How to Scale Integrated Care Management & Mental Health Services ft. Mark Naghsh

CareCraft sits down with Mark Naghsh, a Licensed Social Worker and certified geriatric care manager with over 25 years of experience in healthcare. Mark shares his journey founding AffinialCare, the evolution of his company, and the critical importance of integrating mental health services into geriatric care. Discover how AffinialCare adapted to the challenges posed by the COVID-19 pandemic and learn about Mark's innovative approaches to marketing and service delivery in the ever-changing landscape of elder care.

Key Points:

• The Genesis of AffinialCare: Mark Naghsh discusses the foundation of AffinialCare in 2019 with the ambitious goal of offering comprehensive services including home care, companion care, and creative arts therapy. COVID-19 necessitated a pivot to focus more on care management and mental health services, highlighting the need for adaptability in healthcare services.

• The Importance of Mental Health in Geriatric Care: Mark emphasizes the growing demand for mental health services among the elderly and the necessity of addressing mental health in conjunction with physical health.

• Integrated Service Approach: The holistic approach at AffinialCare ensures that mental health and care management are seamlessly integrated to provide comprehensive support for families dealing with complex dynamics.

• Team Expansion and Marketing Shifts: COVID-19's impact led to a shift from traditional marketing and referral sources to direct-to-consumer strategies, requiring creativity and resourcefulness.

Join us for an insightful conversation with Mark Naghsh as we explore the innovative approaches he employs to meet the complex needs of the geriatric community. Discover the transformative impact of integrating mental health services into elder care and the power of adaptability and innovation in navigating the future of healthcare.

Episode Link: Spotify

Transcript

[00:00:04] Ariadne: Thank you so much for being here on the CareCraft podcast. Today I'm talking with Mark Naghsh, who is a Licensed Social Worker and also a certified geriatric care manager with over 25 years of experience in healthcare. He was previously the Vice President of Operations with SeniorBridge, a home care company, and then was the Director of Northeast Operations with Humana, leading 20 branches and 54 million in revenue.

He founded AffinialCare in 2019, which provides care management services in New York and the Hamptons. Thank you so much for being here with us, Mark.

[00:00:38] Mark: Thank you for having me.

[00:00:39] Ariadne: First off a question I ask a lot of people that join the show is there's lots of different names for the work that care managers do. There's, you know, care coordinators, care coaches, navigators, advocates, et cetera. Do you distinguish between the different titles? And what do you personally prefer to call yourself?

[00:00:59] Mark: That's interesting because originally we were considered the National Association for Professional Geriatric Care Managers, which was a mouthful.

So then they decided, oh, why don't we move to something a little simpler? And they turned it into aging life care professionals, which I think is, is more appropriate. But in some way, it also sounds like we're aging life care professionals, like we're aging professionals that are providing support. So, in some way, it sounds like, okay, you know, are we, are we just old people providing support for older people?

That you know, I usually when I when I think of it just from a perspective of what the consumer sees us as I always think of it as we are the professional son or daughter in that the relationship we have with the communities that we're supporting or the people we're supporting, we're using our professional expertise to do the things that a son or daughter could do if they had that knowledge base.

And so, so I, I coined it that way when I'm talking to the public. But I, I lean more toward the geriatric care managers that provide care coordination and care advocacy.

[00:02:03] Ariadne: Got it. That's super interesting. And can you take me back to your experience and the decision to actually start AffinialCare and what led you to transitioning from your previous roles into owning your own practice?

[00:02:17] Mark: Sure. So yes, after much experience working with SeniorBridge and ultimately in Humana obviously saw that there was a big need for the support in the communities at large. I've always done that to a certain extent. I've always been in the community, providing support, even when I was. I mean, I've shared this with you in another conversation, but when I was like, 11 years old as a paper boy, I found myself doing community advocacy and in the varying places I delivered newspapers.

