This week, we continue our treatment tour at Eleanor Health in High Point, North Carolina. It’s a new-ish (and pretty groundbreaking) outpatient clinic with a unique payment model and an emphasis on evidence-based care. We chat with our old friend, Dr. Nzinga A. Harrison, Eleanor’s Chief Medical Officer, about the clinic’s unparalleled access to MAT and their emphasis on a problem-solving, rather than a fit-someone-inside-a-box, approach to treatment. We meet a clinic member who, at 60 years old, is committing to treatment for the very first time. And we meet an incredibly passionate staff as they pull every possible string to get 100% of people who walk through their doors the tools to meet their individual recovery goals.
Please note, Last Day contains strong language, mature themes, and may not be appropriate for all audiences.
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[00:03] Jack Register: Grab a chair and let’s go ahead and check in uber-quick. So why don’t we go ahead and start with you. How are you today and where you at?
[00:11] Nurse Judy: I’m gray.
[00:12] Jack Register: Ok, so you’re gray today. All over gray or just spots?
[00:15] Nurse Judy: All over gray. I didn’t sleep well. It was another one of those wake up at 4 o’clock in the morning, couldn’t get back to sleep, you know. My brain is on overdrive. Feeling a little stressed.
[00:31] Stephanie Wittels Wachs: So if you had to guess, where do you think I am? Group therapy? Maybe a warm-up at an intro to theater class? Nope. I’m at a staff meeting. And this is a daily ritual for this team.
[00:46] Jack Register: Cool beans. All right. So today I am bright, sparkly, glittery colors today. I have been here since 7:30. Uber-weird. Could not sleep last night. Decided to get up, throw on the Harry Potter shirt, like, OK, we’re gonna do what we need to do today.
[01:03] Stephanie Wittels Wachs: That bright, sparkly, glittery fellow is Jack Register. He’s the clinic manager here at Eleanor Health in Highpoint, North Carolina. Jack starts each day by asking his team three simple questions: What color represents you today? Where are you at? And what do you need from the rest of the team? It’s a quick way to get everyone on the same page, which is important here, because as Jack told us, in the world of addiction, things can change at any moment.
[01:35] Stephanie Wittels Wachs: Can we put you on tape for one second? Like, it seems like there’s some, like, drama happening here.
[01:40] Jack Register: There is.
[01:44] Stephanie Wittels Wachs: Like, I just like, see you pacing back and forth, like on the phone, and some member came in sick. What’s going on?
[01:54] Stephanie Wittels Wachs: I’m Stephanie Wittels Wachs. Today I’m turquoise, or maybe a seafoam. And this is Last Day.
[02:09] Stephanie Wittels Wachs: If the name Eleanor Health is ringing a bell, it’s probably because you heard it from Last Day fan favorite, doctor Nzinga Harrison. She’s a co-founder and chief medical officer of Eleanor Health. And when we talked to her back in August, this place was just about to open its doors for the first time. Now it’s up and running. There are four different clinics in North Carolina.
So what is Eleanor Health?
[02:35] Dr. Nzinga Harrison: So, Eleanor Health is a comprehensive, longitudinal substance use disorder treatment program for individuals with opiate use disorders or other substance use disorders as well.
[02:47] Stephanie Wittels Wachs: Put another way. Eleanor Health is a really innovative outpatient facility. Nzinga is a doctor, and she’s about to throw out some clinical terms, so quick refresher. The American Society of Addiction Medicine outlines four levels of care. Level One is outpatient; that’s less than nine hours a week of treatment. Level Two includes intensive outpatient or partial hospitalization for nine to 20 hours a week. Level Three is residential, and level Four is medically staffed treatment at a hospital.
[03:21] Dr. Nzinga Harrison: So we do Level One care, but when we move into the communities that we’re going into, we’re trying to create a part of the continuum that has been missing, which is a place for people to come to after their Level Two. For people to come to after their Level Three residential care or for those who it’s appropriate to come straight to us from detox. Our goal is to individually conceptualize each person that comes into our clinic and help them craft the formula that will most quickly get them to recovery as defined by them. Because many of the treatment programs have been borne out of the abstinence-based model, which means you can never use anything ever period again, or else you cannot be in this program. You’re not considered to be in recovery. Our program sets those goals with the patients. So if we have a patient who wants treatment for their opioid use disorder, but they’ve had, you know, a non-hazardous drinking pattern and they want to continue to drink a glass of wine at night, we can set the goal to treat an opiate use disorder and you can still have a glass of wine at night. Unlike other abstinence based programs, where it’s like you have to be able to commit to absolutely nothing at all or you can’t be here.
[04:45] Stephanie Wittels Wachs: By providing this level of flexibility, they believe their members are more prepared to actually maintain recovery, which is really the most important part, right? OK, let’s frame this in a different way, one that will be very familiar to many listeners. So think about dieting. I can go on a paleo, Whole 30, sugar-is-evil kind of diet and say I’m never going to eat another carb for the rest of my life, but that will never happen. I am setting myself up for failure. And I’m giving myself an out if it means that the moment I slip up and eat a cookie, I am a bona fide fuckup and my diet is over. Eleanor Health doesn’t make it so easy to quit.
