discontinue in the first month. Before stabilization. Before the medication has time to work.
Virtual prescribing solved access. It did not solve retention. The prescription is one touchpoint in a months-long treatment arc.
PubMed 38400724, 2024
The prescription started. The patient stopped.
Continuum doesn't.
The Retention Cliff
Two-thirds of buprenorphine patients fall out of treatment before it works. Not because the medication fails. Because the episode goes unmanaged.
28.4% discontinue in the first month — before stabilization, before the medication has time to work. By six months, 64.6% are gone. The median time in treatment is 77 days. This is not a medication problem. It is a continuity failure. The system that prescribes does not manage the episode.
0
Discontinue in month one
PubMed 38400724
0
Gone by month six
PubMed 38400724
0
Median time in treatment, first episode
PubMed 38400724
0
Per-case employer cost, untreated SUD
Avalere 2025
Source: PubMed 38400724. Continuum targets are projected, not observed.
The Cost
$438 billion in annual employer costs tied to substance use disorders. The treatment exists. The retention does not.
An untreated or undertreated SUD case costs employers an estimated $700,000 across healthcare, lost productivity, disability, and replacement. 75% of employers with 500+ employees have at least one member with SUD. Treatment defrays costs by 40% or more — but only if patients stay long enough to stabilize. The 30-day cliff means most of that investment is lost before it returns value.
The Gap
Virtual prescribing is table stakes.
There are 16 virtual SUD solutions on the market. The Peterson Health Technology Institute assessed them and was clear-eyed: virtual care matches usual care, at lower cost to deliver. What it did not move was retention — 13 additional days over six months, no improvement in treatment initiation. That is the honest read, and it is the whole opening. Access is solved. Retention is the problem still standing.
The reason is structural. The existing virtual MAT providers optimize for prescription access. The prescription is a single touchpoint in a treatment arc that spans months, and the rest of the arc goes unmanaged. Continuum is built for the open problem, with the management fee at risk against 90-day retention.
The Model
Identify. Treat. Retain.
Designed to manage the episode, not just the prescription. Each patient gets a named clinical navigator from intake through 14-month maintenance.
01
Named navigator continuity
Same navigator coordinates induction through 14-month follow-up. One person, one record, one continuous relationship. Not a call center. Not a rotation.
02
Structured virtual IOP
9 hours per week of evidence-based programming — CBT, motivational interviewing, relapse prevention, psychoeducation. The clinical program between prescriptions.
03
Buprenorphine via permanent telehealth
DEA/HHS finalized permanent rule effective 12/31/2025. Audio-video or audio-only. No in-person at initiation. In-person within 6 months, coordinated by your navigator.
04
Measured outcomes reported to you
AUDIT-C, DAST-10, PHQ-9, GAD-7 at intake, discharge, and 90 days. Retention metrics. Completion rates. Quarterly reporting to your benefits team in aggregate.
The Episode Model
From intake to maintenance, one continuous thread.
The navigator thread is continuous across all five phases. If the patient relapses at month 14, the same navigator re-engages. The episode model does not reset. It extends.
The navigator thread is continuous across all five phases. If the patient relapses at month 14, the same navigator re-engages.
The Navigator
Same navigator. Same record. The whole episode.
From induction through maintenance. The episode model does not reset. It extends. The navigator who started with the patient at intake is the same person at month 14.
Patient Story
What continuity changes.
Marcus, 34. Commercial insurance. Construction foreman. SUD diagnosis at 31.
Before Continuum
Started buprenorphine through a virtual prescribing platform. Completed the initial telehealth visit. Filled the prescription. Attended one follow-up. By day 23, he stopped logging in. No one called. The prescription lapsed. He returned to the ED fourteen months later after a relapse event.
With Continuum
Re-engaged through his employer's EAP referral. Navigator assigned within 48 hours. Buprenorphine re-inducted under the same navigator who would stay for the full episode. Completed induction. Completed 10 weeks of structured IOP. Stepped down to outpatient. In active maintenance at month 14.