And so it's always been kind of part of me. And so, as I discovered care management through social work. Through I'm sorry through SeniorBridge. And then through Humana watching what they're able to do in a very large populace. Thought it was a real great opportunity. I think what got lost in translation for some of these larger companies is that individual support, you know, they had, you know, caseloads of 150 people and they were talking to them over the phone and they lost the the element of kind of engaging, you know, in the in the home space.

You have a great opportunity, especially when you visit the homes to see what's really going on and then provide that support that's necessary for them versus what you hear over the telephone. You know, people are going to give you a different message over the phone than they are when you're actually sitting in front of them.

So, you know, so when I used to do village care, I used to do in person psychotherapy. Which I thought was really, really interesting because you had this opportunity to see what was really going on, so people couldn't really say that everything's okay when you saw that everything wasn't okay in their home space.

And, and so when I decided to depart from Humana the opportunity for me to do this on an individual basis was important. Because I wanted to do the one to one. I wanted to get people to go into the home to provide that support and be more of a community activist for the folks that are looking for that support in the home.

So, so it was kind of, it was kind of a relief to be out of the corporate structure and to do this individual practice because you can make a difference by doing individual practice. So I've gotten full circle from like very large company, you know, influencing, you know, social workers and care managers and then going back to my roots and just being able to do it individually with my team.

[00:04:42] Ariadne: That's awesome. And I mean, what did that look like from day one for you? Because you were coming with this experience of really operating at like a huge scale. And now kind of starting your own shop.

[00:04:54] Mark: Yeah, that's that's well, basically, you're, you know, you're all things. So when you start your own company, it's, you know, you're the marketer, right? You're the provider. You're, you know, you're all of the different elements. You're HR you're the payroll team. So that part took a little adjusting because I, I definitely had been removed from it for quite some time working from the individual departments.

So I think that there were some difficulties around that adjustment initially threw myself into the mix by just doing straight marketing and you've got a lot of a lot of progress through that. But really, in over time, it took a little, it took a lot of work to kind of get up and running by getting people to understand what it is you do.

I think that's the biggest challenge I think for care managers is being able to have people understand what it is you actually do. Even professionals like life, aging life care association still, we still have difficulties communicating to the to those that we serve what it is that we're actually doing because it doesn't make sense.

Sorry, what was that? It doesn't make sense to most people because they're like, say, Oh, I'm a care manager. It's like, well, you manage my care. And really what a care manager is, is it's a, it's basically a partner in providing health care support while you're trying, going through a difficult time or through different challenges you may be having navigating the fractured health care system.

[00:06:27] Ariadne: Yeah, I think that's something I've heard from a lot of care managers, right? Where the feedback they get from clients or potential clients is like, Oh, I didn't even know you guys existed right as a concept. I guess, do you think it's fundamentally like a marketing challenge that people aren't aware that you can have this kind of support, or it's just still like a very nascent space and people are getting used to it.

[00:06:54] Mark: Yeah, I think, I think it's a marketing challenge. Honestly, I, I believe that we have a tendency to confuse the market and can be very candid. Obviously, you know, I may get in trouble for saying it, but I'm going to say it. So, if you change your name from geriatric care manager to aging life care professionals, if you're marketing aging life care professionals, and you use the term, I'm a care manager, you're already confusing the market.

I think we have to be cautious about what our, you know, what we're communicating. To the market, I think the area, like I had mentioned earlier, with regards to being the professional son or daughter, I think that's what seems to resonate most with people when I'm trying to explain what we do. I can go through all the machinations, care advocacy, right?

Care coordination all the different elements that we provide. But when I tell them that this, you know, I use my professional skill set, or we use our professional skill set, To help support you as though we were dishonored daughter, it resonates for them because they understand that they only have so much time, or even if it's you know, I get a lot of guardianship cases, you know, even that piece, it's like, oh, I have somebody who's going to be advocating because they have this professional knowledge business.

[00:08:08] Ariadne: That makes perfect sense. And what does AffinialCare look like today? I know you you started back in 2019. How, how has it changed in the last 5 years?

