Q&A with Cody Gajnos of Groups Recover Together

Q: Cody, can you tell me a little bit about your role at Groups and how you got here?

I’m the Senior Manager of Care Design and Innovation at Groups, and I’ve been with the organization for about six years. I started as an Operations Coordinator, meeting members in person, conducting drug screens, and checking people in for group sessions. I’m also in recovery myself, which has been a huge driving force in the work that I do. I’ve taken various courses in data analysis, project management, and program management, and I’ve had amazing mentors who helped me get to where I am today.

In terms of tangible projects, I’ve helped structure our social care support model. This includes building our Recovery Support Specialist team, which supports members in person and in the community, and our Entitlement Specialist team, which helps members virtually with Medicaid and other benefits. We also have an Early Engagement Team, which is focused on helping new members adjust to treatment, specifically around Suboxone.

Q: Can you describe the current model and how it has evolved over time?

When I started at Groups, the model was pretty basic. We had an Operations Coordinator, a counselor, and a provider. We primarily did weekly outpatient therapy with Suboxone prescribing. Over time, we realized that this setup wasn’t sustainable. We needed additional team members to support members' social care needs, like housing or insurance.

Over the past four to five years, we’ve invested heavily in that model. Now we have specialized roles like Recovery Support Specialists, who are peers providing in-person care; Entitlement Specialists, who help with Medicaid and other benefits; and the Early Engagement Team, which focuses on helping new members during the critical early phases of their recovery.

Q: What kind of support do you provide beyond clinical care?

We do a biopsychosocial assessment for every member during admissions. This helps us understand their treatment history, their current needs, and any social care issues they’re facing. We’ve also created a proprietary health check-in that allows members to self-report their needs, which we combine with clinical assessments from our counselors and providers.

Beyond the therapy and prescribing, we help members with things like repairing relationships, finding housing, and seeking employment. We’ve found that addressing these social care needs leads to better retention and improved recovery outcomes.

Q: How do you handle the variations in Medicaid policies across states?

We have a strong compliance team that helps us understand the regulatory variations across states. We also hire people who live in the communities we serve and already have knowledge of local policies. This local expertise is essential, and then we layer in the regulatory requirements we need to follow.

Our payer success and contracting teams also play a big role by maintaining relationships with payers and state partners. They inform us about upcoming changes. Two major changes we’ve navigated recently are Medicaid redetermination and SNAP enrollment policy shifts. For example, in Indiana, people with felonies used to be ineligible for SNAP, but now they can enroll.

We don’t just rely on individual outreach to inform members about these changes. We use group sessions to provide education about Medicaid redetermination and social care needs like rental and utility assistance, which have been especially critical since the COVID-19 pandemic.

Q: Can you share strategies that have worked well for engaging members, and any that didn’t go as expected?

One successful strategy has been our intensive outreach pilot. We contact members daily for four days straight, and this has resulted in 65% engagement. That engagement, whether it's positive or not, is an important step.

On the other hand, we’ve also tried using personalized language in our centralized outreach teams, referencing facts like, “I see your group is at this time—can we meet afterward?” But this didn’t increase engagement as much as we expected. The issue is that members don’t always know the centralized outreach team calling them, which is why we often rely on local care teams to follow up.  

Q: How do you track and manage social care needs?

We track everything in an electronic health record system. This allows us to follow what needs were identified, when they were addressed, and by whom. Our quality team monitors this closely to ensure that we’re helping members as quickly as possible.

For example, during the Medicaid redetermination process, we learned that reaching out to members within 24 to 48 hours of them expressing a need is crucial. The longer the delay, the less likely members are to engage with us. Our goal is always to act promptly.

Q: With the complexities of each state having different Medicaid and social care programs, how do you ensure consistency in your approach across different regions?

 It’s a challenge, but we have systems in place. We hire people from within the states we operate in, so they already understand the local regulations. We also have a compliance team that helps us navigate these complexities, ensuring that we're both adaptable and consistent in our approach.

In terms of scaling, we’re mindful of balancing state-specific needs with standardized care. For example, the Medicaid unwinding process was something we handled by leveraging both local knowledge and national best practices. We also stay on top of policy changes by engaging with our state partners and payer teams. When there’s a shift, like the reopening of rental and utility assistance programs, we use both individual and group outreach to inform our members and ensure they’re aware of the support available to them.

Q: Your team has done a lot of experimentation to engage members. Can you share how you’ve structured those efforts and tracked the results?

Definitely. We’ve experimented a lot over the last four years to find what works best for engaging members. One of the biggest lessons we’ve learned is the importance of promptness. If someone needs help, we aim to get them in touch with the appropriate team member within 24 to 48 hours.

We document everything in a centralized system, so we can track when a need was identified and when it was addressed. This allows us to see whether we’re meeting members' needs and to make improvements where necessary. We also use tools like group sessions to educate members about available resources and changes in social care policies, which has been especially useful in addressing Medicaid redetermination and other key issues.

We also leverage our marketing teams heavily in this process. They help get the word out about important initiatives, like Medicaid redetermination, rental assistance, and utility support. For example, during the Medicaid redetermination efforts, we didn’t just rely on automated or individual outreach. Our marketing team helped amplify the message through campaigns, and we used group sessions to provide education on specific issues happening in states like Virginia. The marketing support is critical to making sure that we reach as many people as possible.

Q:  Appreciate you spending time illuminating Groups’s social care philosophy and processes with us. Thanks Cody!

Of course, thank you!