treat the disease of addiction in the comfort of a safe environment • Relentless Advocacy – We work with lawmakers and insurance companies to ensure care is affordable, accessible, and available to our patients. Our dedicated staff is interventionist-trained and committed to fight for our patient’s rights and work tirelessly to remove the prejudice of addiction • Community of Recovery – We help our patients replace negative people, places and things with positive people, places and things • Integrity of Treatment – ensures that our patients receive the highest level of care in our beautiful facilities with the promise of a healthy progression into recovery • Restoring Confidence – our unprecedented leadership training skills designed to restore patient confidence (Dale Carnegie, Tony Robbins, Napoleon Hill) helps them transition successfully into a life of recovery 23 ICOMMITTO PUTTING THE PATIENT FIRST ALWAYS Wewllrelmtlenly lulu-uh an behl?of i" Ma?a-mum Haw-ill unplug Impmheruin mul?d'lciplimnr Hamill include mandatory with ulmufmp?onllh-dmhd?w mm Family immnt in ?nlncill munch parlor it. nulls. mm nfnur i exploratmtiue lulutimll in than hrdmisu'on ?r WW PATIENT We will mmit in dink-Imus?. ?twill pet-ion? mum: unfam- pltil'?t'l physical . Indira I I 4? ?IL-nil to akingthu multiph mill him any and with quu?om mm and mating need it. lid reviewing? much h'nwtinl medical II is mihbh. Weu'illhutuurpltimtlui?idini?, HI: 1will alt-Hilh cup-nth! dammit! mmhenlive MPH-1- mm. can manta-mint plum til-um ind, unwind, lid audited hymedicll. ?chi-try. dink-l. mud in dimmralcu: ?Martin's: HY COMMITMENT: RCA’s Highlights  RCA has built an industry changing platform to rollout a national series of neighborhood based, family focused, comprehensive substance abuse treatment centers  RCA has assembled a world class management team capable of scaling a multi-site substance abuse treatment organization across the United States • The average experience of RCA’s management team is 20 years and the combined team has operated over 800 behavioral health and over 400 other healthcare facilities • RCA’s management team has led organizations that treated over 65,000 patients daily • The RCA team has extensive expertise in delivering exceptional clinical care along with healthcare operations, acquisition and integration, finance and accounting, IT, billing, sales and marketing, human resources and training • The RCA team also has extensive real estate and business, new site development and implementation including acquisition, zoning, licensing, construction, and design procurement are also core strengths of the RCA team 25 RCA’s Highlights (continued)  RCA is creating the first of its kind, neighborhood based comprehensive treatment centers which include inpatient/residential and various outpatient modalities, family services, mental health treatment and spiritual centers and recovery support (coaches, AA, NA, NARANON, ALANON, etc.) in one location making treatment availability much easier for the patient • RCA will also operate several specialty facilities  RCA has opened four sites with eight additional sites opening within the next 18 months throughout the Washington D.C./Baltimore, Philadelphia/Wilmington, New York, and Boston MSA’s  RCA’s facilities incorporate the finest materials including those found in leading hotels around the world, including superior quality mattresses and bedding, elegant bathrooms, spectacular meeting environments, fine food and service, and a staff dedicated to attending to RCA’s patients daily needs with warmth and enthusiasm; comfortable surroundings help patients focus on their treatment  The RCA Training Department provides training on clinical delivery of care, health records completion, evidence-based practices, supervision of the company, organizational skills, etc. to ensure RCA professionals deliver the best treatment in the industry while outlining specific career tracks for RCA staff 26 IE 27 Rmn'c? The “Florida Model” • The “Florida Model” of substance abuse treatment provides housing in one location and treatment in another − Providers house patients in rented houses and motels, and bus patients to and from their treatment sessions which are held in remote office buildings and strip shopping centers • There is little structure and supervision in the home or motel, people can come and go as they please and are at high risk of relapse during the non-treatment hours • Florida Model operators generally do not provide detoxification services • Florida Model operators generally do not employ medical personnel around the clock or at all • Florida Model operators are usually “Out-of-Network” with insurance companies and target patients with PPO policies with rich “Out-of-Network” benefits • Florida Model operators rely on excessive point-of-care and laboratory testing for a large part of their revenues • Many Florida Model operators rely on “Patient Brokering” to fill their facilities • Most Florida Model operators cannot receive Joint Commission Accreditation or qualify for “InNetwork” contracts with major insurance companies • Attorney Generals in many states, including Massachusetts, are investigating the business practices of Florida Model operators • There is pending legislation, nationally and at the state level which will place minimum requirements