[00:08:19] Mark: It's a great question. So it started out with a lofty goal of doing all things for everybody. I think it narrowed down over time. Initially we were doing we were doing kind of more of the home care companion combined with care management. We also had we don't do as much of it now actually, not at all really. We had art therapy and creative art therapies involved in it as well. COVID kind of whittled that away because really doing in person visits for for creative arts therapy was considered not to be an essential need.

 So it pivoted more towards the straight care management support with specialized care. Care advocacy within our companion support. So I have I guess we're probably about 12 people now. So we've grown pretty much a lot, but we, we're doing more on the psychotherapy side. We're doing more mental health support.

And, and I think there's, there's a big need for that for the geriatric community. I just recently wrote a blog on how important it is to provide mental health services for people that are aging and I'm starting to get more of that more calls for that. And I think it's essential for that because it gets left out.

People think, oh, because they're older fixed in their right in the ways, but everybody could benefit from individuals or, you know, that can focus on some of the comorbidities of going on. It's for instance, we'll focus on they're not taking their medications, but why aren't we looking at, you know, maybe some of the mental health reasons as to why, you know, there's some resistance to taking that medication or there's a history around that and then cultural sensitivity as well.

So, so, yeah, we've kind of moved into more of a as I said, it's the care advocacy care coordination, but also mental health services.

[00:10:04] Ariadne: Do you find that people find you more for the mental health services and the therapy and then transition to also potentially like care management services or vice versa?

[00:10:15] Mark: I think it's a hybrid. I think it's both. I've had people that have come on looking for the support for the for the mental health reasons. And obviously, as I go in, or we go in as a team, we will see things. That could be improved upon based on the support that's being provided and if there's if it's if it's needed, then, you know, we'll have that conversation, you know, I don't I've never been a separatist.

So, in other words, if you bring me, you know, if you bring our company on, then mental health is going to be part of the process, especially, especially if you're working with a family that's dealing with a lot of conflict. Then you need that, that therapeutic understanding of family dynamics to help navigate those situations, you know, it's not just a one fit solution for people.

So so that's why I think it's important to have both, but yeah, it kind of is, it kind of is both. Sometimes it's, you get the mental health because you have the care management and then sometimes the mental health leads toward care management, to put it more simply.

[00:11:21] Ariadne: Yeah, it's not one size fits all. And you said you guys are up to 12 people. When you started, was it just you or you also had started already with a bit of a team?

[00:11:32] Mark: I did. I had lofty goals. So yes, I had, I had a care coordinator. I had myself and I had a marketing person when we started over time. Once again, I started just before, before COVID hit. I had my own challenges.

So everything got like my traditional methodology in terms of marketing was what I experienced at SeniorBridge, which was hospitals and sub acute rehabs, which is what typically people do to get care management services referred out as well as, you know, lawyers and doctors and everything got shut down.

So I had to pivot. So I meant went more toward direct to consumer. While while COVID was happening, and also it didn't make sense to have an office when you actually didn't have an office space close to you. So, it led to. You know, me becoming kind of all of those things. Or, you know, as, as COVID progressed.

And then and then after, like, back in 2022, we started to build up again in terms of the team. But still, I'm primarily doing the marketing side.

[00:12:41] Ariadne: What was that transition like? It's not like you were planning to mostly target other businesses, hospitals facilities. And then you went to direct to consumer. But that's something you are familiar with from a marketing perspective. Or that was also a bit of a learning curve.

[00:12:58] Mark: Actually, no, I did have experience with it when I was at Humana. I worked with the marketing team for them on the SeniorBridge side. The, the difference between what Humana had to offer us versus what I was doing myself was, is that the budget was completely different.

You know, we had a pretty large budget from Humana or SeniorBridge at the time in terms of using, you know, Google AdWords, et cetera. And so we, you know, we got a huge influx of referrals. If you have the funds to do it you know, Google really, or any of the online advertising is probably a good way to to access people.

But over time yeah, I had to be pretty creative around how I did that. And so it was really, the marketing came from the blogs Google reviews and kind of building a reputation in the community as to being somebody that's going to provide the right care at the right time.

