This week, we’re talking to a group that is focused on populations with complex comorbid physical and behavioral health conditions. As we’ve discussed quite a bit on the blog, we know that when mental health and substance use disorders go untreated, they can cause individuals much more difficulty dealing with their symptoms. If paired with a chronic illness, this burden only significantly increases. This combination leads many patients to seek emergency care at higher costs to health plans. These payers are eager for solutions that address untreated behavioral health conditions to reduce these costs.

When it comes to supporting patients dealing with multiple chronic conditions with underlying behavioral health issues, it is important to have a care team skilled in engaging patients with personalized plans and timely care. The team from Ontrak Health shared their approach with us.

How do unaddressed behavioral health conditions contribute to inflated health care costs?

One of the key healthcare challenges we are tackling at Ontrak Health is how to engage complex populations with unaddressed behavioral health (BH) conditions + chronic physical conditions into high-value care to meaningfully reduce medical expense.

When an individual is not receiving adequate treatment for a behavioral health issue - such as depression, anxiety, or substance use disorder – and they are not engaged with a primary care provider or proactively managing their other chronic physical conditions, their physical health will likely deteriorate until they require crisis care in an ER or hospital setting. It is well documented that preventable ER and inpatient stays are one of the main drivers of avoidable healthcare costs. 

Unfortunately, in many cases the BH issue will continue to be unrecognized or undiagnosed in the urgent care setting. For example, take an individual with diabetes who has exacerbations that land them in the hospital twice. They are stabilized at the initial visits, but then a few months later are back in the hospital, and the diabetes is labeled as refractory (not responding to treatment). However, the underlying cause is actually undiagnosed alcohol use disorder that is destabilizing their blood sugar. Alternatively, it could be untreated depression or anxiety that is preventing them from participating in diabetes management or adhering to treatment plans.

It is this cycle of low value utilization that contributes significantly to inflated healthcare costs.

Our focus at Ontrak is helping individuals achieve lasting health improvements to reduce medical expenses. We do this by removing barriers to care, empowering sustainable behavior change, helping members develop self-efficacy, and connecting them with providers to address underlying behavioral health conditions. Through this proven approach, we are able to deliver a significant and durable reduction in ER and inpatient utilization and costs across our member base.

What does Ontrak's AI-driven, integrated care model look like? And how does it drive deeper engagements and better outcomes? 

Ontrak recently announced an industry-first Advanced Engagement System that will enable us to deliver precision behavioral health by infusing AI into every step of the behavioral healthcare journey. Our AI-powered platform will optimize program eligibility, member identification and outreach, coaching interactions, provider visits, interoperability of data between Ontrak, providers, and health plans, and last but not least, outcomes.

Once enrolled into the Ontrak program, AI will match members with the best Ontrak Care Coach to help them work towards their health goals, and also recommend the best behavioral health provider match for treatment. Once matched with a member, our coaches take a person-centered approach to engagement, and connect in the ways that work best for the member, allowing the coach to become a trusted advocate and resource. 

Our integrated platform will also facilitate collaboration between coaches and providers by offering unprecedented visibility to a member’s care journey, progress and health outcomes, and providing seamless exchange of session notes and other data. 

Lastly, our AI-infused services will help coaches develop deeper engagements with members by enabling highly personalized, timely, and empathetic care, while maximizing the efficacy of treatment plans by providing, for example, real-time feedback on fidelity to evidence-based models.

Leveraging AI to optimize each step in the care journey alongside personalized, high-touch coaching means that we can deliver better outcomes that last.

How does Ontrak's high-tech, human-centered approach deliver a reduction of medical expenses for health plans?

As noted earlier, we deliver meaningful cost savings to our health plan partners by durably reducing avoidable inpatient and ER utilization. Across our Medicare, Medicaid, and commercial member base, we have reduced hospitalizations by 63% and ER visits by 42%, on average. A soon-to-be published analysis of the “treatment effect” of the Ontrak program demonstrated a $486 PMPM greater cost savings durable over 24 months for Ontrak graduates compared to a propensity-matched control group who did not enroll in Ontrak.

We are able to deliver superior outcomes by leveraging AI combined with deep human connection that allows us to identify, engage, guide to treatment, and activate previously unaddressed populations.