Steve Priest, CEO & President, Spero Health

In an interview with Invest:, Steven Priest, CEO and president of Spero Health, discussed the company’s expansion, the impact of social determinants on recovery, the evolution of telehealth, and forming the nine-company National Alliance for Comprehensive Addiction Treatment Solutions (NACATS). “It focuses on creating sustainable reimbursement models, aligning with clinical outcomes, and sharing best practices. The collaboration is still early, but it is already showing promise.”

What have been the key milestones for Spero Health over the past year?
I started Spero Health in January 2018 as a startup focused on outpatient addiction treatment. Over time, our patient population evolved, and we now offer a much broader set of services related to substance use disorder.

Today, we operate 75 clinics across six states, providing counseling, physician and nurse practitioner care, and extensive recovery support coordination. About 65% of our patients are Medicaid-based, and our fastest-growing group is Medicare. We are fully outpatient, helping people live at home, return to work, and rebuild their lives, often in rural communities, though we also serve metropolitan areas.

One major milestone was partnering with eight other organizations to form the National Alliance for Comprehensive Addiction Treatment Solutions (NACATS). Post-pandemic, delivering care has been challenging, especially amid Medicaid redetermination, which left many patients without coverage and created a gap for the working poor.

Substance use patterns have also shifted. The rise in fentanyl and methamphetamine use forced us to keep refining our clinical model. Despite these complexities, we improved new patient retention, a key predictor of long-term recovery. Patients who stay in recovery for six months have a much stronger likelihood of lasting success.

I am proud that by refining our model, expanding tools and resources, and maintaining focus, we have helped more people achieve long-term recovery. Since inception, we have treated nearly 60,000 individuals, with about 23,000 last year alone. Our mission which is saving lives, instilling hope, and restoring relationships, happens one human being at a time.

NACATS brings together nine similar organizations across the country. It focuses on creating sustainable reimbursement models, aligning with clinical outcomes, and sharing best practices. The collaboration is still early, but it is already showing promise.

In what ways are social determinants of health shaping your strategy for recovery support services?

When I founded the company, I underestimated how significantly social determinants would affect recovery. If someone struggles with food insecurity, homelessness, or transportation barriers, it becomes incredibly difficult to focus on long-term recovery. That reality pushed us to dedicate significant effort, whether reimbursed or not, to helping patients address these needs.

Our recovery support coordinators connect patients to primary care providers and community resources. We see ourselves as the quarterback, guiding patients to the services they need, and we work closely with nonprofit partners in every community.

Stabilizing social determinants acts as a launchpad toward sustainable recovery, improving both behavioral and physical health outcomes.

How has technology, specifically telehealth, changed the way you deliver care?
Technology has definitely evolved, and it continues to change the way we deliver care.

Before the pandemic, telehealth was almost nonexistent due to strict regulations. When COVID-19 hit, those rules were suspended, and in two weeks, we shifted from no telehealth to about 95% telehealth delivery.

We also made a strategic decision to keep all clinics open. Many patients needed a safe space, not just for addiction care, but for other types of support. Staying open became a stabilizing force, especially in small rural communities.

By April 2020, almost all care was virtual. By midsummer, patients started returning to clinics. Today, about 23% of our care remains through telehealth.

There is no fixed ratio for telehealth and in-person care; it depends on each patient’s needs. Patients further along in recovery may thrive with virtual visits, but early recovery often demands real human connection. Addiction is, in many ways, a disease of disconnection, and building trust and communication skills usually requires face-to-face interaction.

Virtual care can never fully replace in-person presence. Sometimes, people simply need human contact. Moving forward, we expect about a 70-30 split between in-person and telehealth services, but flexibility will be key.

What are some of the unique challenges you are encountering in behavioral health delivery today?
Like many others, we faced high turnover during the pandemic. While that has stabilized, caregiver shortages remain a challenge, making technology even more vital.

Healthcare providers cannot easily raise prices when costs rise. Instead, we must find ways to deliver excellent care more efficiently. Our mission remains helping people achieve long-term recovery, not maximizing profits.

Our six-month retention rate is two to three times the national average. Like our peers, we know the care we deliver works. But it starts with getting patients into care and stabilized.

Workforce shortages and economic pressures are real. Some states have increased reimbursements thoughtfully, but uncertainty in Washington, D.C., regarding budget cuts and Medicaid work requirements creates risks. Historically, treatment qualified as an exemption from work requirements, but any policy shift could create new barriers for patients.

We need reimbursement models that work for everyone: taxpayers, employers, government programs, insurers, providers, and patients. If patients cannot afford care, they cannot access it. Without stable outpatient care, patients too often cycle between ER visits, hospitalizations, and homelessness.

Stable, affordable, local outpatient care is essential. Providers must also sustain enough margin to survive. With rising costs and flat or declining reimbursement, that remains a real challenge. Fortunately, our senior team knows how to operate at scale, and we have preserved the margin necessary to grow.

That said, we have not opened a new facility in two years. Market uncertainty makes it harder to justify new investments until volumes can stabilize. That is why collaboration through the NACATS is so important.

Given the challenges, how do you feel about the future of your work and the industry?
Despite all the challenges, I’m still incredibly bullish about the work we do. First, I know the care we provide works. I see it firsthand in people’s lives. In fact, our “Stories of Hope” book of handwritten letters from patients talking about their care experiences all tell the same story: lives are being transformed. Patients come into treatment broken, and within 30 days, they are stronger. In 90 days, they are more confident, reconnected with their families, getting jobs, and reclaiming their lives. We get letters from parents who have reunited with their children from foster care. We hear from people who thought they would never be a good parent or hold a job again, and now they are thriving. We know it works.

The second reason I’m optimistic is because the patient population remains vastly underserved. Millions of Americans are struggling with substance use disorder, and most receive no care at all.

There has been some improvement — overdose death rates declined by about 20% to 25% this past year. Increased Narcan availability has helped, and even illicit drug cartels seem to be adjusting to avoid killing their customer base. Through our toxicology testing, we see trends showing some shifts in drug potency.

At the same time, I believe providers across the board, outpatient, inpatient, and everywhere in between, have made a meaningful difference. Our approach works when human beings are ready to accept help, and our job is to meet them at that moment.

Outpatient, local, affordable care is what patients need, especially those in lower socioeconomic brackets. They need treatment that fits into their lives so they can still be parents, go to work, and rebuild.

I also believe the industry needs to consolidate. Scale matters. Bigger platforms create long-term sustainability. They allow organizations to leverage technology better, operate more efficiently, and weather economic ups and downs. That is why NACATS exists; even though we are technically competitors in some areas, we all agree on the bigger goal: improving access to sustainable, high-quality, comprehensive care. Not just offering one piece of the solution, but truly integrating counseling, medical care, medication-assisted treatment, and recovery support into one place.

Consolidation will make the entire field stronger. It will allow more people to get more care in more places. That’s what matters most: saving lives, instilling hope, and restoring relationships.

It is an incredibly difficult space to work in, but also one of the most rewarding. Every day, we know we are making a difference. And that’s why I’m excited about the future.