[00:13:51] Ariadne: That marketing piece is something that has come up a lot because it, especially if you are just getting started and you are one person, right?

Like, it's very overwhelming to, basically take on a full time job that is marketing. At the same time, it's like you're, you're trying to provide care. So I guess any words of advice on like, how you would balance it in the beginning,

[00:14:13] Mark: I would say, instead of trying to be all to everyone is to be uniquely yourself.

In other words, understand what it is that you do really well and position that in places to people that find that a value. What I see a lot is, you know, everyone tries to do everything and then they end up, like, not being able to find the right messaging and the right partners. Right. You're looking for your community champions who believe in what it is you're trying to do and so understanding what that is.

So if you're specifically, like, very much involved in benefits, you know, Medicare, Medicaid, those type of things, then align that marketing to that skill set. You know, so who would those people be? And that's that would be my advice. I wouldn't try to just catch everyone.

[00:15:04] Ariadne: That's a very sage advice. Basically, find your niche, right? And like what what you think you are particularly good at and focus on that. I am curious a big sticking point and something that other guests on the podcast have talked about feeling just like very icky about is actually like the pricing component and how much do you charge?

And so curious, you know, like what your approach has been to pricing and maybe how that's changed also from like, when you first started needed more clients to where you are today.

[00:15:40] Mark: Yeah, that's a very good question. Yeah, it's a very difficult conversation to have with people when you mentioned you know, the cost of the service that's being provided and and it's, it's, this has been going on since back to the day when I was at SeniorBridge, you know, eventually it's, it's, it becomes more it's harder to have those conversations because people hear, oh, my God, that's the amount of money per hour that, you know, And it's like, well, if you paid an attorney, it would be this amount, right?

And, you know, I, I always say that people value money over health. Until they lose their health, and then they'll pay all the money in the world to try and get their health back. So it's really more about the preventative element, you know. Would you, what would you pay to avoid a hospitalization? Or what would you pay in order?

Like if you, if you, if I was to say to you that, you know, if we did these, this, this amount of things, obviously we can't prevent all hospitalizations, but if we can reduce the risk of a hospitalization, the cost of a hospitalization, not just financially, but also health wise. Is is humongous. And I think that's how I typically frame it when I'm having conversations where people are pushing back on it.

And we have to also be honest if somebody doesn't want to pay for that, then they're probably not a consumer that really values what it is that you're going to offer. And what I get concerned about, to be frank, is that there's a lot of healthcare companies, specifically home care, that say they offer care management.

And really, it's somebody in an office that's doing care coordination, and I'm not saying that isn't, you know, helpful, but it's not true care management. And so people believe that, oh, well, I get it for free at this agency. You know, care managers are, you know, you call on the weekend, you know, 11 a. m. or something, and there's an issue.

They, you know, they will help, you know, and I think that's the difference is that you, you have a partner, you don't just have a home care company. That's going to be like, oh, okay. I'll, I'll get back to you on Monday. Or, you know, I don't have the clinical expertise to help support you right now. So that's, that's a big differentiator, but it's, it's difficult to talk about the money piece.

I, I, you know, I think everyone has difficulty with it. I honestly wish that Medicare would. You know, release the hounds and pay for it, because I think it would reduce reduce hospitalizations and save a lot of money. You know, when I worked with SeniorBridge, you know, Dr came up with the idea back in the day around care management from on the health care side.

Now, Aetna has it, United Health has it, they all have care managers now because they realize that it reduces hospitalization. And yet somehow or another, we, we can't get reimbursed for it. I think that's. That I think we need to work on as a, as a professional community to lobby more around why professional care managers in the community can't get reimbursed through Medicare.

[00:18:39] Ariadne: Is that something that you think is likely to change in the next five to 10 years, or do you think that's farther out in the future?

[00:18:48] Mark: I think it's farther out. I think we, I don't think we're a very strong lobby. I, I believe that that's something that. You know, as we're speaking, I'm considering the idea that we're, you know, we're missing this opportunity.

