Nina Underman leads strategic operations at Aware Recovery Care, where she supports care model execution and services growth for the in-home provider of substance use disorder care.  Nina’s prior healthcare operations experience has spanned rural healthcare systems, national provider groups, and corporate-backed startups. Nina received her BA in neuroscience from Bowdoin College and her MBA in healthcare management from The Wharton School. 

Nina Underman, VP of Strategic Operations at Aware Recovery Care

The Pulse: Can you introduce yourself and how you came to be at Aware Recovery?

Nina Underman: While at MaineHealth, I saw the realities of delivering care to an older, rural population in a state that struggles with healthcare labor and was facing an opioid crisis. I was deeply inspired by the amazing clinicians and leaders at MaineHealth and became really interested in care model innovation and implementation. Why was it that all these new apps and models that were going to change the game were not changing the game for communities and clinicians who really needed them, like those I worked with in Maine?

I wanted to understand innovation at scale, so I went to OptumCare. I was curious about how the largest employer of US physicians thinks about care delivery. It was important to see the impact of scale in action. Incumbents and startups really can develop best of both worlds scenarios that help patients, and that was a perspective I really value from my time there. Prior to Aware, I was fortunate to help launch Author, a Humana-backed startup that is now Author Health. After working closely with the team to launch the behavioral health delivery arm as a NewCo, I was excited to explore behavioral health more deeply.  After learning about Aware Recovery Care’s clinical model and approach to caring for SUD, I jumped at the chance to work at a company so dedicated to changing the way addiction is treated. 

The Pulse: Given that your focus is around addiction, rehabilitation, and behavioral health, could you give a little context on what being the Head of Strategy at Aware means and what problems you are trying to solve?

NU: Aware Recovery Care provides in-home substance use disorder care to young adults and adults in 11 states. We have 300 peer coaches living in recovery who visit clients in their home on a weekly basis, supporting them on their individualized recovery path. Because addiction is a family disease, family education and family therapy are a part of our program, as is individual therapy and care coordination. 

I love Aware’s model because it addresses three major barriers in this space and, I would argue, in healthcare generally. First, we solve access barriers. Some folks don’t like group settings, can’t leave work or childcare obligations to seek care, or don’t meet inclusion criteria for facility-level care.  This is a non-issue for us because we provide the care in the home.  Second, we solve care continuity issues. There’s no single, linear recovery pathway that everyone follows. We can support clients across all the ups and downs and lefts and rights in their recovery journey, with an emphasis on non-punitive, harm reduction care. Third, we solve a longitudinal problem. It’s totally possible some folks can achieve their treatment outcomes in 90-120 days, but when they go back home, how do they maintain them? We don’t have facility costs so, by treating clients in the home, we can stay with them for up to a year, able to walk with them as they truly build and practice the lifestyle changes necessary for lasting recovery.

My specific focus is on expanding access to this model by creating additional products and partnerships to help clients achieve their goals, and bringing our care to the Medicaid population. 

The Pulse: What does addiction recovery care look like in America today? And what are the gaps that Aware is trying to rectify through this?

NU: For those that do seek treatment and can access care, the addiction ecosystem has traditionally been fragmented and time-boxed. A variety of physical and now virtual settings exist where folks can receive medical and therapeutic care, depending on acuity. But because we don’t prioritize care continuity or actual lasting recovery as the end outcome, some cycle in and out of care in these settings, without sustaining their treatment goals. There’s also a huge cost to payors and clients as they foot the bills for these stays and the co-occurring medical and behavioral health costs that are often present.

We have fantastic relationships with other members of the care ecosystem and for some, one IOP or residential stay is exactly what they need, which is great. But because recovery is so personal, we know other approaches are needed. That’s  where Aware sees industry-leading outcomes with longitudinal, cross-continuum care  led by peers and anchored by medical, behavioral, and family support. We don’t expect all new diabetics to master living with diabetes in 60-120 days. It takes time and practice to build those resilience muscles that truly allow for lasting management of a chronic disease. And that’s exactly what Aware’s model provides. Along the way, this practice helps folks see they can really thrive and live life, not just manage a chronic disease. And I really feel that’s what all of us, regardless of condition, deserve from our healthcare. 

The Pulse: How does Aware make addiction recovery more personalized?

NU: The home setting is so personal. We literally meet people where they are because we show up to their home two to three times a week for a year. We can really see the environment and that helps us with care planning. What hobbies are they interested in? What education or community engagement would be fulfilling to them? What primary care needs have remained unaddressed because they didn’t want to tell their PCP about their substance use? 

We also get personal not just with clients but also their families and allies. How can we really dig in and change the family system? It’s deeply personal care, and that’s why it’s so impactful. Having dedicated peers leading the program adds another personal element. Our peers are some of the most incredible people I’ve ever met. They share their own experiences, allowing the client to see an example of life beyond substance use from someone who once was in their shoes.  

The Pulse: You mentioned you were there during Maine’s opioid crisis. And I know since the COVID 19 pandemic, there’s been a lot more people at home, maybe not having and being able to do those routines. So since the pandemic, how has your team’s thinking shifted regarding addiction and rehab?

NU: That’s a great question. We have definitely seen growth in demand for services while folks were at home, out of their routine, particularly with alcohol use disorder. It’s caused us to think about how to scale services effectively, given the increased need. We’ve also seen more adolescent demand since the pandemic. 

But what’s been great is because our model is so personalized, because we have the flexibility to be outside of a brick and mortar setting, we are able to pivot very quickly to respond to what the client needs. In the pandemic, we did more outdoor walks and hikes with clients and more things like virtual cooking classes; these remain highlights for clients and peers to this day. 

The Pulse: As a final question, what advice would you give to your younger self as you looked to get involved in the public health space?

NU: You can build a fulfilling career by helping others. I have not felt I’ve had to make “career sacrifices” to work in this space.  So my advice would be to focus on how your role will make the mark that you want to make and what you want to learn.

Interviewed by Adhiti Rajesh, January 2024.

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On Feb 15-16, 2024, Wharton is excited to feature more expert perspectives at our annual Wharton Health Care Business Conference. This year’s conference is themed ‘The Resilience Edge.’ Conference details and tickets are available here.