on drug and alcohol rehabilitation facilities, virtually outlawing the Florida method of operation • The Florida Model operations rely on “Out-of-State” patients, removing patients from their families and their neighborhood 28 What Treatment Does a Florida Model Provide? • Partial Hospitalization • Intensive Outpatient 29 Florida Model – Housing With Limited or No Supervision (separate location than counseling) http://www.nbcnews.com/feature/megyn-kelly/florida-s-billion-dollar-drug-treatment-industry-plagued-overdoses-fraud-n773376 30 Florida Model – Housing With Limited or No Supervision (separate location than counseling) https://www.nytimes.com/2017/06/20/us/delray-beach-addiction.html 31 Florida Model – Counseling in Strip Mall http://www.nbcnews.com/feature/megyn-kelly/how-find-good-drug-treatment-program-avoid-bad-ones-n776101 32 IE Rmn'c? 4% .- . Boston Center for Addiction Treatment i RCA at Westminster a" O. RCA at Westminster ?MyMAIN ENTRANCE RCA at Lighthouse The RCA Model • RCA builds neighborhood based, world-class centers for addiction treatment • Each RCA facility is specifically designed and constructed to provide five star clinical care and accommodations • All RCA facilities are constructed with internal corridors, limited entrances and exits, living accommodations, fitness, dining, yoga, therapy, treatment and meeting rooms all in brand new custom designed and constructed state of the art facilities • All RCA facilities provide 24/7, 365 days per year medical and clinical supervision to 100% of its inpatient patients • All RCA facilities provide III.7d, Medically Monitored Intensive Inpatient Services, and III.5, Clinically Managed High Intensity Residential Services • Most RCA facilities also provide Partial Hospitalization, Intensive Outpatient, General Outpatient and Family Counseling programs • Every RCA patient is accounted for every hour, 24 hours a day, 7 days a week, 365 days a year • Every RCA facility hosts 12-step meetings on-site for the community and our patients 42 The Florida Model All RED time is a breaking point, time a patient may, for whatever reason, change their mind 43 The RCA Neighborhood Model All RED time is a breaking point, time a patient may, for whatever reason, change their mind 44 The RCA Operations, Safety, Compliance and Licensing Team • Led by J.P. Christen, Christina Madeira and Chardonnay DiNenna • RCA has 899 employees • All RCA facilities are licensed to operate in their jurisdiction • All RCA facilities operate under strict compliance guidelines and are audited regularly by members of the RCA safety, compliance and licensing team • All RCA facilities are also audited regularly by federal, state and local licensing authorities • All RCA facilities are also routinely audited by members of the RCA operations team • All RCA facilities are also routinely audited by the insurance companies that RCA has “In-Network” contracts with • All RCA facilities are also routinely audited by the clinical team • Once open, all RCA facilities are accredited by The Joint Commission and are subject to a 3 to 4 day inspection as well as routine unannounced audits • RCA has over 16 employees in their corporate auditing, clinical auditing and safety, compliance and licensing team • Maintain the integrity of the RCA mission 45 RCA Human Resource Team • Led by Bill Anstee, Chief Human Resource Officer, has 25 + years of experience with hospitality operations and health care human resource with the Marriott organization and Sodexo Quality of Life Services Group. He has also assisted teams with the start up of a Senior Living division for Sodexo and the National Contract team for all the Marine Corp bases in the US. The RCA human resource department is staffed with 14 team members, responsible for recruiting and retaining over 2,000 best-in-class members of the RCA team • The RCA human resource department is currently hiring 200 people per month and is scheduled to hire nearly 1,000 additional team members in 2018 • The RCA human resource department designed a revolutionary hiring methodology, incorporating digital marketing, the Laborocity Linear Path Process and a national recruiting team which substantially increased RCA’s ability to efficiently and quickly hire superior teammates at a time where there is near zero unemployment • The RCA human resource department oversees onboarding, recruiting and retention, employee benefits and employee engagement • The RCA human resource department works in partnership with RCA’s marketing department to communicate, build and reinforce the RCA mission, value and culture • The RCA human resource department has embarked on a revolutionary and innovative methodology for documenting, communicating and reinforcing highly granular job descriptions and responsibilities for its team members • The RCA human resource department grows its field of world-class team member candidates by actively engaging with communities, universities and colleges to educate and inspire candidates to embrace a career in addiction treatment • Maintain the integrity of the RCA mission 46 RCA Clinical, Architecture and Training Team • Led by Deni Carise, PhD. • The RCA Clinical Architecture and Training Team has 21 team members and develops, trains, promotes and ensures quality of all clinical services delivered at RCA. The team is