How we deliver care
We treat people where they are — through mobile units and a fixed clinic. Medication for opioid use disorder (MOUD) is the front door: it brings patients in and is billable fast. Behavioral health — therapy, psychiatric care, case management, and peer support — is the depth that keeps patients in treatment and makes each clinic profitable. A medication-only patient is worth about $2,590 a year; add behavioral health and that rises to about $6,640 a year.
What we actually do
Two distinct treatment settings, one care model. Mobile units — vans staffed by a prescriber and care team — reach rural counties and underserved neighborhoods that have no provider nearby. A fixed clinic anchors the work and carries the steady patient panel. Both run the same model: start the medication, then build the full behavioral-health relationship on top.
We do this through Two Dreams, an already-licensed Illinois treatment provider. That existing license is the slow piece every competitor lacks — so we skip the slowest startup step and start treating patients in weeks, not years.
The care model in plain terms
Opioid use disorder is chronic, and most medication patients also live with depression, anxiety, PTSD, trauma, or bipolar disorder. Treating those conditions is good medicine, and each service is separately reimbursed by Medicaid and Medicare.
The medication visit is the start, not the whole business. It enrolls an engaged patient we can then care for fully. Adding behavioral health to that patient costs almost nothing — they are already here.
The front door — medication
In-clinic and telehealth buprenorphine is billable within 4–8 weeks under Two Dreams' existing state license — no waiver, no patient cap. It is the Year-1 cash engine and how patients first find us. Methadone, which requires a licensed opioid treatment program, is a separate 9–14 month build that adds revenue later; naltrexone rounds out all three FDA-approved medications.
The depth — behavioral health
Once enrolled, the patient is handed off directly to psychiatric care, individual and group therapy, intensive outpatient, case management, and peer support. That turns a single medication relationship into a deeper, recurring one that lasts years instead of months — and keeps patients in care.
Earning more from a patient we already have is the cheapest growth there is: almost nothing to add, and it keeps patients in care longer for more recurring revenue. Skipping behavioral health leaves most of the value — clinical and financial — on the table.
What we bill for
Each service below is reimbursed separately by Medicaid, Medicare, or both, under standard federal (CMS) and Illinois Medicaid billing rules. Codes are kept out of the main table for readability — a short reference follows. Dollar amounts are per-patient-per-year planning estimates.
| Service | Who delivers it | Paid by | Est. annual / patient |
|---|---|---|---|
| Buprenorphine treatment (in-clinic + telehealth) | Prescriber (physician or nurse practitioner) | Medicaid + Medicare | ~$2,590 |
| Opioid treatment program bundle — methadone (Year-2 build) | OTP team (prescriber, nurse, counselor) | Medicaid + Medicare | ~$8,800–10,900 |
| Psychiatric evaluation (intake) | Psychiatrist / psychiatric NP | Medicaid + Medicare | ~$160 |
| Psychiatric medication management | Psychiatrist / psychiatric NP | Medicaid + Medicare | ~$900 |
| Individual therapy / counseling | Licensed clinical social worker / counselor | Medicaid + Medicare | ~$2,000 |
| Group therapy | Licensed clinician / counselor | Medicaid + Medicare | ~$700 |
| Intensive outpatient (higher-need patients) | Clinical team | Medicaid + Medicare | ~$5,000–8,000 (subset) |
| Collaborative care (monthly, team-based) | Care manager + consulting psychiatrist | Medicare + Medicaid (varies by plan) | ~$1,600 |
| Case management / care coordination | Case manager | Medicaid | ~$1,200 |
| Peer recovery support | Certified peer recovery specialist | Medicaid (often grant-funded) | ~$1,000 |
| Telehealth behavioral health | Any of the above clinicians, remotely | Medicaid + Medicare (telehealth parity is permanent for behavioral health) | folded in; raises retention |
Buprenorphine bills through the monthly care-management bundle (G2086/G2087/G2088) plus office-visit codes. Methadone uses the OTP weekly bundle (Medicare G2067–G2073; Illinois Medicaid H0020). Behavioral health uses standard psychotherapy and evaluation codes (90791/90792, 90832–90837, 90853) and Illinois Medicaid rehabilitation-option codes (H0004, H0005, H0006, H2014). Collaborative care moved to new Medicare codes (G0568–G0570) on 1/1/2026; the old codes (99492–99494) ended 12/31/2025. None of this changes the per-patient economics — only the claim forms.
