Q&A: Genoa CEO talks mental health pharmacy access under ACA, potential replacement
Genoa, a QoL healthcare company, has put mental health care at the center of its business model — almost all of its 357 locations are located within community mental health centers in 42 states and the District of Columbia, and its telepsychiatry services serve 24 states. In a recent study published by the Journal of Managed Care Pharmacy, patients who had their prescriptions filled at a Genoa on-site pharmacy on-site at their community mental health center had adherence rates of 96%, with a 40 % lower rate of behavioral health related hospitalizations than the control group.
Genoa CEO John Figueroa points to the Affordable Care Act as one reason the company has seen growth, as since 2009, more patients have been able to seek behavioral health services than before the bill’s passage. As Congress debated the American Health Care Act, Figueroa spoke with Drug Store News about what a replacement should do for the behavioral health patient population.
Drug Store News: John, what impact have you seen the Affordable Care Act have on patients that would use a Genoa pharmacy at their community mental health center?
John Figueroa: I think the introduction of the Affordable Care Act was very positively impactful when it comes to behavioral health. The country has been talking about mental health and parity for decades, and it really was the ACA that began to think about mental health like any other chronic disease and established the ability for people to get covered and get care. One statistic that I think is important is that 30% of the individuals who receive coverage under ACA have a mental or substance abuse disorder. So of everybody who's been covered sine 2009, 30% of them fall right into my category. Because of that, the amount of care that was being administered in community mental health centers went up significantly, because all of a sudden, this population that was never covered walks into a community mental health center and now they're covered. That has been, I think, substantial from the standpoint that we're getting these patients the care that they need and they're becoming players in society as opposed to disappearing in society. We've managed to track them because of their coverage in hospitals, ERs and in jail settings to ensure that they continue to stay on their meds whenever a relapse occurs or something happens. The impact on the severely mentally ill has been positive when it comes to ACA because of that coverage in allowing us as caretakers to deal with that disease.
DSN: About how many people fall into the category of patient Genoa typically treats through their on-site pharmacies?
JF: The other statistic that we use all the time is that one out of five Americans as a whole in our society — 20% — depend on psychotropic medications to stabilize their conditions, and this can be from depression to chronic diseases. Therefore, we're obviously very concerned about, if all of a sudden a lot of these folks are no longer covered, what happens. Our fear is that they don't come back to the community mental health center, they can't get the care or the pharmaceuticals that have made them better and the net result is an increase in hospitalizations, an increase in ER visits, a number of increases in incarcerations and violent crimes, which in my opinion just increases the overall cost to states and the federal government that could be negated by allowing us to continue to cover this patient population. That's why I’ve been advocating to everyone who will listen. We're in the middle of this debate and it's just astonishing to me that we would be willing to change the progress we've made with this particular patient population overnight.
DSN: What would you recommend a replacement bill include?
JF: There are really two things that I’d include if I could wave a magic wand. With all of the changes that potentially are going to take place here, I would keep pharmacy and mental health as essential benefits in any bill. … And I would exempt mental health benefits from a per capita cap, so as they continue to perhaps bundle or do different measures for coverage, take mental health and pharmacy for mental health out. We have proven that if you keep patients under care and on their meds, costs are lowered in health care and in society, and I would argue that that's exactly what we need to do now.
Genoa CEO John Figueroa points to the Affordable Care Act as one reason the company has seen growth, as since 2009, more patients have been able to seek behavioral health services than before the bill’s passage. As Congress debated the American Health Care Act, Figueroa spoke with Drug Store News about what a replacement should do for the behavioral health patient population.
Drug Store News: John, what impact have you seen the Affordable Care Act have on patients that would use a Genoa pharmacy at their community mental health center?
John Figueroa: I think the introduction of the Affordable Care Act was very positively impactful when it comes to behavioral health. The country has been talking about mental health and parity for decades, and it really was the ACA that began to think about mental health like any other chronic disease and established the ability for people to get covered and get care. One statistic that I think is important is that 30% of the individuals who receive coverage under ACA have a mental or substance abuse disorder. So of everybody who's been covered sine 2009, 30% of them fall right into my category. Because of that, the amount of care that was being administered in community mental health centers went up significantly, because all of a sudden, this population that was never covered walks into a community mental health center and now they're covered. That has been, I think, substantial from the standpoint that we're getting these patients the care that they need and they're becoming players in society as opposed to disappearing in society. We've managed to track them because of their coverage in hospitals, ERs and in jail settings to ensure that they continue to stay on their meds whenever a relapse occurs or something happens. The impact on the severely mentally ill has been positive when it comes to ACA because of that coverage in allowing us as caretakers to deal with that disease.
DSN: About how many people fall into the category of patient Genoa typically treats through their on-site pharmacies?
JF: The other statistic that we use all the time is that one out of five Americans as a whole in our society — 20% — depend on psychotropic medications to stabilize their conditions, and this can be from depression to chronic diseases. Therefore, we're obviously very concerned about, if all of a sudden a lot of these folks are no longer covered, what happens. Our fear is that they don't come back to the community mental health center, they can't get the care or the pharmaceuticals that have made them better and the net result is an increase in hospitalizations, an increase in ER visits, a number of increases in incarcerations and violent crimes, which in my opinion just increases the overall cost to states and the federal government that could be negated by allowing us to continue to cover this patient population. That's why I’ve been advocating to everyone who will listen. We're in the middle of this debate and it's just astonishing to me that we would be willing to change the progress we've made with this particular patient population overnight.
DSN: What would you recommend a replacement bill include?
JF: There are really two things that I’d include if I could wave a magic wand. With all of the changes that potentially are going to take place here, I would keep pharmacy and mental health as essential benefits in any bill. … And I would exempt mental health benefits from a per capita cap, so as they continue to perhaps bundle or do different measures for coverage, take mental health and pharmacy for mental health out. We have proven that if you keep patients under care and on their meds, costs are lowered in health care and in society, and I would argue that that's exactly what we need to do now.