I just don't think we're strong, strong enough as a lobby or big enough as a lobby. But I, I do, I know that they offer some care management support. They get reimbursed for it if you have a physician that's running it. So there is a lot of care management organizations that are being reimbursed as long as there is a physician signing off on it, but you're losing an opportunity for all the other folks that are out there.

Care management organizations actually call me and say, we really need that kind of that, the type of stuff that care management or managers do, the private ones, the private care managers do, it's what they really need.

They actually crave it. And they struggle because they want to be able to actually hire us internally. So there may be an opportunity within those care management organizations to align with them. Because I did have a few calls you know, they have hundreds and hundreds, thousands of members that could really use that individualized care plan. that we provide, which is different than what they provide.

[00:19:59] Ariadne: What is your advice for any listeners that are thinking about starting their own practice? Where would you recommend they go first?

[00:20:10] Mark: Well, as I had mentioned earlier, I think it's, it's about knowing what your niche is, right? Knowing what it is that you specifically are good at and also as to whether it's, you know, Something you are passionate about.

I think 1 thing I see that I see the most successful care managers are the ones that are passionate about making change. And understanding that it's an uphill battle, because you're, you're kind of not kind of, you're actually facing people that have been a particular way for a long period of time. And you need to be okay with knowing how to communicate and advocate for them.

So if you're, if you're thinking of going into care management, which I think is a. Is needed, as I've said before, I think it's important. It needs to be in reimbursement already. You also need to understand that it's an uphill battle that it's going to take time and energy. And if you, if you really do the work that is important for your community.

People will recognize it and you will have an opportunity to grow.

[00:21:13] Ariadne: And do you remember who your 1st client was with AffinialCare?

[00:21:18] Mark: That's a good question. Yeah, she's still in service now.

[00:21:24] Ariadne: Oh, that's awesome. How? How did you get connected with that first client? Was that someone you already knew before you made the decision to open for business?

[00:21:33] Mark: No, actually, it was, it was actually connected to my first salesperson. She had somehow or another, she had a relationship with facility in downtown Brooklyn. I mean, sorry, downtown Manhattan. And they said they had this need for this particular person and didn't know what to do with her.

And so we got connected to her. She turned 98 in February.

[00:21:54] Ariadne: Oh, that's incredible. That's awesome. And I guess what were your lessons from those first handful of clients? Did you realize that you were going to broad yourself and like, then start narrowing in on a particular niche?

[00:22:11] Mark: Yeah. I, well, I think it finds me. I always joke about how I, I am the person that resolves the most complicated clients. And so it's always been, it was a skill set that we had at SeniorBridge. It was, I think, something that I've always worked with is, you know, the resistant client. I've been talking about that a lot more lately, doing a lot of conversations with community members and doing some CEU actually support.

In the community around this whole thing around resisting client. So I would say that's it. So people who refer to me are like, this is somebody we can't, we can't seem to settle down. They, you know, there's people in and out of the, out of the home all the time. They're not compliant. And so that they found me over time.

Once in a while, I'll get like an easier one, but most of the people are, you know, very, very complicated and, and difficult in terms of their ability to accept change.

[00:23:12] Ariadne: Well, it seems like you guys have had tremendous growth in the last couple of years. Where do you see the organization going in the next five years?

[00:23:21] Mark: I, as I was kind of hinted at, I planted a few seeds in this conversation. I think it's really getting to the point where reimbursement is coming more from, you know, insurances and government focusing on the mental health and care coordination in the home environment, more so being more proactive and preventative in that approach and being aligned with partners that have that same vision.

And, and I'm, I'm seeing it. I see us moving in that. Collectively, I see it moving in that direction. As you're seeing more mental health services being provided across the board, right? COVID just kicked that up like 100 notches, you know, it's, it's, it's accessible to everyone now and people are understanding the importance of it.

