Barry Karlin oversaw the growth of CRC Health Group into the nation's largest chain of addiction treatment centers and arguably the industry's most scrutinized provider entity. Today, Karlin has similar designs for the effect he intends to have in the pain management field, wanting to build the country's largest pain management company over the next five years.
“I'm hoping our impact here is exactly the same, although I'd like to do it much faster,” says Karlin, whose Prospira PainCare opened for business 18 months ago (Aug. 1, 2012).
Although there is some programmatic overlap today between the worlds of addiction treatment and pain management, Karlin has come to see the fields as significantly different, although elements of his prior work in one certainly have crossed over to his present efforts in the other.
“In my CRC days I became aware that 30% of our patient base at the time was addicted to prescription painkillers,” he says. “They had been habituated to their pain—they had not received any treatment for their underlying condition.”
After Karlin stepped down from CRC in 2010, he reconnected with one of the private equity firms that had been an original investor in the addiction treatment organization. Several private equity investments and some of Karlin's own personal funds generated a total of $68 million in initial funding, giving Prospira (the company name is derived from “positive“ and “aspirational”) the opportunity to become a major player in a huge market.
“The pain management world is 10 times bigger than the chemical dependency market,” Karlin says.
Prospira has completed half a dozen acquisitions of pain management practices in the past 18 months, and now has a presence in the states of California, Florida, Georgia, Michigan and New Jersey. Karlin says its goal in the various locations involves establishing regional “centers of excellence” in pain treatment, with satellite operations situated around a service hub.
The company website describes Prospira's approach this way: “From evaluation and diagnosis to testing and treatment, Prospira PainCare brings all of the resources necessary—in a single location—to treat acute, chronic or intractable pain.”
Prospira's facilities emphasize the efforts of a treatment team, with nurse practitioners, physician assistants, psychologists, art therapists and case managers all potentially involved in an individual's care. A physician coordinates the clinical services.
“The pain world is very much physician-driven,” says Karlin. “The addiction world is more counselor-driven, with doctors in support.”
Practices in the Prospira family commit to a minimal use of opioid medications. Treatment services take an integrated, whole-person approach that features aspects of medical intervention, physical therapy and behavioral therapy.
One important strategy employed by Prospira is functional restoration, an intensive effort to increase functioning and improve patients' ability to manage their pain.
Karlin says that if a patient already has a medication dependence issue, he/she cannot be treated at a Prospira facility and would have to be referred to an addiction treatment center. He sees the two treatment systems as distinct, even though some addiction treatment organizations have begun establishing pain management or pain recovery initiatives within their programs. “I see pain recovery as a tiny component of what addiction treatment programs do,” he says.
Other areas of difference that Karlin sees include a broader mix of payers in pain management (where workers' compensation and Medicare are prominent), and less concern about zoning and neighborhood opposition considerations when siting pain facilities.
Growth opportunities abound in the pain area, given the increased recognition of the issue as a fundamental medical problem and the fact that according to data, only diabetes appears to take a higher toll in overall societal costs.
“Pain is everywhere,” Karlin says, adding that factors such as the aging of the Baby Boomers and the generally overweight population promise to intensify the problem. The number of pain specialists in the country has soared from about 200 in the year 2000 to around 3,500 today, says Karlin.
One priority that Karlin has carried over from his CRC days is the importance of using data to help define best practices in treatment.
“We are establishing sophisticated enterprise systems for collecting large amounts of clinical data,” he says. “We're hoping to be a factor in defining effective pain management. Right now the most commonly used tool for assessing pain is a subjective scale.”