[05:27] Dr. Nzinga Harrison: And the way we do that is unparallelled, if I say so myself, access to MAT.
[05:34] Stephanie Wittels Wachs: I know. I know. All Last Day roads lead back to MAT. But even if you’re sick of hearing it from us, there are many institutions who still haven’t gotten the memo.
[05:46] Dr. Nzinga Harrison: The true abstinence-based program would even consider it MAT unacceptable. And we know that about 40 percent of substance abuse treatment programs are not accepting people who have MAT as part of their formula.
[05:58] Stephanie Wittels Wachs: Yeah. We will get into this more next week, but there are a shocking number of recovery programs that are providing extraordinary care, but still have strict rules against people using medication assisted treatment. From some AA groups to 5-star residential facilities, you can literally get kicked out for being on MAT.
[06:20] Dr. Nzinga Harrison: The difference between that approach and Eleanor Health’s approach is that we know that the value in maintaining our treatment relationship — even if your urine drug screen is not turning negative — supercedes the risk that we create by kicking you out of treatment so we don’t kick people out of treatment. It just means we need to let the relationship grow. We need to consider a different intervention that might be more effective for you in this moment. We need to identify something that you haven’t put your finger on yet that we haven’t put our finger on yet that’s driving the continued use. And so it’s a problem-solving relationship first type of approach as opposed to if you don’t stop using right now, you’re not ready to be in treatment.
[07:07] Stephanie Wittels Wachs: That’s incredible. That’s truly groundbreaking. Last week we got into why the 30-day model doesn’t work for most people. Some places, like The Women’s Home, are solving that problem by offering extended residential options. Eleanor Health is essentially meeting a similar goal in a slightly different way. They provide a soft place to land no matter where you are in the recovery process. Just got out of residential and don’t know how to get back on your feet? You are welcome here. You’ve never been to treatment before, but know you need help? You’re welcome here. They like to say their level of care is for 100 percent of people at some point in the illness. tThey offer what’s called a wrap-around model, which essentially means wrapping a comprehensive set of services and support networks around people rather than forcing them into a predetermined treatment box.
[08:06] Dr. Nzinga Harrison: So we enter into treatment using evidence-based methods. So everybody will get screened for depression, anxiety, trauma. We have our psychiatrist in-house. You can get started on your MAT no more than two days from your first contact with us, because we know it’s critical to be there when the time is right. We have a one-year program, which reduces in intensity as the symptoms of the substance use disorder reduces. But what’s beautiful about it is that, let’s say you’re in Phase 3, but some confluence of factors leads to an increase of your symptoms. Guess what? We can increase the intensity of your service with us based on what you need at that time. We’re really aiming to just call out stigma. And so we want people when they walk in our doors to feel a warm embrace, to feel like they have joined a community that will always value them and always have their best interests at heart, and proactively look for them if they come up missing, I tell my patients, you’re the expert in you, I’m the expert in medicine. Each of these expertises is equally valuable and we put them together to come up with something amazing. So that’s Eleanor Health.
[09:17] Stephanie Wittels Wachs: Yeah, I was going to say it seems like a utopia.
[09:21] Dr. Nzinga Harrison: Yeah, I’m glad that you said that. The idea that humans have around utopia is that it’s you can’t actually get there. And then in this context, you actually can.
[09:34] Stephanie Wittels Wachs: The funny thing about utopias is that they start in real places, often real places grappling with very basic problems.
[09:44] Dr. Nzinga Harrison: What we’re finding is that these communities are desperate. They’re so happy. We’re saying we’re moving in, we’ll do the hard work for you. If you prescribe the MAT, we’ll do the wrap-around services. People are so excited. The emergency departments: “we would get people started on Suboxone, but we don’t have anywhere to send them when we discharge from the hospital. We’re so happy that you’re coming.” And so the reception has been overwhelmingly warm. The treatment practitioners in the community want to be doing the right thing. The system just is not making that easy or possible right now. And so we hope to ease that pain point as we move into communities and the arms have been wide open so far.
[10:27] Stephanie Wittels Wachs: Eleanor Health is a centralized hub with a very dedicated set of community partners. They don’t offer every single service in-house. Instead, they work with a network of providers, residential facilities, hospitals, physicians. So if you really need inpatient care, Eleanor Health can find that for you, make sure it’s in your insurance network, and then stay in touch throughout your stay to make sure that you have a plan in place when you’re done. But it’s important to mention that Eleanor Health is still in its infancy. They’ve been building their program from the ground up and Nzinga has been recruiting an army of staff members. But she and her co-founders are very picky about who is allowed to enlist.
[11:08] Dr. Nzinga Harrison: We are not bringing people into our leadership who are not heart-aligned or mission-aligned. The first level screen has zero to do with medical skill. Zero. What I have told my person who’s doing my screens for me is you talk to this person on the phone and you listen for pejorative language. You listen for explicit stigma. You listen for implicit stigma. You listen for lack of the harm reduction relationship, first orientation. And if you hear any of those things, they don’t make it past the first screen. Because I can train you to practice MAT. I cannot train you to have the heart and the compassion and the commitment that the people we’re serving need each and every one of us to have.
