Improving outcomes for those with SMI

Opportunity for risk-bearing partners

Almost half of your health plan costs are associated with the ~7% of adults with Serious Mental Illness (SMI) on government insurances who haven’t responded to outreach by mail, phone, digital, or clinics.

There is a ~$100M+ annual net margin opportunity per million adults on Medicaid and/or Medicare, depending on demographics and state rates.

firsthand has launched in multiple states with a tech-enabled team of health plan veterans, clinicians, data scientists, entrepreneurs, and operators with firsthand experience. firsthand is achieving impact at scale using a whole-person approach that balances attention to mental health, medical conditions, and social determinants.

meet firsthand’s leadership team

1. firsthand’s impact:

Improved market positioning, RFP quality, and market expansion through a tailored, high-touch SMI solution

  • 45,000 attributed lives across multiple states, in deep collaboration with existing community providers

  • 20% engagement of previously unengaged and “unengageable” individuals

  • 75-percentage point improvement in MLR off 200%+ baselines, yielding $45M+ revenue and expense improvement per $1B in enterprise spend

2. The problem payors face:

Individuals struggling with complex SMI are not well served by existing systems and are unengaged in care

  • States and communities are more aware than ever of these gaps and are asking vendors for answers

  • Health plans mostly lack the engagement solutions to state SMI needs, even as 20+ states have launched health home programs tailored to SMI, a 7x increase from a decade ago

  • Average MLR of 200%+ for the top 30% most acute members with SMI in MMA, D-SNP, and specialty plans

  • Only 24% of this complex cohort engages with community mental health centers (CMHCs)

  • This complex cohort is highly attached to its health plan as member churn for the cohort is only ~1% per year, demonstrating the need for deep investment

3. firsthand’s solution:

Identify, engage, and navigate SMI members to appropriate benefits, resources, and care pathways through a field-based team of peers, nurses, and technologists. firsthand is creating value for health plans by:

  • Finding and engaging high-cost members with SMI through targeted, field-based outreach

  • Steering members to a curated network of high-quality CMHC partners who deploy evidence-based clinical and SDOH interventions to drive clinical savings

  • Ensuring that members are enrolled in the correct health plan and qualified into the appropriate benefit programs (SSI, SSDI, SNAP, etc.) to enhance health plan revenue and member SDOH needs

  • Completing whole-person clinical reviews and appropriate documentation for all members enrolled in firsthand