As the mental health crisis has increased demand for behavioral health services, Innovive Health has found its niche delivering care to Medicaid patients in their homes. The provider is now looking to deepen its roots in the three states it operates in and further expand its geography.
Innovive’s founder and CEO, Joseph McDonough, is also preparing to become involved in value-based arrangements with the company’s payer partners in order to overcome the constraints of fee-for-service models.
Medford, Massachusetts-based Innovive is a home-based care provider that serves complex behavioral health patients receiving Medicaid in Massachusetts, Colorado and Iowa. The company offers skilled nursing, case management, medication adherence, care coordination, wound care and behavioral health services.
Additionally, McDonough is working to establish data-sharing arrangements with “visionary” managed care programs to better determine what drives positive and negative patient outcomes.
McDonough sat down with Home Health Care News on its Disrupt podcast to discuss the growing need for behavioral health services, the company’s growth drivers and its aims to capitalize on the cost savings it passes on to its payer partners.
Below are selections from that conversation, edited for length and clarity.
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HHCN: There is a rapidly growing population of behavioral health patients across the US. Can you talk to me a little bit about the demand you’re seeing at Innovive?
McDonough: There is really a crisis out there. The demand has significantly increased since the COVID-19 pandemic, and according to the National Institute of Health, one in five American adults lives with some form of mental illness. It’s almost 60 million people nationwide.
It’s really a true crisis, and unfortunately, access to care is limited. Twenty-five percent of that number say they have a difficult time accessing care. And there’s a significant increase in the younger population as well. I think there is going to be a big issue over the next coming decade, and it’s something that we’re really trying to get in the thick of and really try to help.
A few years ago, you described your company as one that focuses on the 3% to 5% of individuals who drive roughly 50% of the costs in health care. Can you go into detail about what that looks like at Innovive?
Even though it’s a significant population, it’s almost a forgotten population, except for the cost. We estimate that our services, you know, save up to $200,000 to $250,000 per patient in Massachusetts, about $135,000 per patient in Iowa, and about $200,000 per patient in Colorado. Our program significantly reduces hospitalizations and ED utilization as well. We really create a much better quality of life for the patients, as well as creating significant cost savings for our Medicaid plans and our payer sources.
Can you talk about the company’s geographic expansion over the past few years and how this aligns with trying to meet the demands of the national mental health crisis that you mentioned earlier?
There’s demand everywhere in this country, in all 50 states, even Puerto Rico as well. Our first state, we picked Colorado. Colorado has a Medicaid system that closely mirrors what Massachusetts does, but they do have a significant need. They have a suicide rate of 21.1 people per 100,000, compared to the national average of 13.1 people per 100,000. Governor Polis of Colorado has invested over $550 million for health equity programs for this population. So we thought it would be a great state for us to address.
Iowa is another state where we have a partnership with the Medicaid managed care plans there. Iowa is a state that is not only last in the country for the amount of hospital beds they have, but they have 128,000 Iowans who have a serious mental illness. These are states that have a lot of needs, and we are partnering with different providers there and payer sources. We’re really looking at deepening our relationships in those states, as well as expanding [into other states that have a need for our services] as the years go forward.
Aside from geographic expansion, what were some of your company’s other growth drivers this year?
It’s really managed care partnerships. We have a unique opportunity with visionary managed care programs to really create a program, for instance, with data sharing. One of the things, whether it’s a Medicaid program or a managed care program, that they don’t fully understand is what happens to these patients once they get out of the hospital. What are the drivers for negative outcomes? What are the drivers for optimal outcomes?
For instance, we have data that shows that at the 15th month mark of us caring for a patient, we stop hospitalizations almost altogether. And we don’t know why it’s 15 months. But we also don’t have insight into what happens to a patient, you know, before they are referred to us. So being able to partner with visionary managed care partners and have an understanding of the data that happens before we take on a patient, and combining the data, we can really create a better understanding of what drives positive outcomes as well as negative outcomes, to really change the future of care for this population, so that that’s a real growth driver for us.
How is technology helping Innovive address its challenges?
Technology is always important. We’ve been cloud-based for many years. It’s really allowed us to be able to spread geographically and be effective operationally throughout multiple states.
We do a lot with Salesforce. We have a very innovative sales force model in our intake department that we use, and we’ve closely partnered with them to make sure that once we onboard patients, we’re able to really communicate with all the stakeholders.
Of course, we’re looking at AI right now as well, as far as care delivery. Once we get into the value-based program and the predictive analytics space, that’s going to become important as well. Technology is going to be a huge thing, particularly AI, over the next five years.
Where is Innovive at in terms of value-based care today?
We’re exploring several value-based arrangements with our payer partners. We definitely would love to capture some of that value (that we save per patient), as well as entering into data-sharing arrangements with multiple payers.
Massachusetts right now is exploring a value-based arrangement, and so we’re hopeful that will come aboard. I want to get away from a fee-for-service model.
What plays into your company’s decision to increasingly dive into value-based care?
Fee-for-service is constraining. It’s not necessarily appropriate. I think the more stakeholders can coordinate care in the community and utilize technology more, the more savings to be had. And I think there’s a better quality of care that can be had for the patient, and better outcomes can result. I look forward to working with payers and the state of Massachusetts and hopefully Colorado someday, to help put together a system that can better care for this patient as well as constrain costs.