Here Now Health, a virtual provider of mental healthcare to foster kids, is now live in New Mexico with Presbyterian's Turquoise Care Medicaid program.
Here Now aims to connect Medicaid-covered youth with mental health services in a fragmented foster care system, partnering with Medicaid plans and referral partners like counties, agencies and nonprofits. The startup, which has been live for about a year, is already operational in Virginia and Missouri and expects to launch in several more states by the year’s end.
About 400,000 kids and youth are in foster care. Medicaid generally covers most of them, regardless of income, until 26 years old under the Affordable Care Act. However, it's not uncommon for states to have multiple managed care organizations involved.
This setup complicates referrals to mental health services for case workers and foster parents, Here Now executives say. But that is slowly changing. A number of states have received federal approval to establish specialized managed care programs to specifically serve foster kids.
“It’s been a growing actual phenomenon," Here Now Founder and CEO Michelle Turner told Fierce Healthcare. These specialty plans are typically run by a single payer, simplifying the process. "Texas was the very first state to move toward a sole source [plan]," Turner says 17 states today have such plans. Those are the states Here Now is particularly interested in expanding to.
Besides simplicity, there is another advantage: specialty plans often take a more creative approach to coverage, according to Turner. Virginia's foster care specialty plan provides foster children over 18 a free cell phone, for example.
Here Now's services are virtual to maintain a relationship with a kid no matter where they go. Lack of continuity of care is a huge problem for foster youth. “We’re built to make sure we can stay with them,” Turner said. Foster case workers can refer to Here Now in three minutes using its referral form. Here Now then takes care of the eligibility checks and tracks down any missing or inaccurate information, like child birthdates. Here Now claims to save case workers five hours, on average, per referral.
A key differentiator, Turner says, is that Here Now specializes in child welfare as a provider.
“[Just] any Medicaid-covered therapy is not good therapy. You need individuals that understand the nuance,” Michelle Turner, Here Now’s founder and CEO, told Fierce Healthcare.
This showed up in Turner’s own experience. She and her husband have fostered 43 kids together and have six children, four of whom are adopted.
After a six-month wait to get in with a covered mental health provider for her oldest child, Turner recalled, during the intake, the therapist asked her son to clarify who his "real" siblings are.
Turner immediately knew they wouldn't continue seeing that therapist, who had displayed ignorance of the intricate family dynamics involving foster and adopted kids. “That’s the reality,” Turner said.
In addition to hiring therapists with lived experience in child welfare, Here Now also trains its providers in culturally sensitive language, such as asking a child to explain their relationship to, and preferred term for, the adult attending a session with them.
“We know that a big part of therapy being impactful is actually building that trust, and words are so important when you’re trying to build that therapeutic alliance with the youth,” Turner said.
Here Now’s clinical model draws on the work of Florida State University’s Institute for Child Welfare, the only academic research center focused on clinical models for foster youth, according to Turner. Caregiver support is a crucial piece of the puzzle, which is why Here Now serves youth and adults in varying capacities.
“The main factor for stability for youth in the foster care system is actually the stress level of their caregiver,” Turner said. “You cannot provide stability for a child by simply providing therapy to them. You have to reduce the stress of the adults in their lives.”
Caregiver sessions can help explain children's diagnoses, give caregivers a space to be heard, and better understand how to parent specific age groups, like teens. These sessions are billed to Medicaid as a family session.
Due to the overall lack of focus on this population in the healthcare sector, Turner believes value-based care (VBC) is greatly undertapped as a payment model. In one state, Here Now has a simple value-based arrangement where it receives a bonus for getting kids into outpatient therapy. Turner hopes to expand into more complex VBC arrangements over time.
“The more we can show that we reduce the overall cost of care, that we keep kids out of crisis by getting them into really high-quality outpatient care,” Turner said, “over time we will be able to sign more value-based agreements and take on risk alongside these health plans, because we have the same mutual goal.”
Here Now also functions as a triage partner to Medicaid case managers. Once someone is referred to Here Now, providers can do an assessment within 24 to 48 hours and determine whether they need higher acuity care. Here Now will then remain on standby for when they are ready to step down.
In one case Turner described, Here Now discovered upon intake that a foster youth about to be placed in a new home had suicidal ideation with a plan and intent.
Here Now recommended immediate inpatient services for the youth, and in the meantime, had a caregiver session with the foster mom. Here Now then continued to be their long-term therapist.
Here Now has served 250 kids to date and has raised over $4 million to date from SoGal Ventures, Healthworx Studio, Hopelab and others.