Samir Malik, the CEO of firsthand, and Marie Hannah, a recovery peer for the company based in Nashville, know that those in the greatest need of behavioral health treatment are often the hardest to reach.
The New York City-based startup uses a field-work-heavy approach to peer support work as part of a value-based care partnership approach with predominantly Medicaid plans. Through its intensive nonclinical work and reimbursement model, firsthand seeks to bring the latest in behavioral health trends to the forefront to mend bridges burned by the traditional health care system.
“What we recognize is that 70% of this cohort that’s unengaged is not unengaged because they don’t want to get better. They do. They’re trying hard every day,” Malik said on Behavioral Health Business’ maiden voyage episode of the podcast Behavioral Health Business Perspectives. “But their interactions with the health system and the social services system haven’t given them hope that that’s the pathway forward.”
Malik and Hannah joined Aging Media Network’s Bob Holly for a conversation about the rising importance of peer support, firsthand’s work, and the impact it can have on the behavioral health system and the lives of patients.
In February, the company announced a $28 million funding round led by GV. A few months later, the Biden administration released model standards for how peer support services should look and work to help standardize programs across states, revealing an interest at the highest levels of regulatory power in elevating the place of peers in the addiction and mental health treatment space.
Highlights from the conversation are below, edited for length and clarity. Subscribe to BHB Perspectives to be notified when new episodes are released.
BHB: A good place to start would be at the very beginning to help folks understand what firsthand is trying to do. Can you give me the firsthand origin story?
Malik: [Community mental health centers] deliver life-changing work. The work that people like Marie are doing to support individuals has really transformed the lives of folks who otherwise wouldn’t have many other resources. These safety net organizations are providing a place for individuals to find companionship, find treatment, and start a pathway to recovery. And yet, so many folks are struggling and unengaged. firsthand was really built out of recognizing that there’s some great work happening in communities today. But far too many folks are not engaging with those services.
And for those who maybe don’t understand what a peer does, how would you describe your role and the unique perspective you bring to working with firsthand patients, Marie?
Hannah: My role as a peer is to offer support, guidance, and empathy to patients or individuals who may have experienced similar struggles as me. I help them navigate their recovery journey and connect them with necessary resources.
Samir, I know you have a payer background. I wanted to ask what the payment landscape looks like at firsthand. What are the main reimbursement streams for your services?
Malik: I think the magic is in our model. What we hope unlocks other peer-based and lived experience-based programs is that there is a lot of upside to be had by using lived experience to help individuals find recovery. Our model is one where we’re really focused on a value-based arrangement with our health plan partners; we only do well if they do well, and the health plan only does well if the individuals we’re engaging find a pathway to recovery, find better care, and reduce utilization of high-cost care settings like the emergency room and the inpatient setting.
What we know to be true is that the work Marie and her teammates are doing is demonstrating those types of outcomes — that folks reduce their utilization of ED and hospitalization stays dramatically after engaging with our team. It’s in those savings that we can justify the intensiveness of our model and the field-based orientation of our work.
Are we talking mostly about Medicaid plans? Is it commercial? What space specifically?
Malik: There are individuals struggling with serious mental illness across all payer products: Medicare, commercial and Medicaid. But we are predominantly focused on the Medicaid cohort, largely because we see the greatest share of serious mental illness in that cohort and also the greatest need in terms of acuity access, utilization of high-cost services, and social gaps to be filled.
There’s been a lot of traction for peer-based models lately and a lot of recognition from both private payers and the very top of the federal government. Why is that important? Is it important? Marie, I imagine that when you have HHS and SAMHSA saying, “Hey, there needs to be real standards for this,” it helps affirm what you’re doing.
Hannah: Yes, absolutely! I believe it’s important to continuously improve our skills and knowledge to better serve the community. I know how diverse we are as a work team and as a committee, which is why I think being updated and connected to the community through training and recertification is essential.
Malik: At a systems level, it’s terribly important to see our regulatory infrastructure support and advocate for the power of lived experience. It’s real! We’re seeing it every day in all of our markets that building trust and helping folks stay engaged and adhere to care and recovery are built on a foundation of trust.
And that lived experience is unique in its ability to generate trust. So for [the federal government] to signal, “Hey, we value that, too, and we’re willing to find reimbursement structures to compensate for that in the marketplace,” suggests we’re opening up a whole new frontier of labor supply in the marketplace.
So many people like Marie, who otherwise wouldn’t be able to put their skills to work in helping folks find recovery, will soon be able to because the standards are coming to place. There are becoming protocols and certifications that then lead to putting those skills to work in a way that is remunerable in our healthcare system. So very, very positive and bullish on what this means.