The patient journey
The key move is the intake hand-off: get the patient from medication into behavioral health early. Behavioral-health uptake is the single biggest driver of revenue per patient, so we capture it from the start and keep it.
Referral & engagement
Patient arrives via ED, jail/court diversion, shelter, mobile outreach van, or self-referral. We screen Medicaid/Medicare eligibility at intake — uninsured patients bill $0 and are grant-covered, so screening protects the revenue mix.
Start medication (the front door)
Buprenorphine starts in clinic or by telehealth — billable right away under our existing license. The patient is now enrolled, and the recurring monthly care bundle begins.
Psychiatric evaluation & hand-off
An evaluation identifies co-occurring depression, anxiety, PTSD, or trauma, and the prescriber hands the patient directly to therapy and psychiatric care — the moment that more than doubles annual value.
Behavioral health added on
Individual and group therapy, psychiatric medication management, monthly collaborative care, and — for higher-need patients — intensive outpatient. Each is a separate, recurring service for a patient already here.
Case management, peer support & retention
Case managers and certified peer recovery specialists support the patient — both reimbursed and proven to keep patients in care. Telehealth extends every service to rural and mobile patients at low cost.
Sustained recovery & growing value
Integrated-care patients stay in treatment about 2.5 years versus about 1.3 on medication alone. Both medication and behavioral-health revenue recur, so lifetime value grows — and documented outcomes help win the next grant.
The per-patient math
These figures use a Medicaid-weighted payer mix, realistic per-service uptake, and about 70% retention. Not every patient takes every service; those uptake rates are already baked into the blended numbers below.
| Revenue component | Medication only | Medication + behavioral health |
|---|---|---|
| Buprenorphine treatment (blended) | ~$2,590 | ~$2,590 |
| Psych eval + medication management (~60% uptake) | — | ~$650 |
| Individual therapy (~70% uptake) | — | ~$1,500 |
| Group therapy / IOP (subset) | — | ~$350 |
| Collaborative Care (CoCM, ~35% uptake) | — | ~$510 |
| Targeted Case Management (~50% uptake) | — | ~$560 |
| Peer recovery support (~50% uptake) | — | ~$480 |
| Blended annual revenue / patient | ~$2,590 | ~$6,640 |
| Median retained tenure | ~1.3 yrs | ~2.5 yrs |
| Estimated lifetime value / patient | ~$3,370 | ~$16,600 |
| Multiplier | 1.0× | ~2.6× annual · ~4.9× lifetime |
Behavioral health makes a patient worth about 2.6× more per year and roughly 4.9× more over their lifetime — from extra reimbursed services plus far longer tenure (more months and weeks billed). The more patients we move into behavioral health, the more each clinic earns from the same number of people.
| Share of patients in behavioral health | Blended revenue / patient / yr | Annual revenue from 340 patients |
|---|---|---|
| 0% (medication only) | ~$2,590 | ~$0.88M |
| 50% | ~$4,615 | ~$1.57M |
| Base case (~70%) | ~$5,425 | ~$1.84M |
| 90%+ | ~$6,235 | ~$2.12M |
Getting patients into behavioral health at intake is the single most valuable lever for revenue. See how it flows through to profit and margin on the Financial Model page.
Integrated care improves retention & outcomes
The clinical case and the financial case are the same case: behavioral health keeps patients in treatment, which turns one visit into years of recurring revenue while producing the documented outcomes that win the next grant and stronger contracts.
Retention drives everything
Peer support, case management, and collaborative care raise 90-day retention from about 70% toward 85% — roughly a 17% revenue boost from more weeks billed. Patients who stay are patients who recover.
Treating the whole person is good medicine
Treating addiction without the underlying depression, anxiety, PTSD, or trauma fails and loses patients. Adding psychiatric and therapy services is better clinically and financially.
Outcomes win the next grant
Longer tenure and better retention build a multi-year outcomes record — the evidence that wins larger grant renewals and value-based contracts.
The cheapest growth we have
Earning more from a patient we already have costs almost nothing to acquire. Our mobile units feed new patients into this high-value integrated-care population — see Mobile Units.
Two Dreams is a full behavioral-health and addiction home, not a pill counter: medication brings patients in, and behavioral health is the recurring, growing revenue that makes each clinic profitable. The figures here are planning estimates grounded in federal and Illinois Medicaid rules; final rates drop into the model without changing the logic.