also responsible for architecting the entire treatment delivery system for all RCA facilities as well as creating a center of excellence through research, education offerings, presenting at industry conferences and publishing • The team consists of three groups: (1) Training, (2) Quality Assurance and (3) Outcomes • The Training group identifies, develops and provides training on all aspects of care delivery and operations. This includes clinical services and operations, providing ongoing coaching and tracking of competency in skills. Our masters level staff have specializations in family therapy, cognitive behavioral treatment, motivational interviewing, clinical supervision, treatment systems and implementation. They provide training and ongoing coaching for all staff • Maintain the integrity of the RCA mission 47 RCA Clinical, Architecture and Training Team • The Quality Assurance group develops foundational tools and practices for clinical programming ensuring adherence to best practices and all regulatory/accreditation requirements − Additionally, the Quality Assurance team provides fidelity monitoring of service delivery, measurement based care, and practice implementation. Performance Improvement measures are created based upon results of fidelity monitoring, with focus on improving patient care and treatment effectiveness • The Outcomes/Research team ensures excellence by using patient surveys, data and outcomes to document treatment effectiveness and improve care and services. Patient satisfaction is reported on a weekly basis and information is provided to each site and the main office − Led by Debbie Van Horn, Ph.D., they also implement performance measurement and outcomes studies, following up on patients after discharge. Below is an example set: • Wave 1 (April-July 2017): 118 patients followed up to 12 weeks • Wave 2 (July 2017): 69 patients contacted at 4 weeks • Wave 3 (current – began July 26) - 60 patients per week added to follow-up sample 48 Our Patients • 60% between the ages of 18 to 34 addicted to opioids and heroin • 30% between the ages of 18 to 85 addicted to alcohol and benzodiazepines • 10% between the ages of 18 to 85 addicted to cocaine, crack, methamphetamines and other substances • 75%+ also abuse alcohol • 40% of patients have a co-occurring disorder • 68% are male, 32% are female • At BCAT, 60% are male, 40% are female • At Westminster, 73% are male, 27% are female • The most prevalent age range for patients attending treatment is 24 to 26 • The majority of our patients are millennials RCA Treatment Philosophy • Structured treatment in an inpatient facility is an essential gateway step to achieving long term recovery • Creating a first class patient centric environment is essential to opening the patient’s heart and mind to accept treatment • We incorporate the latest evidence based practices into our everyday treatment services, delivered with fidelity and integrity • We incorporate other helpful engaging services that promote patients wellness leadership skill and self-care abilities, such as leadership seminars, yoga, exercise, life skills, nutrition, fitness and physical health and relaxation training RCA Treatment Philosophy • We build our facilities in the neighborhood, making it easy for families to visit and stay involved (studies show the likelihood that people will stay in treatment and maintain recovery is greatly increased by family involvement) allowing patients to develop sober support networks with others in the community • It is essential for the family to participate in therapy and treatment with and parallel to the patient • We incorporate a rigorous 12-step immersion for all patients while in treatment and focus on at least 12 months of 12-step participation post discharge • We provide a continuum of care which includes detoxification, inpatient residential, PHP, IOP, OP and Medication Assisted Treatment, where appropriate (Provided through our outpatient network), 12-step (Often times in our centers for addiction treatment) and alumni participation through our alumni groups RCA Treatment Philosophy • A majority of our patients have significant co-occurring disorders, we provide psychiatric services for each of our patients to assess and treat co-occurring disorders • We have discovered that there is significant need for more comprehensive psychiatric treatment • We are in the process of implementing this more comprehensive psychiatric treatment in Massachusetts by building a separate and distinct psychiatric practice to ensure immediate service for our patients • A majority of our patients have acute medical issues (95% of our patients have not seen a primary physician or dentist in the past 12 months), we are rolling out separate and distinct medical practices to ensure that our patients receive the proper medical attention they need RCA Treatment Philosophy • Our patients require sober living housing post discharge from our inpatient facilities • Most sober living facilities are under financed and not supervised, putting the patients in severe risk of relapse • Travel and transportation poses a major barrier for patients’ ability to attend outpatient treatment and 12-step meetings • RCA has designed the first national program for “Structured sober living” which provides 12-step meetings life skills training