Boulder Care, a virtual substance use disorder (SUD) provider, has appointed a nationally recognized addiction medicine leader as senior vice president of medical affairs.
Ayesha Appa, M.D., hailing from the University of California, San Francisco (UCSF), is a triple board-certified physician in addiction medicine, infectious diseases and internal medicine. At UCSF, Appa directed a novel low-barrier HIV clinic with integrated harm reduction and SUD services. She is also an assistant clinical professor at UCSF, a role she will continue, and is principal investigator on a NIDA-funded randomized clinical trial focused on opioid overdose prevention.
Appa will be the bridge between Boulder’s clinical team and the broader healthcare ecosystem, including payers, provider peers and policymakers. Her goal is to bring clinical authority to the company, helping ensure ongoing clinical excellence. She also plans to help define what quality in SUD looks like beyond abstinence—like retention in treatment, quality of life or ED utilization.
Though overdose deaths fell 21% in 2025 from the year prior, there were still an estimated 73,000 deaths. Most (80%) of rural counties have no buprenorphine prescriber. In 2023, some of the latest data available, only 15% of people with SUD got treatment.
“We’re at an inflection point in addiction medicine in the U.S.,” Appa told Fierce Healthcare. “That ongoing massive gap between what we know to be data-driven and effective, and what people actually experience when they try to access care, has driven me.”
SUD patients often face discrimination and stigma, including from the healthcare system itself, when seeking treatment. Access gaps are also a major problem. Addressing both elements, what drew Appa to Boulder was the company’s commitment to harm reduction and telehealth.
While harm reduction might mean different things to different people, to Appa it’s mostly about mentality: being patient-centric and honoring goals without judgment.
“There are so many myths and, in particular, lots of denigration of harm reduction that is happening in the last number of years,” Appa said.
There is a misconception that harm reduction is at odds with treatment, per Appa. There is a longstanding debate, for instance, about supervised injection sites.
In Appa’s view, if someone wants to continue using, their life is still worth protecting. Welcoming patients regardless of their goal in treatment is backed by data. Needle exchange programs, which seek to minimize the risk of infection among users, have repeatedly been shown to have a positive impact.
Seeking treatment can be overwhelming. “If you can create a clinically safe space, you can more effectively deliver care,” Appa said. “Ultimately, harm reduction is just saying patient-centered care for addiction.”
To that end, Boulder has patient navigators, enrollment specialists and peers ready to support patients. If someone starts enrollment, but drops off for any reason, an enrollment specialist will follow up within five minutes to help them navigate next steps.
Boulder conducted nearly 200,000 telehealth visits in 2025. While it may seem like brick-and-mortar treatment sites compete with telehealth, the opposite is true, per Appa.
“We are 25 years into this overdose crisis,” she said. “Our access gaps are massive.”
Telehealth can quickly respond to patients, a crucial component of addiction medicine. When someone is ready to start care, she said it should be treated as an emergency.
Most patients engage with Boulder through an on-demand visit experience. This was designed in response to the longstanding challenge of high no-show rates for scheduled appointments in behavioral health. When Boulder shifted to on-demand visits several years ago, per Appa, the company reduced its no-show rate from 40% to near zero. This way, patients can join on their own schedule and providers can spend more of their time supporting patients.
Boulder has supported 35,000 patients since its founding in 2017. Nearly three-quarters of Boulder patients remain in care at six months, which the company says is three times the industry average. Boulder’s quality and effectiveness measures rank in the 90th percentile of HEDIS measures, and the company claims payer partners report up to 50% cost savings through reduced utilization of EDs and inpatient treatment programs.
“Dr. Appa is one of the most respected and forward-thinking leaders in addiction medicine today,” Stephanie Strong, founder and CEO of Boulder Care, said in a press release. “As Boulder expands across the country, we have the opportunity to redefine what high-quality addiction care looks like at scale. Dr. Appa brings the clinical leadership, scientific rigor, and systems-level thinking needed to ensure our care remains deeply human, scientifically rigorous and capable of driving durable outcomes for patients, communities and payers.”
Editor's note: A previous version of this article mistakenly stated that Ayesha Appa, M.D., is Boulder's first physician executive. She is not the first.