[11:58] Stephanie Wittels Wachs: And this brings us back to these sparkly gentlemen we met up top, Jack. He has heart, compassion and commitment personified. And this is most obvious when he’s talking about the people he serves.
[12:13] Jack Register: We don’t call them patients. We don’t call on clients. They’re members. And they’re members for life. And that’s the reason why we’re here. That’s why the doors are open. I actually got involved in policy work as an advocate and lobbyist, first with my trade association and social work, and then in larger contexts. And I frankly got really just tired of banging my head against a wall. At one point I wanted to be politically active, but then I lost my mom in 2009, at the age of 56, from her mental illness. She should’ve been a grandmother, she was suddenly gone. And my family didn’t even really know how to function. At the moment when I was at my, “I don’t know if I want to be a social worker anymore. Is Walmart hiring?” Eleanor Health called. And so what I’m able to do here is a combination of all my skills, a combination of all my experiences. I can bring my grief here, the grief of the people that I’ve lost, and know that I can help somebody else not end up there.
[13:15] Stephanie Wittels Wachs: Jack’s not in this alone. We also talked to community recovery partner Bruce Wright. He’s the boots-on-the-ground guy at Eleanor Health.
[13:23] Bruce Wright: Most of the people that work here, they worked in other fields, other jobs and they hit like ceilings of what help they can provide. They cared too much at the other job. They were, you know, admonished for giving a shit, basically.
[13:44] Stephanie Wittels Wachs: Bruce realized early on that these people do very much give a shit and that they run things a little differently around here.
[13:52] Bruce Wright: I’ve never been to orientation where they use Jay-Z as — I was like, “oh man.”
[14:04] Jay-Z audio: In 1986, when I was coming of age, Ronald Reagan doubled down on the war on drugs that had been started by Richard Nixon.
[14:12] Stephanie Wittels Wachs: The leadership team who was conducting Bruce’s orientation played this short film. It was produced by The New York Times and it’s Jay-Z doing a voiceover about the history of the war on drugs and racial inequity in the criminal justice system. And there’s an artist, Molly Crabapple, that is sketching it all out as he speaks.
[14:30] Jay-Z audio: Young men like me who hustled became the sole villain and drug addicts lacked moral fortitude.
[14:35] Stephanie Wittels Wachs: I’ve watched this video dozens of times over the years. It is truly riveting and very informative.
[14:41] Bruce Wright: Then we had a discussion. They say, yeah, this is going to make some people feel uncomfortable, but we’re gonna be real with each other. I was like, “don’t fuck this job up. Excuse my French, but I could be me. I could say what I wanted to say and I could feel the way I wanted to feel. It was still valued. It wasn’t, you know, frowned upon. You could be yourself.
[15:13] Stephanie Wittels Wachs: You’re a whole person.
[15:18] Stephanie Wittels Wachs: The whole-person approach. We’ve heard variations of this idea pop up a lot lately. Last week it was The Women’s Home, with their trademarked whole-life model. Sometimes it feels like the recovery world’s version of “all-natural” or “organic,” a buzzword that may or may not be real, but lends an air of credibility. But at Eleanor Health, everyone — from the staff to the people they serve — embody the whole-person approach, which is to say they’re human with their own backstories, their own emotional needs and their own opinions.
[15:55] Jack Register: And I come at this with lots of passion and lots of energy. Because I have personally lost lots of people I care about and love and come out of one of those families that got beat up by mental health and addiction, and I would prefer for people not to be beat up here.
[16:11] Stephanie Wittels Wachs: It’s clear that Jack has empathy for the people who come to Eleanor Health looking for help, and that help is truly unconditional.
[16:19] Jack Register: We believe in an incremental harm reduction approach because the minute that we come at you like a ton of bricks, you’re going to respond by getting flattened. So if they decide to bail on us for a bit, OK. Our model is built in a four-phase approach. In phase one, you get tons of touches with us. You might hear from us eight times a week. If we gotta come to your house, we’ll come to your house. But the idea is we kind of really give you a lot of connection initially. And then as you start to figure out what you need from us, we start pulling back the pieces that you don’t need. And that gives us the ability to scale and serve other folks, and gives us the ability to uniquely be present in what folks are looking for.
[17:04] Stephanie Wittels Wachs: You keep using the word touch. How do you define a touch?
[17:09] Jack Register: Everything from a phone call, to a face-to-face, to meet you in the community coffee shop here where you are, to a formal meeting, a session, to meeting with one of our providers. All of those are considered touches. We want it to be what you need, we will do. So, for example, we have a story that one of our members lived in a local tent city. He was homeless. And Shelby was able to meet with him and he kept saying, “I’m worried about my tent blowing away. I can’t talk to you if my tent is going to blow away.
[17:43] Stephanie Wittels Wachs: FYI: Shelby is the other community recovery partner at Eleanor Health. Sadly for us, but awesome for her, she was on vacation when we visited Eleanor Health. And while we didn’t get to meet her in person, it is clear that this lady is mighty loved around here, because she always goes above and beyond.