14 mo.
Continuous retention
1
Navigator, entire episode
0
Readmissions
Illustrative vignette based on composite published treatment patterns. Not a specific patient or observed outcome.
Coverage Model
What exists. What Continuum delivers.
Virtual MAT Vendors
Episode management
Not offered
Navigator continuity
Resets or absent
Structured IOP
Not offered
Employer outcome reporting
Not offered
Retention guarantee
Not offered
Buprenorphine prescribing
Yes (table stakes)
Virtual-first
Yes (table stakes)
Continuum
Episode management
Full 14-month arc
Navigator continuity
Named, permanent
Structured IOP
9 hrs/week virtual
Employer outcome reporting
Quarterly aggregate
Retention guarantee
Performance-backed
Buprenorphine prescribing
Permanent telehealth
Virtual-first
KY + OH launch
Competitor capabilities (Bicycle Health, Boulder Care, Ophelia, Workit) based on publicly available information as of May 2026. We welcome correction.
The Guarantee
If retention falls below threshold, we credit the fee.
Enhanced fee-for-service with a capped performance guarantee. If 90-day retention across a cohort of sufficient size falls below the agreed threshold, Continuum credits a percentage of the management fee. One trigger, one metric: retention. Bounded, auditable, not open-ended.
65% Target
90-day retention target vs. 48.4% national baseline. The gap is the value.
Fee at Risk
Management fee credited if threshold not met. Continuum carries the clinical execution risk.
Published Either Way
We will publish the result either way. Binding falsification criterion. Public, measurable.
Built For
Three stakeholders. One outcome standard.
Employers
Self-funded employers
Identify Continuum in SUD benefit communications. Provide referral pathway from EAP. That's the full implementation. Quarterly aggregate reporting at renewal.
For Employers
What you do. What you get.
What you do: Almost nothing. Identify Continuum as a benefit option in SUD communications. Provide a warm referral pathway from your EAP or care management team. That is the full implementation.
What you get: Quarterly aggregate retention and outcome reports. Navigator accountability metrics. Completion rates by episode phase. Performance guarantee tracking. A clinical program you can point to at renewal that demonstrates you are governing the SUD population, not just covering the prescription.
What month 14 looks like
You sit in the renewal meeting. Your broker asks what you have done about SUD. You hand them a quarterly report that shows: 14 members referred, 12 inducted and reached the 90-day mark, 9 retained in active treatment at 90 days — a 90-day retention rate of 75% against the 48.4% national baseline, comfortably clearing the guarantee threshold — and AUDIT-C scores improving by an average of 6 points from intake. Your stop-loss carrier sees a governed population, not an unmanaged risk. That is the conversation Continuum makes possible.
Continuum operates alongside your existing carrier and benefits structure. We do not process claims or adjudicate benefits. We do not replace your EAP. We handle the high-acuity SUD cases that EAPs and standard networks are not designed to manage through a full treatment episode.
Your self-funded clients have members on buprenorphine right now. Most will stop before it works. Continuum gives you a clinical recommendation with measured outcomes and a performance guarantee.
For Brokers
Language you can use
"You have members on buprenorphine right now. Most of them will stop treatment before it has time to work. Continuum is a virtual SUD treatment program that assigns a named navigator to every member and manages the full treatment episode. They measure outcomes, report quarterly, and put their management fee at risk against retention. The pilot is 90 days, no integration, no minimum volume. I'd recommend a 15-minute call."
An untreated SUD case costs employers an estimated $700,000 per case across healthcare, lost productivity, disability, and replacement.7 75% of employers with 500+ employees have at least one. The pilot launches in Kentucky in 2026.
For Health Plans
Your SUD-attributed members cost 3-5x your book average.
