Author Heath: Addressing the Unmet Mental Health Needs of Seniors in MA
The Driver:
Author Health recently raised $115 million in a Series A funding round from General Atlantic and Flare Capital Partners. Author Health is a hybrid care platform focused on providing in-office and virtual mental health services to seniors enrolled in Medicare Advantage plans. The funds will be used to help Author expand geographically and increase its partnerships with both payers and providers.
Key Takeaways:
Over a quarter of Medicare beneficiaries reported skipping or putting off needed mental health care because of costs, compared to fewer than 10% of older adults in the U.K., France, Germany or Sweden (Commonwealth Fund)
45% of all opioid-related deaths involve individuals 45 years or older, and since 1999, drug overdose death rates have increased the most (by 6-fold) among those aged 55 to 64 years (JAMA)
Approximately 1.7 million Medicare beneficiaries were estimated to have past-year substance use disorder (National Library of Medicine)
While older adults comprise just 12% of the population, they make up approximately 18% of suicides (National Council on Aging)
The Story:
Author Help was founded by Gary Gottlieb, the former CEO of Partners HealthCare and Katherine Hobbs Knuton, previously CEO of Optum Behavioral Health. Both Gottlieb and Knuton are psychiatrists and lamented the ways that the system has not worked, particularly for Medicare patients in need of care for more serious mental health conditions.
For example, as Knutson noted at the Behavioral Health Business Invest conference last year while at Optum, she “saw the power of value-based care in addressing the interplay of physical and behavioral health [and noted] the pain point for insurers trying to find innovations and services on the market that help them address diverse populations.” She highlighted that these solutions often misallocated conditions and resources, with severely ill patients in need of psychiatrists often unable to see them for care.
Similarly, as Gottlieb noted in an interview with the Boston Business Journal, “Since my earliest days as a geriatric psychiatrist and later as an executive, I’ve been active in developing and supporting programs that are focused on the care of the whole person, her/his/their family, and the system around them and that work to integrate behavioral health and primary care, for older patients in particular,”
In the words of the company, Author Health was born out of the necessity to fundamentally shift how our health system prioritizes behavioral health and preventive services. By aligning Medicare Advantage health plans and clinicians to improve health, and using a combination of technology and community relationship-building to open access for hard-to-reach populations, Author Health is primed to meet the growing demand for psychiatric care on a national scale.” Currently, services are covered by Humana Medicare Advantage only but are working towards gaining more insurance providers in the near future.
The Differentiators:
Author Health separates itself from other comparable digital health companies by focusing on serious conditions instead of mild ones as well as by deeply integrating their services with primary care. According to the company, patients “with serious mental illness and substance use disorders often suffer from co-occurring medical conditions and health problems like diabetes, high blood pressure, and cardiovascular disease.” and are in need of integrated care. As such the company offers a team-based approach to psychiatric care, bringing together specialized physicians, nurses, therapists, and community health workers to deliver a mix of virtual and in-person care for individuals who are often disconnected from the traditional healthcare system. Through this model, patients and their caregivers are given an avenue to reconnect with healthcare providers and receive personalized and comprehensive treatment within their communities, and outside of hospitals and institutions.”
The severe mental health conditions available for treatment and support include depression, anxiety, schizophrenia, psychosis, Alzheimer's Disease, dementia, and substance use disorders, among others. The company believes “This care delivery model leads to improved quality of life for patients and their caregivers, as well as a reduction in medical emergency and inpatient hospital care, which in turn creates savings for health plans focused on value-based care.”
The Big Picture :
There is currently a lack of coverage for serious mental health needs for older adults, partly as a result of Medicare coverage gaps. According to the Commonwealth Fund, Medicare is reported to not cover assertive community treatment, peer support services, or psychiatric rehabilitation. This is a significant problem, especially considering the large number of Medicare beneficiaries with co-occurring substance use disorders and mental health conditions. In fact, research from the National Library of Medicine stated that "approximately 1.7 million Medicare beneficiaries were estimated to have past-year substance use disorder," and a large portion have co-occurring mental health conditions. Moreover, "45% of all opioid-related deaths involve individuals 45 years or older, and since 1999, drug overdose death rates have increased the most (by 6-fold) among those aged 55 to 64 years" compared to other age groups within the United States. In addition, as noted in “Patterns in Geographic Distribution of Substance Use Disorder Treatment Facilities in the US and Accepted Forms of Payment From 2010 to 2021” one reason that Medicare beneficiaries have difficulty accessing services for SUDs is due to low acceptance of Medicare in SUD treatment facilities. Despite the prevalence of high mental illness and substance use disorders in the Medicare enrollee population, coverage gaps remain a need to be addressed by solutions like Author Health.
Author Health Nabbed $115M To Serve Medicare Patients. It’s Not The Only One, Author Health Raises $115M for Senior-Focused Mental Health