[18:05] Jack Register: She’s like, OK, what do you need and make that not happen? He goes, “well, if I can hammer it up against the, you know, the thing, the pole there.” And she’s like, OK. So she went and got some hammer and nails, came back and handed them to him. And he hammered up his tent and then talked to us. He’s now in transitional housing. He looks like a million bucks. He looks like a different guy. Every time he comes in I don’t recognize him. He comes up and gives me a bear hug and goes, “it’s Bobby. I know you don’t remember me.” Because he doesn’t even look like the guy that we met. And he said, “I guess I have to be loved by y’all whether I want to or not.” That’s what our folks did here.
[18:44] Stephanie Wittels Wachs: So you’re just removing barriers left and right.
[18:47] Jack Register: That’s what we’re all about. You’ll hear that from every member of our leadership. Our job is to remove the barriers to get folks to the next place. So if that’s a little barrier, or if it takes time and it’s a big barrier, that’s what we’re here for.
[19:02] Stephanie Wittels Wachs: You’ll notice that a lot of this is the same thing The Women’s Home offers for the women they serve in Texas. And while they certainly have their differences, the broad strokes are the same: compassion, connection, community, tools to help members cope with trauma for the long haul. Forever. And these things do seem to be effective for members, but they also inspire and motivate staff.
[19:27] Bruce Wright: I feel like I work at Google or something, to tell you the truth, because every angle — they really take away all excuses for — you know, of course, people have to be tired. They have to be ready. However, they give you everything that you need to be successful. You know what I mean? And I don’t see any place like that.
[19:57] Stephanie Wittels Wachs: OK. I know Nzinga said up top that this is a real-life utopia, but all the employees were so over-the-top positive that I was starting to feel like I was stuck in The Truman Show. Like were all these people actually paid actors? When we come back, I talk to someone who is not on the payroll.
[22:50] Stephanie Wittels Wachs: We’re back.
[22:53] Cindy Evenhart: I’m Cindy Evenhart and I’m 60 years old.
[22:56] Stephanie Wittels Wachs: Cindy hobbled in for her interview wearing a big black medical boot. She’d had a major accident a few months ago that messed her up pretty good, landed her in the hospital and put her in close contact with lots of high-powered opioids. Cindy’s injuries set off the most recent and arguably the most intense cycle of substance abuse. But her story is deeper and way longer than that.
[23:22] Cindy Evenhart: If I look at the big picture, it goes back 30 years, 35, a long time. But then I went through a long period of time doing great, you know, being married, having children, you know, running a business, being the perfect mom, taking the kids everywhere, packing their lunch, going to all their games, going to school and doing all that. Well, the kids grew up. My husband left. Empty home. Move to a one-bedroom. It’s just me struggling to figure out who me was. Everything was changed and gone. I’d jump back on that road, making bad choices and not thinking I was hurting anybody, you know? It’s just me. I’m not hurting anybody. Nobody really knows. I saw what it was doing to me. Just couldn’t continue doing that. I got to figure out who I am and where I’m going. But without drugs.
[24:35] Stephanie Wittels Wachs: One month before we met Cindy in this tiny back office at Eleanor Health, she decided to reach out for help. She called on Thursday. Bruce picked up the phone. And she realized she had no idea what to say or how to say it.
[24:52] Cindy Evenhart: Because I was afraid that if I said what was true, that he would say, you can’t come here. And I was struggling for what to say — and I forgot how he said it, but he basically said you’re a current user and that was true, I had just done drugs before I called. And he was like, it’s OK. Why don’t you come see us tomorrow. I was like “Wow. Okay, I’ll come.” And then I came and, you know, sorry, but I did drugs before I came. And I came in and talked to Shelby. And she was so kind and so understanding and so nice. But she pulled at that cup to drug test me, and I said, “hey man, I’m gonna fail that drug test. I can already tell you.” “It’s OK, got to do it anyway.” She just kept saying, “it’s OK.” And I told her what she would find and that’s what she found. And she didn’t say, “see you.”
[26:01] Stephanie Wittels Wachs: Instead of sending her away, Shelby sent her over to Jack. He sat with her and talked to her and the whole time he was smiling. It all felt like a dream, especially because she had just had the complete opposite experience at another treatment facility.
[26:21] Cindy Evenhart: I don’t know if I didn’t meet the criteria. I don’t know if I wasn’t kicked down enough or I was kicked down too much. And I was just like, I can’t even like come and try?
[26:39] Stephanie Wittels Wachs: All Cindy wanted was a chance to try, but she was knocking on the wrong door. And like David Smith said a couple weeks back, there shouldn’t be any wrong doors. Cindy had a moment of clarity and Eleanor Health welcomed her with open arms.
[26:56] Cindy Evenhart: I walked in here and they were so nice to me. And the people I talked to — I just got more comfortable and more comfortable. And when I left, I said to my mom, “I don’t even know if this is real. It’s such the perfect place for me. I’m scared that it’s not really real.” I’m still new and green and everything to it, so everybody just makes me feel really comfortable. And I felt comfortable being open and honest and not leaving things out about myself to not look so bad.
[27:36] Stephanie Wittels Wachs: How does that feel?
