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How Value-Based Care Could Transform Serious Mental Illness Treatment

Serious mental illnesses (SMIs) are very costly to treat. Patients with SMIs also have much worse health outcomes.

Value-based care could help providers treat SMI patients better. It allows them to get creative and focus on the whole person. It includes physical, mental, and social well-being.

“Value-based care breaks the cycle of only providing reimbursable care,” says Sonia Garcia of Amae. “It allows for more holistic care that leads to true recovery.”

SMI has a huge financial and human cost each year:

  • Over $300 billion in economic costs
  • 10-20 year reduction in life expectancy for patients

Currently, physical and mental healthcare for SMI is very fragmented. Value-based care promotes a whole-person preventative approach instead.

“The current reimbursement model doesn’t support the comprehensive care SMI patients need,” explains Christina Mainelli of Quartet. It includes physical health, mental health, social services, employment support, housing, and more.

Companies like Quartet and Amae are using a whole-person approach for SMI care. Quartet recently launched a value-based model with multidisciplinary teams. It is moving further towards per-member-per-month and full-risk payment models for SMI.

Value-based care also enables beneficial wraparound services. For example, one Chicago insurer installed air conditioners in members’ homes during a heatwave. It cleared out overflowing hospitals overnight.

Peer support specialists are another key service for SMI patients. They can build trust with a population in the system that has repeatedly failed.

“Peers are essential for engaging SMI patients in care when doctors and nurses can’t,” says Samir Malik firsthand. His peer-based SMI care company enrolls 7 out of 10 patients they engage.

Peer services could also help with behavioral health staffing shortages. “Enabling reimbursement for coaching and wraparound services frees up providers to support higher-acuity patients,” notes Mainelli.

The tools to help SMI patients aren’t new—just the payment models. Value-based contracting could finally bring proven interventions to scale.

“We know what works for SMI,” says Malik. “We just haven’t aligned the economics to make it widely available. Value-based care changes that.”

5 Innovative Companies Tackling Serious Mental Illness

Serious mental illnesses (SMIs) like schizophrenia, severe bipolar disorder, and major depression affect about 5% of Americans. SMIs are incredibly costly, leading to negative health outcomes. The economic cost exceeds $300 billion annually.

Several companies are working on solutions to challenges in SMI treatment:

  1. Vanna Health: Uses a for-profit, community-based model. Led by former NIH Mental Health director Dr. Thomas Insel. Aims to prove profitability and scale community SMI care. Takes a whole-person approach.
  2. Innovive Health: Focuses on physical health and medication management for SMI patients. Provides in-home skilled nursing, therapy, and aides. Trains staff to treat SMI alongside chronic conditions. Currently in Massachusetts, plans to expand.
  3. Amae: Integrates behavioral health, primary care, and community support. Helps SMI patients reenter society through employment assistance. Long-acting injectable medications are used to improve adherence and reduce side effects. Based in Los Angeles.  
  4. Firsthand: Employs peer support to engage SMI patients in community care. Peers have firsthand SMI experience and build trust with unengaged individuals. Takes an in-person, boots-on-the-ground approach. Technology-enabled but not tech-focused.
  5. Akin: Supports SMI caregivers through digital psychoeducation. $79/month subscription includes lessons, guidance, and community. Aim to reduce SMI hospitalizations by 20-50%. Views family support as key to recovery.

Other notable companies in the SMI space include:

  • Cerebral
  • Valera Health
  • NOCD
  • Established providers like Acadia, LifeStance, Universal Health Services

As more innovators enter the SMI treatment space, there is hope for improving care and outcomes for this high-need population. Successful models could transform the landscape in the coming years.

Amae Builds Business Around Whole-Person, Integrated Care

Amae, a San Francisco-based provider, is improving care for serious mental illness (SMI). The company uses a holistic approach to unify fragmented parts of healthcare. Amae provides behavioral health care, primary care, and community support.

