“We understand the state well, and we understand the payers,” said Jonathan Wolf, CEO and founder of Pyramid Healthcare, during a May 25 meeting at the Robert C. Carpenter Community Building in Franklin.
Founded in 1999, Pyramid is an integrated behavioral healthcare system with more than 80 residential and outpatient facilities in the northeast and southeast. The company has had a presence in North Carolina for about a decade, including in Asheville, Brevard, Charlotte, Gastonia, Mars Hill and Stokes County.
Pyramid’s integrated system is a continuum that goes from detox to residential treatment to transitional housing to partial (outpatient) hospitalization to intensive outpatient services to fully-outpatient care. The full continuum lasts a year or more.
Last November, Pless spoke to a gathering of local elected officials and administrators at Holly Springs Baptist Church in Macon County, proposing that the seven western counties of Cherokee, Clay, Graham, Haywood, Jackson, Macon and Swain pool their national opioid settlement funds — more than $22 million, in total — to fund the operations of a facility in the western part of the state.
At that time, Transylvania County jumped on board. The group has since been joined by Madison County.
Pless represents Haywood and Madison counties, but throughout the process has enjoyed support from his Republican colleagues who represent the rest of the west — Macon County Sen. Kevin Corbin; Cherokee, Clay, Graham and Macon County Rep. Karl Gillespie; and Rep. Mike Clampitt, who represents Jackson, Swain and Transylvania counties.
Clampitt, a longtime fire captain in Charlotte, again spoke in favor of the idea while mentioning a half-brother who recently passed away after a lifetime of substance abuse problems.
Ultimately, the North Carolina General Assembly would be the entity to fund the facility, if Pless can get the money.
“Your representatives are going to try to help them build a facility when they tell us what size they want and how much money they want,” Pless said. “We’re going to try to do that. We kind of have a handshake [agreement] that when that time comes, we’re going to get help.”
Pyramid would first assist clients by navigating the health care coverage side of things, attempting to utilize the client’s private insurance for payment or qualifying them for Medicaid. If neither of those options work, the counties would foot the bill from the settlement funds — essentially, drug company money.
“I don’t want the state of North Carolina paying for it, and I don’t want the counties paying for it, because it will bankrupt all of us,” Pless said.
Wolf told The Smoky Mountain News that the first two steps, detox and residential care, would cost about $8,000 per person, but the full six-stage program, once established, would total $10,000.
Macon County, Pless said, is probably the most central location for the facility, given the massive size of the coverage area — from Murphy to Madison County, and everywhere in between.
Making access to care even easier, Pyramid VP of marketing Dan Gellman said that almost 100% of their assessments or admissions are transported at no cost by Pyramid’s fleet of drivers, who currently make more than 40,000 trips annually, driving roughly 2.5 million miles.
Aware of NIMBYism that has plagued the drug treatment debate locally, Pless has garnered support from Macon County Commissioner John Shearl and Franklin Town Council Member Stacey Guffey, both of whom spoke strongly in favor of the Macon County location.
The specific location, however, is one of several challenges that will need to be worked out once the facility materializes. Developable land is rare in the west, and site prep costs are much higher than in flatter areas of the country.
Several people at the meeting expressed concern that the facility would eventually be overrun by justice-involved people who end up with judicial or DSS referrals.
“We’ve never been overrun by criminal justice,” Gellman said, adding that if they were, they’d simply move people to another Pyramid facility.
Pless and fellow legislators have pushed for strong local control of the county funding streams, allowing individual counties to determine the extent to which they’ll participate. Gillespie, a former county commissioner like Corbin and Pless, supports the approach.
“All of us believe that the best decisions are made at the local level, not the state and federal level,” Gillespie said.
Yet to be determined is how the facility’s beds — maybe 100, maybe more — would be apportioned out to the counties. They could end up being reserved on a per capita basis, or perhaps assigned on a first come, first serve basis.
Staffing the facility may also be tough, with a general shortage of health care professionals recognized across the region and the state.
Pregnant clients represent safety and liability risks; however, Pyramid does treat them in other locations, and could in Western North Carolina as well.
There are also accessibility concerns regarding the elderly. Medicare does not fund detox or residential treatment; however, people who are dual-eligible for Medicare and Medicaid may qualify.
The final issue relates to the third step of the program, transitional housing. One of the biggest causes of relapse is the lack of safe, affordable, sober living environments.
The affordable housing crisis in the region is already well known, but Pless said the time for addressing the housing needs of people in recovery would come as the facility breaks ground.
Rep. Mark Pless started work on the proposal late last year.
Cory Vaillancourt photo
