In taking on the opioid epidemic, one of the biggest challenges in U.S. health care today, Stephanie Papes is facing her own challenge — building both a health care service and a tech startup.
She’s succeeding so far with Boulder, a Portland-based health-tech company that recently raised $10.5 million and inked a partnership with Premera Blue Cross.
Started in 2017, Boulder launched in Oregon about nine months ago, and began treating 100 patients with its full-service clinical model and the telemedicine that supports it. Boulder is an app-based addiction treatment program in which those suffering opioid use disorder (OUD) can avoid visits to brick-and-mortar clinics and instead get care and support when and where they need it with the help of a digital platform.
Papes, the founder and CEO, was a Forbes 30 under 30 honoree in health care in 2019 who has a background in venture capital investing and consulting around health care and technology. A graduate of Duke University’s Sanford School of Public Policy, she relocated to Portland after seven years in New York.
Boulder is employing physicians, nurse practitioners, peer recovery coaches and care advocates while also building out product, design and engineering teams.
The Substance Abuse and Mental Health Services Administration reported that an estimated 10.3 million Americans aged 12 and older misused opioids in 2018, including 9.9 million prescription pain reliever abusers and 808,000 heroin users. Papes sees Boulder as a way to reach more of those people.
“Brick-and-mortar facilities are still treating fewer than 10,000 patients,” Papes said. “We really think we can reach hundreds of thousands. That’s the only way we can make a dent [in the epidemic] and technology is the only way we can do that.”
Boulder’s goal through its new contract with Premera is to reach 2 million more people in the Pacific Northwest, cutting costs and improving the patient experience and outcomes in Oregon, Washington and Alaska. National expansion is the hope down the road.
Boulder’s care providers prescribe buprenorphine, described by American Addiction Centers as a “partial opioid agonist,” which is combined with naloxone, a medication used to block the effects of opioids, in the drug Suboxone. Buprenorphine binds to receptors in the brain and activates them only slightly, providing relief from withdrawal symptoms while the naloxone blocks the opioid’s effect, keeping the body from experiencing any kind of high.
Papes called buprenorphine the mainstay of medication treatment at Boulder, adding that it’s “incredibly effective and safe to initiate at home.” She’s proud of an 85-percent treatment retention rate among Boulder patients compared to an industry average of 30-40 percent. But she points to the moralistic stigmatization of addiction in the U.S. as a major barrier that still needs to be overcome.
The work can be a challenge with a tech team that is mostly new to health care and a health care team that is new to startup and tech culture.
“We’re all kind of coming together, aligned under this mission, but it’s a pretty motley crew,” Papes said of the team of 35, which includes 15 or 18 who work out of offices in Portland. “Part of the challenge is just making sure that we’re really learning from each other and for the first time, in many ways, building a truly blended services and technology digital care provider platform.”
Boulder’s platform allows patients to connect with providers 24/7 through secure video and messaging. Trying to reach the average patient with opioid addiction disorder means dealing with some who have altered brain chemistry, and many who are dealing with chaotic things in their lives, Papes said. She marvels at the way her physicians are building closer relationships with patients by being invited into their homes via technology.
“You can see moms who have their children sleeping in the background while they’re taking their video visits,” she said. “So it’s a different type of intimacy than you’d really expect in a clinical setting, which can be really, especially for addictive disease, not a great place to be — very anxiety inducing and stigma driven.”
Patient care can start in a hospital emergency department after an overdose or during a visit to a primary care physician. Patients create an account and talk to a Boulder specialist the same day. They are evaluated and if they’re a good candidate for buprenorphine, an e-prescription is sent to their preferred pharmacy.
A “Boulder Box” is sent to the patient containing narcan, the opioid overdose medication, as well as oral fluid test kits. Those saliva tests, meant to capture whether a patient is taking their medication or if they have other substances that they’re potentially co-ingesting, can be observed over video and a prepaid mailer allows samples to be sent back to a partner lab.
For those who see limitations to screen-based care, Papes is quick to point to the in-person interactions Boulder also helps facilitate, including the work of Kara Nelson, a peer coach lead who founded Haven House in Juneau, Alaska, to support women coming out of incarceration.
“We all at Boulder see Kara as Boulder, she is the company,” Papes said. “Yeah, we’re an app, but we’re also the Karas of the world. We’re out in these communities and trying to connect with people where they live. … It’s not as simple as, ‘some things need to be in person and some things should be in tech.’ It’s more of a ‘what can tech do to help solve problems for us?'”