Getting care for serious mental illness (SMI) can often be confusing and siloed. The emergency room is all too often the de facto front door for care.
However, a growing number of providers across the country are looking to improve SMI care through a community-based approach. One of those companies is San Francisco-based Amae, which is using a holistic care model to unify fragmented parts of the health care sector. It seeks to give patients behavioral health care, primary care and community support.
As family members of individuals with SMI, Amae founders Sonia Garcia and Stas Sokolin saw firsthand the convoluted health care systems patients had to navigate to get care. Garcia serves as Amae’s chief product officer, while Sokolin serves as CEO.
“I started thinking, what if you could build a company to provide extremely high-quality care for those with SMI?” Sokolin told Behavioral Health Business. “And treat those individuals, who right now, do not get any kind of care. The care they get is woefully inadequate, aside from a few systems. What I learned was that for payers, this was a huge problem. These patients were truly expensive. And the outcomes were quite poor for health systems. This was also a problem because they were not structured in a way to deal with this patient population.”
Roughly 5.6% of individuals in the U.S. live with a serious mental illness, but there are often barriers to accessing treatment. The CDC reports that 69.9% of females with SMI and 54.9% of males with SMI receive mental health care.
The estimated lifetime burden of SMI is $1.85 million per patient, according to Health Affairs research.
Amae’s model of care
Amae’s model, which was inspired in part by the Department of Veterans Affairs’ mental health intensive case management program (MICM), includes a psychiatrist, social worker, peer support, health coaches and primary care physicians. The operator is looking to tie physical care into serious mental illness treatment.
The venture-backed Amae opened its first center in Los Angeles. The operator plans on working with commercial, Medicaid and Medicare plans. Its investors include Virtue, Bling Capital, 8VC and Able Partners.
“SMI is prevalent across all three. I think too often we think of the commercial patients as being less likely to have an SMI,” Sokolin said. “That’s not always the case because there’s a lot of dependents [covered under a commercial plan].”
In terms of outcomes, the provider looks at three main areas: physical, psycho mental, and societal and community.
Health outcomes for individuals living with SMI are worse than the general population. In fact, research has demonstrated that individuals with an SMI live 10 to 20 years less than their non-SMI peers, on average. Amae is hoping to change this paradigm by embedding primary care physicians into its model.
Sokolin noted that many primary care physicians are not trained to treat patients with SMI. Additionally, the prevalence of physical comorbidities is higher in the SMI population.
Part of the reason comorbidities are higher in this population is the medications they are required to take to treat their SMI, Sokolin noted.
Medication adherence is one of the organization’s focus areas for outcomes. The provider is using long-acting injectables to help patients stay on their medications. Long-acting injectables are typically antipsychotics that can last three months once they are administered, he explained.
“This really serves two purposes. One is that the patient is adhering for 90 days, which is wonderful,” Sokolin said. “Two is it’s actually a much lower side-effect profile for the patients.”
Yet overall health isn’t just about medication adherence or physical health, Garcia said. It’s also about having purpose. The organization helps patients be a part of their community while potentially finding 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,” Garcia said. “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.”
The provider also treats patients living with SMI and a substance use disorder (SUD). Sokolin said that it’s a part of the organization’s integrated care approach.
“We really wanted to treat both concurrently,” Sokolin. “We believe everything should be integrated. Just as we believe primary care should be integrated with behavioral health, we believe SUD treatment should also be integrated.”
As for the future, the company is also looking to collaborate on research efforts. Specifically, the team is interested in how individual patients will respond to certain treatments based on genetic and clinical factors.
The larger landscape of SMI care
While the SMI population has historically been underserved, a number of new providers are looking to care for that population.
For example, former National Institutes of Health (NIH) Mental Health Director Dr. Thomas Insel co-founded a new for-profit startup called Vanna that connects people with SMI to resources in their community.
It’s not just the private sector looking to incorporate community programs into SMI care. The federal government has invested $300 million in two Certified Community Behavioral Health Clinics (CCBHCs) to help expand access to mental health care and SUD care.
Additionally, the Biden administration awarded $15 million in planning grants to 20 states to support community-based mobile crisis intervention services for Medicaid recipients.
The U.S. Centers for Medicare & Medicaid Services (CMS) is also proposing advanced investment payments to give small providers in rural and underserved areas funding upfront to care for their communities.
“[Providers] can use it to help with community-based organizations, food, housing and transportation,” Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, told BHB in a July interview. “There’s a lot of work that we’re doing to make sure that we are thinking about people more holistically, and marrying our efforts in physical health, behavioral health, health-related social needs towards that end.