Serious mental illnesses (SMIs) are extremely costly and can lead to negative health outcomes, a fact that makes this corner of the behavioral health world ripe for innovation. Specializing in SMI treatment, however, comes with a number of high-stakes challenges.
SMIs – conditions such as schizophrenia, severe bipolar disorder and major depression – impact roughly 5% of the U.S. population. Additionally, the economic cost of SMI is more than $300 billion each year, according to SMI Advisor.
Behavioral Health Business has identified five up-and-coming operators that are looking to tackle some of the biggest challenges facing the SMI space: Vanna Health, Innovive Health, Amae, firsthand and Amae. The challenges they’re working to solve include getting patients into care, the medical cost associated with SMI, integrating patients back into the community, caregiver burnout and more.
Here’s an inside look at the five SMI providers that BHB is watching in 2022 and beyond.
Led by industry leaders Dr. Thomas Insel, former director of the National Institutes of Health (NIH) Mental Health, and Dr. Giovannia Colella, co-founder of OODA Health, Brightline and Castlight, Vanna Health is focused on connecting patients with SMI to resources in their community.
BHB is watching Vanna not only because of its star-studded leadership team, but also its for-profit approach to community-based SMI care.
“We’re quite convinced that there’s a business case to be made, because these are the most expensive patients in many health plans, including in Medicaid,” Insel recently told BHB. “And we’ve seen this in the markets that we’ve looked at – these are very expensive patients. But importantly, the expense is not on the behavioral health side; it’s on the medical side.”
The bulk of community-based SMI care providers operate on nonprofit models. However, the ability to prove profitability could allow these community-based models to scale, according to Insel. And that’s exactly what Vanna is hoping to do.
“No one’s been able to demonstrate to payers, and sometimes to providers, that by providing this comprehensive and continuous behavioral health support and … making sure [patients] get not just behavioral health care, but upstream preventive medical care, … you will bring down the overall cost of care,” the former NIH leader explained. “It reduces the costs for chronic pulmonary disease, for cardiovascular disease, for diabetes – for all the things that are really driving these costs of care.”
Vanna plans to tailor its model to each community it works in and collaborate with local resources. In some markets, the company will bring Assertive Community Treatment (ACT) teams together and will hire community health workers and peers. It will also help train the teams to get them off the ground. In locations where ACT teams exit, it will help connect organizations and unify the patient experience.
Another reason to pay attention to Vanna is its whole-person approach to care.
“What I call the three Ps: providing people, place and purpose for those with serious mental illness,” Insel said. “And that if we did that well, and we did it comprehensively, continuously, compassionately, we could really help a lot of people who today end up incarcerated or homeless or just really struggling. We can help them to have a much better life to help them to thrive.”
The San Francisco, California-based company has raised $4 million in venture funding but is not seeking any new funding for the time being.
Still in its infancy, the company is now talking to partners and choosing pilot programs. If the company does begin to scale, this could be a model for other companies looking to address SMI care in a for-profit and scalable way.
We’re quite convinced that there’s a business case to be made, because these are the most expensive patients in many health plans, including in Medicaid.”
Innovive Health is tackling a major issue in health care: the medical cost associated with SMI.
Specifically, the in-home health care company is focused on providing physical health care and medication management to individuals with SMI. Its services include skilled nursing, physical therapy, occupational therapy and home health aides.
BHB is watching Innovive because it’s one of the few companies looking to address the physical health of patients with SMI in a home environment. Medicare beneficiaries with SMI incur roughly 11 times more mental health services spending and 37% higher medical spending than those with no known mental illness.
“It’s not uncommon for our patients to have up to 10 medical comorbidities,” Innovive CEO and founder Joseph McDonough previously told BHB. “A patient that’s representative of our census could be a 55-year-old male diagnosed with schizophrenia that also has insulin-dependent diabetes. … They may have COPD, they may have cardiac issues.”
While the company does not have behavioral health providers on staff, it trains nurses and therapists how to treat patients with SMI and chronic conditions.
Founded in 2004, the company only operates in Massachusetts. It works with Medicaid and state Medicaid accountable care organizations (ACOs).
The company is currently bootstrapped, but McDonough said it may consider taking on private equity investment as it looks towards expansion. Although the company’s scope is still relatively small, it plans on acquiring new companies in other states in order to expand.
If the provider gains a foothold in new states, its innovative model of treating patients in the home could spread across the country.
Amae is carving out a space for itself in SMI care by focusing on patients’ physical, psycho mental, and societal and community wellness.
Its model was inspired in part by the Department of Veterans Affairs’ mental health intensive case management program (MHICM), which includes a psychiatrist, social worker, peer support, health coaches and primary care physicians.