Most never engage in treatment. The ones who cycle through ED and inpatient cost $28,000+ per year. Your IET engagement rate sits below 20%. Your MHPAEA parity documentation requires demonstrable SUD network adequacy. And your clinical team knows the retention problem is where the spend concentrates, but an internal program runs straight into the duty-to-act barrier that exists precisely because you are the payer.
Continuum is designed for this problem. The model is built to move members from untreated to retained in evidence-based outpatient treatment: better IET engagement, less SUD-related ED utilization, downstream medical cost offset within the first measurement year. Those are the targets the fee is at risk against.
What we deliver to plans
HEDIS-aligned outcome measurement. Our clinical model is designed around your measurement specifications. Initiation within 14 days. Engagement within 34 days. Guideline-concordant pharmacotherapy for every clinically appropriate member. We report outcomes the way you measure them.
Network adequacy without buildout. Expand your SUD treatment network to meet MHPAEA parity requirements without brick-and-mortar investment. Launching with licensed providers in Kentucky, expanding to Ohio. Virtual-first delivery reaches rural and underserved populations where your in-person network has gaps.
Medical cost offset. SUD treatment that retains patients through stabilization reduces total cost of care by 40-50%. At $500 PEMPM treatment cost against a $28,000 annual TCOC for untreated members, the modeled ROI is strongly favorable. Run the arithmetic against your own book.
Claims-integrated, auditable. Standard 837P encounter reporting. Data flows into your warehouse. Outcomes can be verified against your own claims data, not just our reporting.
The treatment gap
SUD treatment access and retention are not evenly distributed. Rural populations, Medicaid members, and communities of color face structural barriers that virtual-first, navigator-driven models are designed to address.
IET Engagement
18%55%
Now → Target
90-Day Retention
48.4%65%
Now → Target
Rural Access
22%85%
Now → Target
Current figures from published national data. Projected figures are Continuum model targets, not observed results.
3-5x
Cost multiplier for SUD-attributed members vs. book average
<20%
National IET engagement rate. Two or more services within 34 days.
40-50%
TCOC reduction when members are retained in MOUD + outpatient
Model Your Book
Run the arithmetic against your own book.
The figures above describe the nation. Set your covered lives and every number below rebuilds from the constants already printed on this page — Kentucky's diagnosed SUD rate of 1,281 per 100K (the launch market), the 18% IET engagement baseline, the 48.4% 90-day retention baseline, the $28,000 annual TCOC for untreated members, and $500 PEMPM. Nothing else enters the math.
Your book · at the rates published above
≈ 3,203
Members with diagnosed SUD
1,281 per 100K · FAIR Health, Kentucky
≈ 577
Engaged in treatment
18% IET engagement · published national data
≈ 2,626
Never engage
the remainder · untreated
The retention cliff · modeled, not observed
$73.5M
Annual TCOC of the untreated members
$28,000 annual TCOC per untreated member · modeled
≈ 298
Of those who engage, gone by day 90 at the 48.4% national baseline
$8.3M modeled annual TCOC if they revert to the untreated path
+96
Additional members retained at 90 days if the 65% target holds
$1.1M–$1.3M modeled offset at 40–50% TCOC reduction, against $6,000 per engaged member per year ($500 PEMPM)
Current figures from published national data. Projected figures are Continuum model targets, not observed results. Retention baseline: PubMed 38400724. Prevalence: FAIR Health, Kentucky. All figures modeled until verified against your own claims data.
Contract structure
Continuum contracts on a per-engaged-member basis. The performance guarantee runs on a single, auditable trigger — retention and engagement (IET improvement and 90-day retention against your baseline) — with fees at risk if the threshold is not met. TCOC reduction is the value the model is built to produce, reported alongside the guarantee but not the thing being guaranteed. Continuum carries the clinical execution risk. You carry the population. The guarantee is bounded, defined in the pilot agreement, and measurable against your own claims data.
