The past several months have been devastating for many behavioral health providers. The COVID-19 pandemic has caused widespread financial strain, forcing some organizations to cut back services, close programs, or face the risk of shutting down entirely. Yet, amid this turbulence, Pinnacle Treatment Centers has managed not only to remain stable but to grow.
Pinnacle is one of the nation’s largest substance use disorder (SUD) treatment providers, serving about 32,000 patients each day. With more than 115 locations across eight states, the organization delivers a full continuum of care. However, it is particularly well known for specializing in Medicaid-reimbursed medication-assisted treatment (MAT), especially methadone.
While many providers were downsizing during the pandemic, Pinnacle was expanding. Right before COVID-19 disrupted the U.S., the Mount Laurel, New Jersey-based company acquired Aegis Treatment Centers, one of California’s largest outpatient opioid treatment providers (OTPs). Since then, Pinnacle has rolled out more than five new programs and centers, including a new OTP in Marion, Ohio. The company also acquired HealthQwest, a Georgia-based MAT provider, further cementing its national presence.
For Pinnacle CEO Joe Pritchard, this growth is no accident. He attributes the organization’s success to a strategy centered on listening to states’ needs and designing services accordingly. At the same time, Pritchard has been vocal about the need for more flexibility around methadone MAT, highlighting the regulatory barriers that often slow patient access to life-saving treatment.
The Expansion Strategy
Unlike some providers who expand with a one-size-fits-all model, Pinnacle takes a localized approach. Before launching new programs, the company talks with state officials and stakeholders to identify gaps in care. “We never assume that we know what a state needs,” Pritchard explained. “We always have conversations and say, ‘How can we fill a need that you have?’ We build out from there.”
This approach has helped Pinnacle grow strategically, with new OTPs planned in Ohio, New Jersey, and Virginia, and over 15 new programs expected to open by the end of next year. The organization blends de novo development with acquisitions, leveraging strong reputations of local providers to expand its footprint. The acquisition of Aegis in California and HealthQwest in Georgia, both with years of community trust, gave Pinnacle platforms to build upon in those regions.
Pritchard also emphasized the importance of being a community-based provider rather than a “destination” center. Most of Pinnacle’s patients live within 30 to 45 minutes of an outpatient clinic and within 90 minutes of a residential program. This model ensures that patients remain close to their families and support systems, which is especially vital during recovery.
Methadone MAT and Regulatory Hurdles
Pinnacle treats approximately 30,000 patients daily with MAT, the vast majority of them on methadone. While buprenorphine and naltrexone (Vivitrol) are also offered, methadone remains the backbone of its treatment programs. However, methadone MAT faces more restrictive regulations than other forms of MAT, and Pritchard has been advocating for greater flexibility.
During the pandemic, the Substance Abuse and Mental Health Services Administration (SAMHSA) loosened restrictions on buprenorphine, allowing physicians to initiate treatment via telehealth. This change helped patients access care more quickly, especially when small practices were shutting down. Yet methadone did not receive the same level of regulatory relief.
As a result, new methadone patients must wait for in-person physician assessments before induction can begin. With many Pinnacle physicians being older or semi-retired, the requirement poses both a staffing challenge and a public health risk. Pritchard has proposed a hybrid approach where patients are assessed in-person by medical staff but can meet with a physician virtually for induction. However, this flexibility has not yet been approved.
The lack of parity between buprenorphine and methadone regulations continues to create barriers to care. “We were hoping they would do the same for methadone, which has not occurred yet,” Pritchard said. He remains optimistic that ongoing discussions could lead to more consistent rules in the future.
Community and Patient Demographics
Pinnacle’s patient population reflects the communities it serves. The average patient is in their early to mid-30s, with an even split between men and women. Most patients are treated in ambulatory settings, though Pinnacle also provides residential programs, sober living, and outpatient counseling.
On the MAT side, the majority of patients are covered by Medicaid, though about 20–25% use commercial insurance. Medicare has recently begun reimbursing MAT, allowing Pinnacle to expand services to older populations as well. Residential programs also serve a mix of Medicaid and commercially insured patients, depending on the state.
Pritchard emphasized that there is no need for patients to leave their state to find treatment. He believes states must build the right mix of services locally, allowing patients to remain close to family and community supports.
The Role of Telehealth
The pandemic accelerated telehealth adoption across the behavioral health sector, and Pinnacle was no exception. The ability to conduct virtual visits, especially for buprenorphine induction, has been transformative. Pritchard believes telehealth will remain a permanent fixture in SUD treatment, though he expects it will evolve into a more structured model post-pandemic.
Currently, many providers rely on laptops and phones for virtual visits, but Pritchard envisions a more formalized telehealth infrastructure in the future. “We’re developing a more well-defined permanent process that will be deployed, post-pandemic, that should be longer lasting and more impactful,” he said.
Policy and the Future of MAT
Looking ahead, Pritchard sees several areas where federal and state policy changes could improve access to MAT. One is the need for consistency in take-home methadone rules. Currently, regulations vary widely by state, with some allowing up to 21 days of take-home doses and others restricting patients to just a week. Standardizing these rules could reduce confusion and expand access.
He also highlighted the importance of integrating behavioral health with corrections. During the pandemic, there has been progress in providing MAT within jails and prisons, along with warm handoffs upon release. Ensuring that reimbursement mechanisms are in place to sustain this continuity of care will be critical moving forward.
Finally, Pritchard believes providers must continue to advocate for a level playing field in MAT regulations. As chair of the MAT committee for the National Association for Behavioral Healthcare (NABH), he has pushed for reforms that recognize the value of methadone alongside other medications.
An Opportunity for Collaboration
Recently, Pinnacle and other large behavioral health providers received letters from members of Congress, including Sen. Elizabeth Warren (D-Mass.) and Reps. Carolyn Maloney (D-N.Y.) and Katie Porter (D-Calif.), requesting information on COVID-19 response efforts. Pritchard welcomed the outreach as an opportunity to educate lawmakers on the realities of providing SUD care during a pandemic.
“What will be critical here is that this goes from a questionnaire to a work group,” he said. “You need to get some of us that deal with this every single day around the table and say, ‘Let us tell you what is working and what’s not and what we need.’”
For Pritchard, real progress will come when policymakers, providers, and payers collaborate to align regulations with patient needs.
Conclusion
Pinnacle Treatment Centers’ ability to grow during the COVID-19 crisis underscores the strength of its community-based model and its commitment to meeting states where they are. But as CEO Joe Pritchard makes clear, growth alone is not enough. Expanding access to methadone MAT, standardizing regulations across states, and embracing telehealth innovations are all essential to addressing the opioid epidemic in a sustainable way.
As the pandemic reshapes the healthcare landscape, Pinnacle’s experience highlights both the opportunities and challenges ahead for SUD treatment providers nationwide.
