‘The Value Proposition Is Clear’: How Innovive’s Home Care Model Keeps SMI Patients Out of the Hospital

Serious mental illnesses (SMI) can steal years from people’s lives.

People with SMIs die 10 to 20 years earlier than most people, according to one study.

Massachusetts-based Innovive Health, an in-home skilled nursing company, seeks to get in front of these issues. The goal is to keep high-acuity, high-risk patients out of the hospital. In turn, patients see improved health and greater quality of life all the while generating lower health care spending.


Innovive CEO and founder Joseph McDonough told BHB in an interview that the average hospital stay for the population the company cares for is 11 days and costs about $38,500. It’s not uncommon for people in this population to be hospitalized 10 to 15 times a year, he added. Hospitalizations are a major driver of health costs.

Compare that to the cost of Innovive Health’s home-based care and coordination services annual cost of $25,000 per patient on average.

“The value proposition is clear,” McDonough said. “The need across the country is pretty significant. Massachusetts is very innovative in how it works with this population and there’s still large amounts of unmet need throughout the state.”


Presently, the company only operates in Massachusetts through partnerships with Medicaid and state Medicaid accountable care organizations (ACOs). Specifically, it specializes in treating those with SMI in their homes.

Other estimates bear out that people with SMI and chronic health conditions see higher levels of health care spending. A 2019 report from the American Hospital Association finds that Medicaid patients with co-occurring behavioral health and chronic physical conditions have two to three times higher health care costs.

Specific to the Medicare population, people with SMI, on average, incur about 11x more mental health services spending and 37% higher medical spending than those with no known mental illness.

Innovive Health sees behavioral health and SMIs as a complicating aspect of physical health. It offers skilled nursing as its primary service. It also offers physical therapy, occupational therapy and home health aides.

While it doesn’t employ its own behavioral health providers, it trains its frontline staff, mostly of registered nurses, on how to care for those with SMI and chronic health conditions. About 90% of the company’s health care staff are registered nurses while about 10% are licensed practical nurses

“It’s not uncommon for our patients to have up to 10 medical comorbidities,” McDonough said. “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.”

Even people without SMI may have a hard time self-administering treatments for chronic behavioral health conditions.

In the case of insulin-dependent diabetes, this would mean testing one’s blood twice a day or more, operating a glucometer, measuring units of insulin based on the glucometer reading and on top of procuring and maintaining all the supplies for diabetes management.

“In that case, that’s going to be the thing that’s going to be driving the hospitalizations — their compliance with insulin or any kind of issues,” McDonough said.

It’s also not uncommon for patients to be prescribed 10 to 18 medications, McDonough said.

The company acts as a convener and coordinator of the many stakeholders in the patient’s care. These could include primary care providers, psychiatrists, diabetes specialists, departments of health providers, vendors and ACOs.

“All the stakeholders may not be actually speaking with each other,” McDonough said. “We’re able to communicate with all the stakeholders, integrate all the stakeholders to create a seamless treatment plan for our patients to create the most optimal outcomes.”

The company also has to address social determinants of health as well through partnerships with patients’ other stakeholders as well as partnerships with community organizations.

Founded in 2004, Innovive Health has bootstrapped its operations. This has allowed the company to make strategic decisions without having to answer to other demands.

“It allows us to be much more creative and really focus on quality rather than quarterly earnings,” McDonough said. “We’re certainly mindful of the numbers … We’re really all about creating the best outcomes for our patients and sometimes the best outcomes don’t correlate with the best numbers.”

McDonough said the company may consider taking on private equity investment as it eyes expansion. But it’s in a financial position on its own to acquire “several companies in other states as we start to expand.”

And McDonough’s goals are ambitious.

“We’re definitely in growth mode and we’re definitely in acquisition mode,” he said. “We want to become one of the largest providers of behavioral health services in the country. We’re really looking to revolutionize the behavioral health space throughout the country. It’s definitely ripe for disruption, for sure.”

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