As the mental health crisis increases demand for behavioral health services, Innovive Health has found a niche providing care in the homes of Medicaid patients. The provider currently has roots in three states where it operates and is looking to further expand its geography.
Joseph McDonough, founder and CEO of Innovive, is also preparing to engage in value-based arrangements with the company's payment partners to overcome the constraints of the fee-for-service model.
Based in Medford, Massachusetts, Innovive is a home care provider serving complex behavioral health patients receiving Medicaid in Massachusetts, Colorado, and Iowa. The company provides skilled nursing, case management, medication adherence, care coordination, wound care and behavioral health services.
In addition, McDonough is working to establish data-sharing arrangements with “forward-looking” managed care programs to better determine what drives positive and negative patient outcomes.
McDonough spoke with Home Health Care News on the Disrupt podcast to discuss the growing need for behavioral health services, the company's growth drivers, and its goal to pass cost savings on to payer partners.
Below are excerpts from that conversation, edited for length and clarity.
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HHCN: The population of patients with behavioral disorders is rapidly growing across the United States. Can you talk a little bit about the demand you're seeing at Innovive?
McDonough: There really is a crisis. Demand has increased significantly since the coronavirus pandemic, with one in five American adults living with some form of mental illness, according to the National Institutes of Health. There are approximately 60 million people nationwide.
This is a real crisis, and unfortunately access to care is limited. Of these, 25% say they have difficulty accessing care. Furthermore, the young population is also increasing significantly. I think there will be major challenges over the next 10 years, and we are committed to tackling them and trying to support them as best we can.
A few years ago, you described your company as a company focused on the 3% to 5% of individuals who generate about 50% of healthcare spending. Can you tell us more about what it’s like at Innovive?
Despite being an important population, they are a largely forgotten population, except for costs. Our services are estimated to save Massachusetts up to $200,000 to $250,000 per patient, Iowa approximately $135,000 per patient, and Colorado approximately $200,000 per patient. Our program also significantly reduces hospitalizations and ED usage. We not only deliver significant cost savings for Medicaid plans and payer sources, but also significantly improve the quality of life for our patients.
Can you talk about the company's geographic expansion over the past few years and how this meets the demands of the national mental health crisis you mentioned earlier?
There's demand everywhere in this country, in all 50 states, there's demand in Puerto Rico. I chose my first state, Colorado. Colorado has a nearly identical Medicaid system to Massachusetts, but with significant needs. The suicide rate is 21.1 per 100,000 people, and the national average is 13.1 per 100,000 people. In Colorado, Governor Polis has invested more than $550 million in health equity programs for this population. So we thought this would be a great state for us to work with.
Iowa is another state that partners with Medicaid managed care plans. Not only does Iowa have the lowest number of hospital beds in the country, but there are 128,000 Iowans with serious mental illness. There are many needs in these states and we partner with a variety of providers and payer sources there. We are seriously considering not only deepening our relationships in these states, but also expanding over the next few years (to other states that need our services).
Besides geographic expansion, what are the other growth drivers for your company this year?
It's truly a managed care partnership. We have a unique opportunity with a forward-thinking managed care program to really create programs like data sharing. One thing they don't fully understand, whether it's a Medicaid program or a managed care program, is what happens to these patients after they leave the hospital. What are the factors that lead to negative outcomes?What are the drivers that lead to optimal outcomes?
For example, data shows that by the 15th month of a patient's care, hospitalizations have almost completely disappeared. I don't know why 15 months. But we also have no insight into what is happening before a patient is referred to us. So by partnering with forward-thinking managed care partners and understanding the data that occurs before we admit patients and combining that data to better understand what drives positive and negative outcomes, we can really change the future of care for this population, and that's a real growth driver for us.
How is technology helping Innovive solve its challenges?
Technology is always important. We have been cloud-based for many years. This allows us to be geographically dispersed and operate effectively across multiple states.
We do a lot of things with Salesforce. We have a very innovative sales force model in our patient intake department, and we work closely with them to ensure that we communicate with all stakeholders once a patient is admitted.
Of course, we're also looking at AI now when it comes to care delivery. As we move into the field of value-based programs and predictive analytics, that also becomes important. The next five years will see significant advances in technology, especially AI.
Where does Innovave currently stand in terms of value-based care?
We are considering several value-based arrangements with our payment partners. We want to not only enter into data sharing arrangements with multiple payers, but also capture some of that value (the savings per patient).
Massachusetts is currently exploring a values-based arrangement, and we look forward to seeing it happen. I want to break away from a pay-as-you-go system.
What led to your company's decision to move more and more into value-based care?
Service fees are subject to limitations. Not necessarily appropriate. I think the more parties involved in coordinating care in the community and leveraging technology, the more savings there will be. I believe this will allow us to provide higher quality care and achieve better outcomes for patients. I look forward to working with payers, the state of Massachusetts, and hopefully the state of Colorado, to help create a system that improves care for this patient and helps contain costs.