[27:39] Cindy Evenhart: It’s different. I don’t feel a whole lot different, but in a way, I do. I keep being surprised at how I do feel because I didn’t expect to feel as good as I do. And I do feel pretty good. But I know it’s because I’m here and I have them, and they continue to — even when I’m not here, I hear them. So what they have said to me and the way they’ve treated me, that goes with me when I leave, which I didn’t expect that. I didn’t expect to hear their voices talking to me. They’re like, “call me anytime.” But I never picked up the phone and called them. But it was like I picked up the phone and called them because they’re talking to me.
[28:36] Stephanie Wittels Wachs: So when you hear the voices of these wonderful people in your head, what are they saying?
[28:44] Cindy Evenhart: I hear, “don’t do that. No, don’t do that. Or if you do, it’s OK. We’re still gonna be there for you.” But it’s more important that I don’t do that.
[28:58] Stephanie Wittels Wachs: Do you hear how Cindy is essentially repeating all the things Nzinga and Jack said, that Bruce and Shelby reinforced in that intake process? There is nothing she can do that will make her unwelcomed here. And this is key because Cindy is very new to this, even though she saw her husband go through AA, Cindy has never been to treatment herself. At 60 years old, this is her very first time.
[29:25] Cindy Evenhart: You know, I came in here and was like, I’m a drug addict. You’re not a drug addict. After we talked, they said you’re a substance abuser. Explained to me and gave me clear definitions and talked to me about the brain and what different things do to your body and how it makes you act and choose and make me look at things different. I still can’t look at myself without saying I chose to be like this. And they are trying very hard to teach me that I didn’t necessarily choose. I still think I did.
[30:04] Stephanie Wittels Wachs: Honestly, at the beginning of the series, this whole addict versus substance user issue felt really important. But 23 episodes in, we’ve heard from a lot of people who strongly and positively identify as addicts. So labels aside, whatever you call yourself, the thing that matters is reframing the idea that she chose this. That to me is the beginning of the brain rewiring process. And that process requires a lot of touches in the beginning.
[30:42] Stephanie Wittels Wachs: So how often are you here?
[30:47] Cindy Evenhart: I come once a week, and now that they’re doing the group thing, I come twice. But they have let me know that I’m welcome to come any day and hang out with them, sit in the lobby, read a magazine, talk to them. If I’m bored or climbing the walls or anything, the door’s open. Come in here. Don’t talk to me. I’ll be here. Pick up the phone, call. We’ll come get you. Wanna go get lunch, you know? Really, really kind and nice and so far everyday, I swear, I thank God that they’re here. I’m afraid that they’re gonna poof, disappear. And I’m so young and new — old in age, but young in this. And I’m scared that it will go away and I’m not strong enough yet. I’ll go back and do what I was doing. I know I will.
[31:54] Stephanie Wittels Wachs: Throughout our interview, you can hear the unbridled vulnerability in Cindy’s voice. And when we came back the next day, I asked Jack if that’s something that concerned him.
[32:05] Stephanie Wittels Wachs: Yeah, when we talked to Cindy yesterday — I have a question specifically about her. So like she seems like she is in such a vulnerable place right now and this is where — I believe in everything you guys are doing here. I’m so afraid for her. Like I am afraid that she’s gonna go home and use and relapse. Like, it’s like I wanted to, like, follow her home, you know?
[32:37] Jack Register: if I don’t hear from her at least every two to three days, we’re gonna call her. And every time I’m with her, I’m like, how are you doing? How are you motivated? But see, here’s the thing about Eleanor Health that’s different: If she relapses, that’s OK. It doesn’t mean she’s out of the program. It just means we redo the plan. Our corporate medical director, Dr. Harrison, has this saying” “if something happens that doesn’t work, it’s not the client’s fault. It’s the plan’s fault.” That means we gotta step back and figure out what we need to do differently. So with Cindy, if something happens, we’re gonna be OK, what do we need to do now? So while I worry for her, too, she’s a survivor and has been through hell and back. And that’s part of her story, is that she was actually able to block her dealers whenever they called her and said, “hey, do you want some free stuff?” And she was able to do that on her own. That’s huge in early recovery! Huge.
[33:31] Stephanie Wittels Wachs: That is huge. But I have to be honest, I was still a little terrified talking to Cindy. We’ve never featured someone who is this new to recovery. It’s still intense just listening to her tape. But I did get to see how much this place means to her. It really is a life vest. And after the break, we get a glimpse of what it looks like when someone who’s drowning shows up at Eleanor Health for the very first time.
[34:05] Stephanie Wittels Wachs: Lemonada Media, the company that produces Last Day, the company where I am the chief creative officer, just turned one. Happy birthday to us! And for our birthday, we have a brand new website. Yay! So go check us out at www.lemonadamedia.com. Go check us out. And this is particularly useful to you, to you Last Day listeners, because on this new website you can find brand new conversation forums for Last Day. Where you can connect with us and each other about what you hear. You can also find a Lemonada Media store with all sorts of Last Day swag. Right now, to celebrate our first birthday with us, you can use the promo code Birthday10 to get 10 percent off your entire order. So visit LemonadaMedia.com and chat with our Last Day community, and use promo code Birthday10 for 10 percent off your swag order today.