Sonia Garcia and Stas Sokolin founded Amae after seeing their family members struggle with SMI. They saw how difficult it was for patients to navigate the healthcare system. Sokolin realized that payers and health systems also faced challenges with SMI care.

Around 5.6% of people in the U.S. have SMI. However, many face barriers to accessing treatment. Amae’s care model includes the following:

  • Psychiatrists
  • Social workers
  • Peer support
  • Health coaches
  • Primary care physicians

The company aims to integrate physical care into SMI treatment. Amae opened its first center in Los Angeles. It plans to work with commercial, Medicaid, and Medicare plans.

People with SMI often have worse health outcomes than the general population. On average, they live 10 to 20 years less than their non-SMI peers. Amae wants to change this by embedding primary care physicians into its model.

The company focuses on medication adherence using long-acting injectable antipsychotics. These medications can last up to 90 days and have lower side effects.

Amae also helps patients find purpose and reintegrate into their communities. The provider treats patients with both SMI and substance use disorders (SUD).

Other companies and government initiatives are also working to improve SMI care:

  • Vanna: A startup connecting people with SMI to community resources
  • Certified Community Behavioral Health Clinics: $300 million federal investment
  • Mobile Crisis Intervention Services: $15 million in planning grants from the Biden administration
  • CMS Advanced Investment Payments: Funding for small providers in underserved areas

Amae plans to collaborate on research to personalize SMI treatments based on genetic and clinical factors. The company represents a growing trend of providers taking a community-based, whole-person approach to SMI care.

Meet the 30 Young Leaders Forging a New Future for the Healthcare Industry

The healthcare industry constantly evolves, and young leaders are at the forefront of this change. In 2022, Insider selected 30 leaders under 40 who are transforming healthcare. These leaders come from diverse backgrounds and are tackling various challenges in the industry. Amae Health founders were notably mentioned along this list: 

 

Stas Sokolin and Sonia Garcia

Stas Sokolin and Sonia Garcia are transforming the way we care for people with severe mental illnesses. They cofounded Amae Health, which plans to create a network of clinics offering resources like primary care, community rooms, financial literacy courses, and vocational training to those with severe mental disorders.

How a Family Tragedy Led to Mental-Health Startup Amae Health

Sonia Garcia faced a family tragedy at a young age. Her father died by suicide when she was just 16. This devastating event shaped her life and career path.

Sonia’s brother also struggled with severe mental illness. He went missing and was found in jail, suffering from mania. The family had a hard time finding effective treatment for him.

These experiences motivated Sonia to focus on improving mental health care. She studied engineering at Rice and Stanford. She also worked as a healthcare consultant and at a mental health startup.

Sonia realized that treating severe mental illness requires a comprehensive approach. Telehealth alone is not enough. In-person care and long-term support are crucial.

In 2022, Sonia co-founded Amae Health with Stas Sokolin. Stas also had personal experience with family members struggling with mental illness. As an investor, he couldn’t find startups tackling this issue effectively.

Amae Health aims to treat severe mental illnesses like:

  • Schizophrenia
  • Bipolar disorder
  • Major depressive disorder

Their approach combines:

  • In-person treatment led by psychiatrists
  • Strong focus on community-based social support
  • Digital health services for long-term care

Amae Health has raised several million dollars in seed funding. Investors include Virtue, Bling Capital, 8VC, and Able Partners. The company plans to launch its first local clinic later this year.

Sonia and Stas believe their model will improve patient outcomes. It could also lead to cost savings for insurers and health providers. Treating severe mental illness requires ongoing, multifaceted care.

The Amae Health team is driven by personal missions, not just market opportunities. Their chief medical officer, Dr. Scott Fears, brings expertise in community-based mental health care for veterans.

Investor Sean Doolan was excited to partner with this uniquely qualified and motivated team. Amae Health is poised to make a meaningful impact in an underserved area of healthcare.