One navigator · the entire episode · paid against retention
The prescription started.
The patient stopped. We don't.
A buprenorphine prescription is not treatment. For most patients it is the start of a countdown — and nobody is managing it.
Two-thirds of patients fall out of treatment before it works. Not because the medication fails. Because the system that prescribes does not manage the episode. Nationally, 28.4% discontinue in the first month, before the medication has time to work, and 64.6% are gone by month six. The median first episode runs 77 days1. The prescription is one touchpoint in a treatment arc that spans months. Continuum manages the arc.
The Peterson Health Technology Institute assessed 16 virtual SUD solutions 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 initiation2. Access is solved. Retention is the problem still standing.
The existing virtual providers optimize for the prescription. The episode goes unmanaged. Continuum is built for the open problem — with the management fee at risk against 90-day retention.
Discontinue in the first month, before stabilization.
Retained at 90 days — the national baseline Continuum is measured against.
Median time in treatment for a first episode.
National buprenorphine retention plotted against Continuum's targeted curve. The empty space between the lines is the value.1
National baseline: PubMed 38400724. Continuum curve is targeted, not yet observed at scale; the 71% 90-day figure is from an illustrative pilot cohort.
Three things move retention, and none of them is a faster prescription. A named person who stays. Structured virtual care that gives the patient somewhere to be. And the medication, prescribed and managed without an in-person gate.
The same clinical navigator coordinates from intake through 14-month maintenance. One person, one record, one continuous relationship. Not a call center. Not a rotation.
Structured virtual intensive outpatient — group and individual sessions on a schedule, with attendance tracked and missed sessions followed up inside 24 hours. The patient has somewhere to be.
Induction and maintenance via permanent telehealth flexibilities — no mandatory in-person visit3. The prescription is managed across the episode, not handed off after the first fill.
Induction, virtual IOP, step-down, and maintenance — with one navigator continuous beneath every phase.
One metric governs everything: did the patient stay through 90 days. Continuum reports it against the national buprenorphine baseline and against the 65% threshold the fee is at risk on.
Pilot cohort, illustrative. Against a 48.4% national baseline — the same number on every report Continuum produces1.
Fig. 3
Every quarterly employer report runs the same comparison: the cohort's retention, the national baseline, and the threshold. No moving the goalposts.
An untreated or undertreated SUD case costs employers an estimated $700,000 across care, lost productivity, disability, and replacement4. The treatment exists. The retention does not. That is the buyer's open wound.
They carry the $700K case directly and feel it on the next renewal. A performance fee against retention is a clean, board-legible buy.
KY and OH carry heavy OUD burden and weak retention. A managed-episode vendor paid on retention fits the value-based mandate directly.
Same clinical gap, larger book. A regional plan without internal SUD episode capability is the natural second meeting.
They underwrite the tail risk of the unmanaged episode. Retention that holds is a loss-ratio story they already price.
No basket of soft metrics, no attribution argument. A single performance trigger the buyer already cares about, measured against a published national baseline.
A buyer's first objection to outcome vendors is attribution. We removed it.
Retention at 90 days is observable, the patient is either in treatment or not. The baseline is public. The threshold is in the contract. There is nothing to argue about at true-up, which is exactly why the fee can sit on it.
Joe Nalley works across the medical and behavioral books that an OUD episode runs through — today as Staff Vice President of Carelon Growth (Elevance Health). Continuum is designed from that seat: the place where retention either holds or quietly becomes someone else's claim.
Across a career in managed care he has served more than 200,000 patients through population health and care management programs. He has built and shipped the patient-facing and payer-facing systems that hold an episode together — the navigator workflow, the accountability dashboard, and the quarterly report that puts retention next to the national baseline.
The result is a model that reads correctly to a payer because it was written by one: a single trigger, a published baseline, and a fee that stands behind the number.
The named-navigator model, virtual IOP structure, and accountability dashboard are built and documented — the operating system the episode runs on.
A complete reporting format that puts cohort retention against the 48.4% national baseline and the 65% threshold, with navigator-accountability and 42 CFR Part 2 compliance built in.
One pilot cohort in Kentucky, one in Ohio. Performance-backed from day one, so the buyer's first dollar is already at risk on the number.
We are placing the first Continuum cohorts in Kentucky and Ohio. The buy is a managed-services engagement, $700K–$950K, with the fee at risk against 90-day retention. We want one payer or employer willing to be measured.
If retention is the problem you keep paying for, the conversation is short: pick the cohort, name the threshold, and let the number settle it.
National retention figures are observed and published. The Continuum 71% 90-day figure is from an illustrative pilot cohort and is labeled as such wherever it appears; the year-one curve in Fig. 1 is targeted, not yet observed at scale.