[35:56] Stephanie Wittels Wachs: We’re back. It’s day two at Eleanor Health, and it is hectic.
[36:06] Stephanie Wittels Wachs: Can we put you on tape for one second? It seems like there’s some, like, drama happening here.
[36:13] Jack Register: There is.
[36:15] Stephanie Wittels Wachs: Like, I just see you pacing back and forth like on the phone. And some member came in sick. What’s going on?
[36:23] Jack Register: So this is sort of the perfect-case scenario. So what we have happening right now is that we have a walk-in member who is brand new to us, who is not in real good shape. Our clinic schedule today is already really packed with not much flexibility.
[36:42] Stephanie Wittels Wachs: Right. So this is the downside of only having open doors. People tend to walk through them, sometimes unexpectedly. So cue the network of providers and community partners.
[36:55] Jack Register: So typically when our providers are not available here in this clinic, I then get online and say to the other clinics, help, help, help, I need somebody. So we have another provider, another clinic who’s going to see our walk-in person. So we’re doing all their intake paperwork here. And then we’re getting them ready to go online to see that person. And so we then come up with the best plan possible. Keep folks comfortable. And my job is to work the magic. Connect the dots. Pull the strings. Do what we need to do. So that’s what’s happening this morning.
[37:26] Stephanie Wittels Wachs: So when you say a member is sick, what does that mean?
[37:30] Jack Register: Usually withdrawals. Usually that means they are in the throes of withdrawal. Or as in our walk-in’s case, I’m ready for care today, damn it. And mom and dad are with us. So we got support system. We got person. We are ready for care now.
[37:47] Stephanie Wittels Wachs: Wow. And you can’t turn that person away.
[37:49] Jack Register: No, ma’am. And we won’t.
[37:50[ Stephanie Wittels Wachs: That’s a critical moment.
[37:51] Jack Register: Yes, ma’am.
[37:53] Stephanie Wittels Wachs: Of course, this is the critical moment. Cindy tried to get into treatment and she was turned away. So she used right up until that first day at Eleanor Health. For opioid users, especially knowing everything we do now about fentanyl, that is throwing that person back into a life-and-death situation, which is unacceptable. But obviously, that level of high-intensity stakes makes work life pretty intense.
[38:21] Stephanie Wittels Wachs: I mean, I guess I was just gonna ask you, like, what’s a typical day for you? And that is what I was expecting to get, so thank you for giving me that tape.
[38:35] Stephanie Wittels Wachs: The woman laughing at me is nurse Judy. As a refresher, Judy was the one who was gray in yesterday’s staff meeting. And it was really hard to get her on tape today because she was being pulled in a million directions.
[38:48] Nurse Judy: You know, you come in and there are people that have walked in. You’ve got to figure out how to fit them in. And you don’t want to turn people down that are needing us, and especially someone that may be, you know, in crisis or almost in crisis. We don’t want to turn them down, so you just kind of jump through hoops, you skip lunch and, you know, hold your pee as long as you can. I told them yesterday, I was like, look, I’m going to pee today. You know I’m an old lady, I got an old lady bladder. I got to pee.
[39:21] Stephanie Wittels Wachs: It sounds silly, but that is the kind of practical consideration you have to make when you work in a field with such noble intentions. I want to absolutely be available to someone in crisis, but also I’m going to pee today.
[39:36] Stephanie Wittels Wachs: I mean, that’s part of the meet-people-where-they’re-at approach. And do you find that meeting people where they are, which is a harm reduction principle, is true in medicine? Do you feel like that’s a concept that you have had in your career? Is that something that’s specific to Eleanor?
[39:54] Nurse Judy: I don’t think it’s just Eleanor, but it’s done well by Eleanor. Done well by Eleanor. And I think that it’s not as common as I would like to see it, because so many times, you know, in medicine throughout these years and years, for me, it’s like, you know, you try to fit people into the box that’s already defined, you know. Diabetes care or, you know, smoking cessation, or things like, you know, you try to fit them into a box. This is how we do it. You know, I’m an old-school nurse. I’ve been a nurse since either of you were born, before either of you were born. I’ve been a nurse since 1975.
[40:35] Stephanie Wittels Wachs: Wow, that is true. I was born in ‘81.
[40:39] Nurse Judy: I knew it.
[40:40] Stephanie Wittels Wachs: Of course she knew. Judy’s been around for a while, but at Eleanor Health, she’s encountering some stuff for the first time.
[40:48] Stephanie Wittels Wachs: It’s interesting, you said you’re an old-school nurse. But Eleanor does all this telemedicine, which seems very progressive.
[40:56] Nurse Judy: Yeah, that is. And, you know, some of the newfangled ways to deliver the care, I’m still kind of muddling my way through. But the mentality and the approach at, you know, really helping, and you know how we do that. I’m hands-on.
[41:13] Stephanie Wittels Wachs: If this is new to you as well, telemedicine is where doctors and patients essentially video chat online. They can see each other and talk to each other in real time. So it’s like any normal appointment. And then Judy does all the hands-on stuff, like taking blood pressure, vitals, stuff like that.
[41:31] Stephanie Wittels Wachs: What are the pros and cons of telemedicine?