outpatient treatment and sober living under one roof • RCA is opening its first facility in Queenstown, MD in March of 2018 RCA Treatment Philosophy • Many patients addicted to heroin and other opioids require long term “Taper” in order to successfully recover • RCA has been actively educating federal and state governments, Medicare and Medicaid, and multiple insurance plans on the need to provide medication assisted treatment (“MAT”) • Recently, the national organization of Blue Cross Blue Shield companies has adopted medication assisted treatment as an approved method of treatment • Medicaid expansion now covers many patients previously not covered for MAT • The MAT industry has traditionally provided minimal counseling in second rate facilities • RCA is rolling out world-class patient centric MAT centers across the United States which incorporate mandatory counseling and connect patients to inpatient and outpatient treatment where necessary Outcomes Example 4-Week Substance Use Outcome Pilot Data (excluding missing data) 1 0.8 0.6 0.4 0.2 0 1 Abstinent 2 3 Week post-discharge Not abstinent 4 In controlled environment 55 Outcomes Example 4-Week 12-Step Attendance Pilot Data (excluding missing data) 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 1 Attended 12-step 2 3 Week post-discharge No 12-step attendance 56 4 In controlled environment Outcomes Example 4-Week Continuing Care Attendance Pilot Data (excluding missing data) 1 0.8 0.6 0.4 0.2 0 1 2 3 Week post-discharge Attended continuing care 4 No continuing care attendance In controlled environment 57 Outcomes Example 4-Week Outcome Data 100% 20% Abstinence Continuirg Care Setf- Help Attendance Attendance I Yes I No I In controlled environment 58 5-. Recovery Centers of America Patient Satisfaction - Overall 100 80 6O 4O 20 1 Overall Patient Satisfcation 59 Recovery Centers OfAmcrica Patient Satisfaction – By Staff 100 90 80 70 60 50 40 30 20 10 0 Psychiatrist Primary Therapist 60 Case Manager RSS Patient Satisfaction 100 80 6O 4O 20 Admission Overal Sat. Speed of Admissions Process 61 5-. Recovery Centers ref America RCA Finance, Accounting, Billing and Purchasing Team • Led by Kevin McClure and Deanna Telese • Is responsible for maintaining a financially responsible and sustainable organization by assisting and managing the creation, maintenance and adherence to detailed annual budgets for every RCA operation • Provides daily dashboard reports to every RCA manager to keep them informed of their daily progress in hitting their financial goals • Is responsible for accurate and compliant billing of all services • Conducts daily meetings with every operation reviewing integrity of all billing from the day before • Established “One RCA,” a national purchasing platform which negotiates standard vendor relations for all locations • Establishes and maintains relationships with all RCA insurance contract holders • Oversees and maintains all RCA leases and contracts • Participates in all senior management meetings • Maintains relationship with outside investors • Maintain the integrity of the RCA mission 62 RCA Strategy, Legislation and Acquisitions Team • Led by Kevin Mullin and Steve Crossley • Identify, underwrite and acquire real estate for inpatient, outpatient, and MAT facilities • Engage law firms, engineering firms and architectural firms in the acquisition, design and zoning process • Prepare investment memorandums and underwriting books for internal and external investment consideration • Source and assess strategic partnership and new business opportunities • Sponsor and support new legislation at the state and federal level to provide better access to care for patients suffering from addiction, especially those with limited means • Provide detailed market and financial analysis for all new business opportunities • Negotiate purchase and sale contracts for newly acquired real estate and strategic corporate acquisitions • Maintain the integrity of the RCA mission 63 IE 64 Rmn'c? Boston Center for Addiction Treatment (“BCAT”) • Acquired in June of 2015 for over $7 million • Former Hunt Hospital • Completely renovated at a cost of over $30 million • Hired and trained staff prior to opening at a cost of over $1 million • Hired Thomas Hall Associates and Barbara Balongue design to create a five star patient centric drug and alcohol rehabilitation facility • 207 bed residential treatment facility providing inpatient and outpatient services to patients • Offering: − − − − − − − Detoxification Residential Rehabilitation Partial Hospitalization Intensive Outpatient General Outpatient Family Counseling Medication Assisted Treatment • Accredited by the Joint Commission, the highest level of accreditation in the industry 65 BCAT Provides Essential Community Partnerships • BCAT offers AA, NA, ALANON, NARANON, ACOA, SMART Recovery, Celebrate Recovery and various family support groups to the community at no charge 7 days a week • BCAT provides a fully staffed and functioning coffee lounge for members of the recovery community and their families free of charge • BCAT has partnered with Phoenix Multisport, a recovery-based fitness training organization, to provide group and individual fitness instruction to patients and the local recovery community in their brand new, fully equipped fitness center • BCAT provides a spiritual