For regional plans, Medicaid MCOs, or provider-sponsored health plans exploring a strategic SUD partnership, we are open to co-build arrangements including equity participation, geographic exclusivity, and shared risk.
Earlier in his career, Joe built a 13-location integrated health system from the ground up — behavioral health, SUD/MAT, primary care, urgent care, lab, imaging, surgical center, and a community hospital — and ran it as CEO through acquisition. Inside it: DEA-licensed, SAMHSA-certified, JCAHO-accredited narcotic treatment programs, detox beds, the full continuum. He watched patients fall through the cracks between levels of care. That system is his operating history. It is not Continuum's footprint — Continuum is the virtual SUD product he designed to close exactly that gap.
Today he is Staff Vice President of Carelon Growth, Elevance Health's specialty health-services arm, where he owns six high-acuity clinical risk books — MSK, Oncology, CHF, Maternity, Autoimmune, and Dementia — across $50B+ in specialty medical spend. He sees both tables: clinical operations and payer economics. The episode-continuity model is not theoretical. It is the answer to a failure he watched happen, member by member, for years.
He also founded and sold ClearBill, a billing-integrity platform that returned $9.2 million to payers in its first six months of full deployment. Across the lifetime of the companies he has led, more than 200,000 patients have been served.
The Pilot
90 days. Measured. Fee at risk.
Kentucky launch. Designed to prove the model on a defined population before scaling.
What We Deliver
Full episode management. Named navigator within 48 hours. Buprenorphine induction. Structured virtual IOP. Outcome measurement at intake and 90 days. Quarterly aggregate report.
What You Commit To
Identify Continuum in SUD communications. Provide referral pathway from EAP. Designate benefits contact. No tech integration. No carrier changes. No minimum volume.
The Evidence
Navigator continuity changes retention.
Recovery peer navigators improve retention. Physician continuity is a key predictor of MAT retention. Interdisciplinary care is necessary. Virtual prescription-only models plateau at 13 additional days.
We will publish the result either way.
If the Continuum-managed cohort does not achieve 90-day retention greater than 65% versus 48.4% national baseline, the model does not work. Public. Measurable. Binding.
Hard Questions
Answered without hedging.
How is this different from telehealth MAT?+
Telehealth MAT gives you a prescriber on a screen. Continuum gives you a 14-month clinical program with a named navigator, structured IOP, outcome measurement, and employer reporting. The prescription is one component. The episode is the product.
What about stigma? Will employees use this?+
Virtual is the answer to stigma. No parking lot. No waiting room. No visible clinic visits. The member interacts with their navigator from a private location. The employer sees aggregate data only. Individual participation is confidential.
We already have an EAP. Why do we need this?+
EAPs handle low-acuity behavioral health: outpatient therapy, short-term counseling, crisis calls. SUD requiring buprenorphine induction, structured IOP, and 14-month maintenance is beyond EAP design. Continuum handles the cases your EAP refers out.
What does the retention guarantee actually cover?+
The guarantee runs on a single trigger: 90-day retention. If retention across a cohort of sufficient size falls below the agreed threshold, Continuum credits a percentage of the management fee. Threshold, cohort size, and credit amount are defined in the pilot agreement. Exclusions: AMA discharge and members who disenroll for reasons outside treatment. Bounded, not open-ended.
Is this legal for controlled substances via telehealth?+
Yes. DEA/HHS finalized permanent rule for buprenorphine telemedicine effective 12/31/2025. Audio-video and audio-only permitted. No in-person at initiation. In-person within 6 months, coordinated by navigator. Permanent regulation, not pandemic flexibility.
Get in Touch
Schedule a conversation.
Accepting pilot partners for Kentucky launch. Self-funded employers, health plans, and brokers managing SUD treatment retention.
13 Kentucky 1115 SUD Demonstration Waiver. medicaid.gov
Continuum Assistant
I can answer questions about Continuum's SUD treatment model, episode management, navigator continuity, the pilot, or evidence base. What would you like to know?