[41:35] Nurse Judy: I think the pro is definitely it’s efficient, it’s efficient. The practitioner gets a chance to see people without having to be here. I think it is efficient for them. But as for us as well, you know, if you can’t get a doctor in at a certain time, then dial up Zoom and boom, there he is.
[41:58] Stephanie Wittels Wachs: This is just one of many ways that Eleanor Health is innovating to keep costs down while maintaining a high quality of care. Here’s an Nzinga again.
[42:09] Dr. Nzinga Harrison: So the other thing I’ll say about substance use disorders treatment right now, like the rest of health care in America, is overwhelmingly fee-for-service. Which means you go see the doctor or the therapist or whatever practitioner, they send a bill to the insurance company, or if you don’t have insurance to you and you pay for that service, and there’s like a fee for that service. The problem with managing chronic medical conditions like that is that so much of what you need to do to support people doesn’t have a code attached to it that you can bill for. And so the system has been built such that you literally can’t do what you need to do and sustain your practice. Because what we need to do is go sit in the E.R. and wait for someone to show up so that we can start the relationship immediately right there in the E.R. What we need to do when a person misses their appointments is send one of our field workers out to their house and say, “hey, we haven’t seen you in a while. We just wanted to make sure you’re OK.” None of those have a fee attached to them that you can bill. And so classically, treatment providers are not able to do that. Eleanor Health is actually negotiating with payer partners for value-based care, which is like when you come in our care, the payment is based on what we need to provide to help you get in recovery as quickly as possible and maintain it for as long as possible. So we’re really looking to change the way substance use disorder care is delivered, but also to change the way insurance is paid for substance use disorder care so that it can more closely align with what folks need.
[43:51] Stephanie Wittels Wachs: OK, sounds amazing. But how does this relationship with the insurance companies actually work? We talked to Corbin Petro, Nzinga’s business partner, and CEO, who broke it down for us.
[44:05] Corbin Petro: I always say we’re sort of the only game in town when it comes to a unique payment model that incentivizes recovery, not relapse. And when we go into a community like in High Point, where we are, we try to serve as many people in that community as we can. We typically go into a market, a state, in partnership with a very forward-thinking health insurance company who has agreed to pay us in a certain way. And so here in North Carolina, our partner is BlueCross of North Carolina, and they’ve agreed to pay us a certain way and they want their members who are struggling with addiction to come to us. And so that sort of has set the groundwork for our ability to sort of treat in our clinical model. And so we’re not paid for quantity, we’re paid for the care and the outcomes that we get for our patients.
[44:53] Stephanie Wittels Wachs: But in order for something like this to actually happen everywhere, policymakers need to get on board. Because as things stand now, access is pretty uneven depending on where you live. Like North Carolina, for example.
[45:07] Corbin Petro: You know, it’s now one of 12 states that has not expanded Medicaid. You’re in one as well, in Texas. And so there’s a dramatic level of need. Over 50 percent of the people in the state who have a substance use disorders are uninsured.
[45:23] Stephanie Wittels Wachs: This is something we talked about with Andy Slavitt back in episode eight. If 50 percent of people dealing with substance abuse are not insured, their best bet is to show up at the E.R., which is inefficient and costly. So when you hear a politician claim to care about taking on the opioid crisis and saving taxpayer money while also voting against Medicaid, call them out on it. Because that does not add up. Eleanor Health has managed to create a business model that is actually efficient and warm. Oh, and based on evidence, which is what you would expect in a medical setting.
[46:03] Corbin Petro: Yeah. That’s why I look at some of the models that exist out there. And it’s often somebody who’s experienced addiction themselves and they’re like, well, this worked for me. It was moving to a new city and training for a marathon. And so they like start this program — or walking through the woods or living in a beautiful place on the beach. And they’re like, this is what worked for me, so it must work for everyone. And that’s not actually evidence. Like we believe in evidence. We appreciate anecdotes, and so we appreciate it. But like we follow evidence. And you can tell our clinics are warm and welcoming, like, come and hang out here if you need to. Like, we’re not a residential, we’re not a home, but we’re a place where you can feel comfortable and come if you need a safe, safe place to come.
[46:53] Stephanie Wittels Wachs: Which brings us back to Cindy, who found that safe place when she needed it most. She is at the very beginning of her recovery journey and that can feel daunting. She’s still in that white-knuckle phase of early sobriety. What Wilma described as walking around without skin, which is literally 100 percent exposed. But in addition to feeling all the scary stuff, she’s in a better place than she’s been in a really long time.
[47:25] Stephanie Wittels Wachs: You feel hopeful.
[47:27] Cindy Evenhart: I feel very hopeful. I think last time I cam or something, he said, “you look good!” And I thought, I feel good. I can’t believe I said that out loud. I feel good. I felt like taking a shower and shaving my legs and putting on clean clothes and putting on makeup and rolling my hair. I felt like doing that. I hadn’t felt like doing that in months.
[47:55] Stephanie Wittels Wachs: That is impressive. That is impressive. Shaving your legs is impressive. Alone. Makeup and hair? Now you’re next level.