BHB is watching Amae because of its efforts to integrate care in a historically siloed health care system. Specifically, the company is looking to unify behavioral health, primary care and community support for patients with SMI.
A key part of its model is helping patients reintegrate into their community, for example, helping patients find jobs.
“We’re not just stopping at ‘good job, you adhere to the medication that was prescribed’, but it’s saying you are a whole human,” Sonia Garcia, COO at Amae, told BHB. “We’re coming in to treat the whole person and understand that throughout these stages of your health, we want to also end up in a place where you feel like as an individual are reentering into your community.”
Amae also caught BHB’s attention for its use of long-acting injectables to help patients stay on their medications.
“This really serves two purposes. One is that the patient is adhering for 90 days, which is wonderful,” Amae CEO Stas Sokolin told BHB. “Two is it’s actually a much lower side-effect profile for the patients.”
The venture-backed startup is currently working in Los Angeles but plans to expand in the future. It plans to work with Medicare, Medicaid and commercial insurers.
While there are a lot of moving parts to this model, if Amae can successfully integrate primary care, physical health and social services, it could provide a path for treating patients holistically and reintegrating patients into society.
Getting patients with SMI into care is still a major challenge for providers. In fact, only 64.5% of adults with SMI received mental health treatment in the past year, according to the CDC.
BHB is watching firsthand because the company is looking to change this paradigm by using peer support networks to help get individuals living with SMI into community-based care. The peer support staff are all living with SMI and may have gone through similar experiences of living in a church, shelter or group homes.
“The real focus for firsthand is recognizing that the vast majority of members on a Medicaid plan with a serious mental illness diagnosis and a high total spend are unengaged in outpatient behavioral,” Samir Malik, firsthand CEO, told BHB.
The New York-based startup was founded in 2021. While Malik was tight-lipped about the company’s funding, PitchBook reports that it raised roughly $14.8 million in venture dollars.
“Peers who have first-hand experience are able to connect with these individuals who are unengaged and build trust with them, be patient, not necessarily present an agenda but really wait until the time is right and then reintroduce to benefits [that could] help them find recovery,” Malik said.
The company uses a boots-on-the ground approach to engagement. It is an entirely in-person service that works in the patient’s community. It does use technology to help run its programs and track data, but Malik specified the company is a technology-enabled provider and not a tech-focused company.
If firsthand can crack the nut on patient engagement in behavioral health, it could blaze the trail for others in the industry looking to get difficult to reach patients into proper services.
While the bulk of innovations in the SMI space focus on the patient, caregivers of individuals with SMI are at-risk of negative mental health impacts including depression, anxiety and burnout.
BHB is watching Akin because of its focus on the caregiver experience. Founded in 2021, the company offers digital family psychoeducation, which is the practice of educating family members about SMIs and how to support SMI patients.
Akin operates on a subscription model. It charges its clients $79 per month. It offers a digital platform with evidence-informed lessons, personal guidance and community support. Its Akin Family Circles tool helps connect clients with other members who are also supporting an individual with SMI.
The company pitches its platform as a tool to help reduce hospital admission rates for patients with SMI. One review finds that family psychoeducation reduces the rate of hospitalization for symptom relapse by between 20% and 50%.
“We see this as very relevant and potentially more relevant to value-based care models where you’re really trying to take a look at the whole patient,” Akin CEO Stephanie told BHB. “We’re thinking about the patient holistically and about the family support system that’s going to have to be an influence on that person’s trajectory for recovery and for [their] wellness.”
Akin is a pre-seed stage venture-backed company. If the startup is looking to grow through additional venture funding, it will be competing in a very crowded digital mental health market. However, the bulk of digital health companies are focused on lower-acuity care.
While Vanna Health, Innovive, Amae, firsthand and Akin are SMI providers to watch in 2022 and beyond, they’re not the only ones attempting to shake up the status quo. Some newcomers including Cerebral, Valera Health and NOCD are also companies that BHB is following closely.
Additionally, a number of established providers including Acadia, LifeStance and Universal Health Services have been treating this population for decades – and will continue to innovate in the future.
Akin, Amae, firsthand, Innovive Health, Vanna Health
Laura Lovett is the Editor of Behavioral Health Business. Prior to this, she served as the Executive Editor of MobiHealthNews, a HIMSS Media publication. While reporting for MobiHealthNews, she won three bronze AZBEE awards including one for impact reporting. In 2019 Lovett took part in the Umass Medical Media Fellowship. Lovett was educated at the University of East Anglia, the University of Massachusetts, and Oxford University. If she isn’t reporting on healthcare she’s probably kayaking on the Charles River or trying a new recipe.
Behavioral Health Business (BHB) is the leading source for news and information covering the mental health and addiction industry. BHB is part of the Aging Media Network.