Charlie Health, a company that offers virtual high-acuity mental health care services, launched a dedicated virtual treatment program for individuals with primary substance use disorders (SUDs).

The new treatment program builds on years of experience supporting individuals with co-occurring substance use and mental health conditions, noted Carter Barnhart, CEO and co-founder of Charlie Health, in an interview.

"We made the decision that we should launch a dedicated virtual program for individuals whose primary need is treatment for substance use disorder, whether that's alcohol, opiates or other substances. But, it really was built off of us tracking people who came into our program, who came in with opioid use disorder, who came in with substance use disorder, as well as other co-occurring mental health disorders, and through tracking those individuals and seeing how they did in our program, that made us build the confidence where we said, 'OK, we can have a dedicated track just for primary substance use disorder,'" Barnhart said.

The program formalizes and expands Charlie Health’s proven virtual intensive treatment model to serve teens and adults whose primary need is SUD care. Charlie Health's approach combines personalized support, specialized clinical expertise and fully integrated, measurement-based treatment, the company said.

"We've been treating co-occurring clients for the past couple of years, and they were then having to go to a different provider to receive MAT (medication-assisted treatment) services. We were partnering with MAT providers, and what we determined was that we could actually more successfully treat those patients under just one umbrella," Barnhart said.

The virtual SUD program offers multiple weekly sessions, including groups, individual therapy, family therapy and MAT services. Clients are placed in curated peer cohorts and matched with a dedicated care team. MAT—including buprenorphine or naltrexone—is delivered as part of a coordinated care plan to ensure treatment aligns with progress.

"We think that so much of our success has been about placing people into curated peer groups. Especially with this SUD population, we know that they need that consistent support throughout treatment. They need to be in groups of people who are similar to them, and then the fully virtual element allows clients to stay connected to work, school, their family, while also receiving really high-quality care, which we've seen is just incredibly helpful in terms of success rates," she said.

Charlie Health delivers strong outcomes for clients with substance use concerns, including those with co-occurring mental health conditions. Among this group, 94% of clients who completed treatment did not require readmission to a higher level of care within three months of discharge, according to the company. Clients completing care also reported an 84% reduction in opioid use and an 80% reduction in alcohol use.

Mental health symptoms improved significantly for this population as well, with more than 70% reductions in both self-harm and suicidal ideation, and reductions of 47% and 46% in symptoms of depression and anxiety, respectively. 

"With the SUD population, typically, they're bouncing in and out of rehab and paying attention to that period right after discharge, those first three months, is when they're the most vulnerable, which gave us a lot of confidence in how we could deploy this program," Barnhart said.

Charlie Health launched in 2020 to deliver virtual high-acuity mental health care for teens and young adults. The startup's aim was to make virtual intensive outpatient treatment accessible to young people and their families with programs that combine supported groups, individual therapy and family therapy into evidence-based, comprehensive and personalized treatment plans.

Charlie Health's initial focus was on providing services to teens and young adults aged 12 to 26 years old, but the company has gradually expanded its services and now provides care to individuals from 11 years old up to 50 years old.

As part of Charlie Health's approach, patients are placed into curated groups with people who are of similar ages or similar lived experiences. 

"We're able to pair people together with other people who are struggling with the same issues," Barnhart said. "It helps them to feel not alone. Now in that environment, when they're in with those groups, this is all evidence-based curriculum that they're being delivered. They're with their peers, engaging with their peers, but also engaging with the clinicians who are delivering evidence-based curriculum that we're constantly evolving and iterating. That's also what gave me a ton of confidence that we'll be able to evolve our SUD curriculum over time and track what has worked and what has not worked using AI to really leverage what is the proper intervention at this moment with this specific type of patient."

There is widespread need for SUD treatment programs as more than 46 million Americans struggle with SUDs, yet only 6% receive treatment each year, according to the National Survey on Drug Use and Health. 

Charlie Health also is partnering with You Are Accountable, a peer-led recovery support program that offers virtual coaching and at-home drug and alcohol testing. The partnership provides clients with an added layer of structure between therapy sessions and helps reinforce real-world recovery skills, according to company executives.

“At You Are Accountable, we believe recovery is sustained through connection, accountability, and trusted support,” said Matthew Serel, CEO and co-founder of You Are Accountable. “Together with Charlie Health, we’re reinforcing the bridge between treatment and real-world recovery, ensuring individuals have the resources and support they need to stay well and build a sustained, dignified, and fulfilling life in recovery.”

Charlie Health's steady growth
 

The new SUD treatment program fits into Charlie Health's larger growth and expansion. The company is now in-network with most major health plans, including commercial and Medicaid, in 37 states with plans to continue expanding to more states. Charlie Health has served more than 50,000 patients to date, according to its website.

"We launched in Montana, on an Indian reservation in Montana, and we had this hypothesis that if we could be successful in this state that only had a million lives that had never had intensive mental health services before, that we could then be successful anywhere. Forget virtual. They didn't even have IOP [intensive outpatient programs] as a level of care in the state of Montana. So, we had to get IOP added to the fee schedule. We had to convince people that IOP was an effective type of treatment. Then we had to convince them that you could do it virtually. And we did it really successfully," Barnhart said.

Charlie Health was able to use Montana as the case study to expand into other states. "As we expanded into other states, they said, 'OK, you're doing really great work with our 26-year-olds. What about our 27-year-olds?' Since then, we've just slowly over time started to experiment, going about four years at a time and tracking the outcomes really closely," she said.

The company's growth is in response to its treatment outcomes—it expands where it has seen treatment and interventions work, she noted, adding that Charlie Health is not interested in expanding its services to other age ranges just to increase its total addressable market.

"There's still a ton more adolescents and young adults to serve, but it's really about that community partnership. What do our communities need and can we deliver the same or better outcomes for that older age range? We'll continue to expand that age range as needed," she added.

Charlie Health is currently piloting a program for 8- to 11-year-old children, Barnhart said, citing a "tremendous need" for mental health services for that demographic.

The company has a commitment to high-quality, evidence-based care, publishing an annual outcomes report (PDF). Charlie Health reports strong improvements for patients in its intensive outpatient program with 93% of clients reporting improvements in symptoms associated with depression, 91% reporting improvement with anxiety and 89% reported improvements in self-harm. Charlie Health also reported significant treatment outcomes in its maternal mental health program with rates of depression and anxiety reduced by half for cohort members.

The company also published peer-reviewed research demonstrating that its virtual intensive outpatient program significantly reduced emergency department utilization for mental health services.

The company also integrates closely with local communities to successfully discharge patients to local providers once they have completed Charlie Health's virtual intensive outpatient treatment program, which typically lasts nine to 12 weeks. 

"We have physical providers in those states, boots on the ground team members, although what we do is virtual in terms of how we deliver treatment, a big part of Charlie Health is community integration. Because we deliver episodic care, we have to be integrated in the community, meaning that we have to have those boots on the ground relationships," Barnhart said. "We have 300 boots on the ground, clinical outreach liaisons throughout the country that are focused on just developing that tight-knit relationship with the community so that our patients can successfully discharge out of Charlie Health."

The company also partners with other organizations to expand access to outpatient mental health treatment. It works with Houston-based Memorial Hermann Health System to fill gaps in critical mental health services, and it partners with Mantra Health, a digital mental health provider for higher education.

While investors have been pouring millions into mental health startups, Barnhart said Charlie Health is not looking to fundraise.

"It's really important for us to not be dependent on capital markets, and the business is self-sustainable. That has been a goal since the beginning," she said.