advisor and spiritual space for patients and members of the recovery community • BCAT partners with North Shore Community College to allow nursing students to work in a clinical environment while earning their degree • BCAT is employing Master in Social Work students from Simmons College • BCAT is partnering with Drexel University to allow psychiatric nurse practitioners to train in RCA’s behavioral medicine setting 66 Boston Center for Addiction Treatment • CEO, Brad Greenstein, has over 17 years of experience in the behavioral health industry with a focus on leadership, operations, reimbursement strategies, and business development. He has extensive experience with startup organizations, multi-state systems, and program development/new business line expansions − Prior to RCA, he served as Senior Vice President of Business Development for Spectrum Health Systems, a multistate, comprehensive behavioral healthcare system headquartered in Worcester, MA − He has served on the board of several community and national non-profit agencies including Foundation for Recovery, Inc., PACT Coalition for Safe and Drug Free Communities, and was appointed by the State of Nevada Governor Brian Sandoval to serve on the State of Nevada Mental Health Planning and Advisory Council along with the State of Nevada Substance Abuse Prevention and Treatment Advisory Board. He currently serves on the National Clinical Advisory Board of SelfRefind, a multi-state provider of Medication-Assisted Treatment • Clinical Director, Heidi Jacobsen, is a clinical director and therapist with over 15 years of experience specializing in mental health and addictions, with a special focus on prescription drugs and opiates − Prior to her role as Clinical Director, Heidi served in the Pinellas County (Florida) Drug Court and as Program Director and Clinical Director for both long- and short-term residential programs in Florida • Medical Director, John Halpern, M.D., is a Board Certified General Psychiatrist, who after completing the Harvard Longwood Psychiatry Residency Training Program, he began a 19-year research and clinical career at McLean Hospital, where he was Assistant Professor of Psychiatry, director of his own laboratory, and served as Director of Division Coverage for the Alcohol and Drug Abuse Division − He is internationally recognized as an expert on the effects of hallucinogen abuse, having authored or co-authored chapters on the topic in most medical reference texts devoted to addiction medicine and/or psychiatry and multiple peer-reviewed papers as well. He has received multiple grants in support of that research, including grants from the National Institutes of Health’s National Institute on Drug Abuse 67 Boston Center for Addiction Treatment • Serves patients within a 90 mile radius • In-network with the following insurance companies − Blue Cross Blue Shield − Tufts Health Plan − Beacon Health Options • Serves MassHealth patients from the following plans through Beacon Health Options − Neighborhood Health Plan − BMC Health Plan − Fallon Health Plan • Currently licensed for 72 total beds − 26 Acute Treatment Services − 46 Clinical Stabilization Services • Pending application for 123 beds • Currently hiring for 207 beds 68 Boston Center for Addiction Treatment • According to the Bureau of Labor Statistics, unemployment in Boston is 3.3% • Hiring of healthcare employees is extremely difficult • RCA created a hiring system in partnership with Laborocity, which reengineered the hiring process • BCAT has treated 910 patients since its inception • BCAT is currently treating 72% MassHealth patients 69 FARM AT. -: DANVERE if. .2552" {if . HUNT MEDICA .. EUEDWJ 1 ?x - .2: .- l? Boston enter for Addiction Treatment 4% .- . Boston Center for Addiction Treatment I Boston Center for Addiction Treatment Bdg?tibn Center for Addiction Treatmen f. CCEPT THE I 11' {'ll 1: cumww. .TO CHANGE 1th 1mm?; 1 t- ?d leum TO 'Im: mum-tum 1-- 1 IE 77 Rmn'c? RCA at Westminster • Westminster was acquired in April of 2016 for $5.6 million • Westminster was completely renovated at a cost of $6.3 million • Westminster hired and trained its team at a cost of over $1 million • RCA at Westminster will be a 90 bed (currently 48 beds) residential treatment facility providing inpatient and outpatient services to patients • Services offered − − − − − Detoxification Residential Rehabilitation Partial Hospitalization Family Counseling Medication Assisted Treatment 78 RCA at Westminster • Serves patients within a 90 mile radius • In-network with the following insurance companies − Blue Cross Blue Shield − Tufts Health Plan − Beacon Health Options • Serves MassHealth patients from the following plans through Beacon Health Options − Neighborhood Health Plan − BMC Health Plan − Fallon Health Plan • Currently licensed for 48 total beds − 16 Acute Treatment Services − 32 Clinical Stabilization Services • Pending application for 62 beds • Currently expansion under construction to allow a total of 90 beds 79 RCA at Westminster i RCA at Westminster a" O. RCA at Westminster RCA at Westminster m: Em?gmsmamn RCA at Westminster RCA at Westminster IE Rmn'c? ?MyMAIN ENTRANCE RCA at Lighthouse a. 7* 5 I 1 RlCKat Lighthouse 0 We a A RCA at Bracebridge Hall I 457? ?1 if M5. RCA at Bracebridge Hall Thank you Evan and David a Recovery Centers Of America