And so I think it's, it's starting to meld together into this place where we're you know, where we're going to be able to see more, I wouldn't say government support, but insurance and, and financial support for individuals to provide the the communities support they need or the help they need.

[00:24:22] Ariadne: Do you think that the market overall is also growing? Like, are there just more families that are in need of this type of support or it's kind of always been a big need and largely unmet.

[00:24:36] Mark: Yeah, I would say it's the latter. I mean, it's, it's, it's, you know, there's a big need. People don't even know that they need it because they don't know it exists, you know, like, going back to what we were talking about early on.

I just don't think the community really understands what it is that it provides. And then when you start doing the work with them, they're like, why, why didn't I know about this? Yeah. And so the, you know, the real low hanging fruit is, is how is the marketing getting better at having people understand it more.

And I think it's through, you know, honestly, I think it's through creating case studies. I do a lot of case studies when I communicate and talk about it in the community. It's really, really giving people very, very specific examples of what a care manager can do.

[00:25:22] Ariadne: What's like an example of a case study that you frequently cite?

[00:25:27] Mark: Well, it depends on which topic I'm talking about. You know, I mean, I, I, I would say that you know, basically case studies around making progress around individuals that we feel that no one can make progress with. It's, it's that idea that you know, taking all the different pieces and fractured elements of somebody's healthcare support, as well as just home support.

And building an infrastructure that allows for them to actually do well. I mean, I have 1 person that I've worked with. I was 1 of another 1 that's still on service that came on early on. And I was told that this person would never ever actually be able to live in the community on their own. And they're still living on in the community on their own almost 5 years later.

And, and so it's, it's, it's that idea that, you know, no doesn't always mean no. And there's always opportunity. And it's really being able to meet people where they're at and help them live their best life in the manner in which they can, you know, that's where I think we see, you know, people will, we have to just be mindful of that when we project out onto others, what is what we want for ourselves and everyone has their own desires.

So I think you know, case study wise, it's really always comes down to that same piece where it's just understanding where people are and being able to adjust as needed for the long haul. It's no, there's no short term solution. Somebody's lived to this for years, right? Somebody's lived 90 years one way.

You're not gonna walk in there and change them. You need to adapt. We need to adapt. Yeah.

[00:27:13] Ariadne: I think one thing that's interesting is just the breadth of situations and, and people that care managers support, right? Like it is truly across all potential conditions and populations and, and settings. And I think that makes it, Difficult to sometimes like quantitatively show like the, the value of, you know, potentially reducing readmissions in a way that isn't true for companies that maybe just do care management, just for like a particular, like dementia or diabetes or something like that.

I'm curious do you see care management organizations like, quantifying their outcomes more so in the future and in order to get to a spot where it is like a more universally reimbursed service.

[00:28:04] Mark: Yes, absolutely. I mean, that's 1 of the founding principles of AffinialCare was, you know, I want, I want it to be data driven

I know if you don't prove the efficacy of the intervention that you're doing, then it has no value. And unfortunately, it always comes down to money. And so if you reduce hospitalizations and it saves an insurance company X amount of dollars. Then that's a value. So, yes, you need your data points and you need to know what those interventional strategies are that lead to those places in which you've actually created that positive outcome.

And so I, yeah, so that's what I think about all the time when I'm doing my work.

[00:28:43] Ariadne: So, what kind of data do you guys track at AffinialCare?

[00:28:46] Mark: No, I mean, we definitely, I mean, we track hospitalizations, rehospitalization. We, we track medication adherence. And also we, we, we use some numbers around acceptance of acceptance of interventions, which is a, it's not really not really data driven in that sense, but it is a frequency piece. I, I believe that. You know, the more people accept the specific interventions, the more likely they are actually to do something. And so there's another area that we, we focus on when we're doing the data analysis of the people we provide support for currently.

[00:29:22] Ariadne: Well, thank you so much for joining us. Mark. I, this has been a super interesting conversation and really appreciate you sharing your insight on the podcast.

[00:29:32] Mark: Appreciate you giving me the time to speak about what we do.