[48:08] Stephanie Wittels Wachs: As the child of a very Southern woman, raised around a very southern woman, I will tell you this is important. My mother does not leave her house without her face on. The way Cindy is describing her process of self-care today, this is how a highly functioning Southern woman shows up.
[48:34] Cindy Evenhart: When I left here from this morning, and I was coming back, my daughter texted me. And mom got the mail out and handed me an envelope and it was a letter from my son. I was like, “oh, I got contacted by two of them in one day!” And I’ve been like — because I hadn’t heard from them. And boom, I heard from them by the time I needed to hear from them. I just looked up. Thank you, God. Because that’s what it was. I haven’t read my letter.
[49:08] Stephanie Wittels Wachs: You haven’t read it?
[49:10] Cindy Evenhart: I haven’t because we were in the car and getting the mail out. But she handed it to me and I was looking at it. And I looked at her and she said why don’t you ready it after? Because you’re going to be upset. Upset in a good way, but you don’t want to go in there and be upset. You’re right. Stuck it in my bag. I’ll read it when I go home. It’ll be good. I’m sure nothing’s wrong.
[49:39] Stephanie Wittels Wachs: If there is one thing Cindy loves, it is her babies who are all grown up now. And in their absence, there is this massive void inside of Cindy that she was used to filling with drugs. Eleanor Health is offering her an alternative: human connection.
[50:00] Cindy Evenhart: So I was sitting out there waiting for my mom. And Bruce was leaving. I was reading a magazine, and he was walking out the door, he was leaving. And he stopped me, turned around, he looked at me, he looked at me again, he’s like, “you need a ride?” And I was like, no, my mom’s coming. “I’ll give you a ride.” I said nah, she’s coming. “You want to go for a ride?” And I was like, sure. Jumped in the car and he ran a couple errands and I didn’t even get out the car. I just went with him and then got back here. A few minutes later, my mom pulled up and she said, “did you just get here?” I said, yeah, I went running errands with one of them. But honestly, I think it was a secret counseling time. Because he talked to me. I talked back. And then the last thing he said before we closed the doors, when we were in the parking lot, he gave me something — a suggestion on something he thought I should try for myself every day. And it was something like writing 10 things down, a goal. I was like, “I can’t do that! 10 things a day? No.” And he said, OK, in a week. Or make it five things a day. And it can be you’re not on your phone as much as you were. Something little. Little Cindy, not big. You keep thinking big. Control of the world level. OK, I’ll think about it.
[51:43] Stephanie Wittels Wachs: Well, I see that you did five things today. You did your hair, makeup. You put clothes on, you put earrings in and then you came here. That’s five things.
[51:57] Woman’s voice: There you go, girl. You on fire.
[52:00] Jack Register: And you got a letter from your son and you got a text from your daughter.
[52:03] Cindy Evenhart: Today has been a great day.
[52:07] Stephanie Wittels Wachs: Oh, and you did a podcast!
[52:08] Jack Register: See, you got your 10. You’re just rocking and rolling.
[52:13] Cindy Evenhart: Earlier, I thought I was going to have a great day. I felt like it. I was having a great morning. Ended up having a great, great day. I really appreciate it.
[52:24] Stephanie Wittels Wachs: We’ve talked a lot this season about the concept of one day at a time. But this is such a beautiful example of what that looks like in real time. When you’ve had such an endless string of terrible days, a great day is a gift. And a great, great day? That is next level. Eleanor Health is helping people like Cindy to experience this, but they’re also serving members who are in a totally different place in their recovery. Next week, we meet Isaac, who encompasses so many of the themes that we’ve been grappling with throughout this season. He is committed to the 12 steps and tethered to an AA community. But there’s something that he is hiding from them.
[53:11] Isaac: I like to go to AA meetings, still. I network and do a lot with these guys. I got really tight with these fellas and they’re helping my spiritual growth. Having said that, though, I still have to keep the issue of my suboxone use separate from them because that they kinda want to get judgmental and they want to be like, well, you’re doing this extra stuff. They don’t really understand that if I remove that piece of the puzzle, I will probably not succeed like I have been for the last almost five years. And it makes me feel kind of dirty, you know, like I’m hiding something that I shouldn’t b e doing when really I’m not. They’re the ones with the problem of how they’re looking at it, but they make me feel like it’s my problem. And I don’t run into that here.
[54:02] Last Day is a production of Lemonada Media. Our producer is Jackie Danziger. Nicolle Galteland is our associate producer. And our assistant producer is Claire Jones. Kegan Zema is our technical director. Brian Castillo is our editor. And our executive producer is Jessica Cordova Kramer. Our music is by Hannis Brown. Special thanks to Westwood One, our ad sales and distribution partner. And a very, very special thanks to everyone we spoke to Eleanor Health. Nikki and I were especially grateful for the bottomless snacks, coffee and Girl Scout cookies. Y’all really know how to make a couple of hungry ladies feel loved. You can find us online @LemonadaMedia. And you can find me @wittelstephanie. if you like what you heard today, tell your family and friends to listen and subscribe, rate and review us on Apple, Spotify, Stitcher or wherever you get your podcasts. I’m Stephanie Wittels Wachs. See you next week.