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Addressing Payers’ $140B Problem: 3 Steps to Manage Untreated, High Cost Behavioral Health Populations

Ontrak, Inc. | October, 5 2020
By: Curt Medeiros, President and Chief Operating Officer, Ontrak, Inc.

Many Americans with behavioral health challenges, despite having access to health insurance, remain untreated. The reasons for this avoidance of care are myriad and highly complex, and the outcomes can be dire. The COVID-19 pandemic raging across the U.S. is only predicted to exacerbate the problem. 

 According to a Kaiser Family Foundation tracking poll from earlier this year, nearly half of Americans reported someone in their family skipped or delayed getting some type of medical care due to the pandemic, including 11% who said the person’s health worsened as a result. Among those who said they or a family member skipped care, about a third said they planned to wait longer or forego care entirely. Latinx, Asian, Black, and multi-racial groups have expressed even higher level of symptoms than non-Hispanic whites, according to the Census Bureau and the Centers for Disease Control and Prevention’s National Center for Health Statistics. 

 For health plans, members’ lack of engagement can lead to untreated conditions growing more acute over time, potentially adding as much as $100 billion to $140 billion dollars in additional behavioral and physical health spending between 2020 and 2021, according to another study by the CDC. The pandemic has placed more people at risk for developing or worsening conditions such as depression, anxiety, and substance abuse disorder.  

Even during non-COVID times however, health plans have generally struggled to engage with members who do not participate in needed care. These individuals may be difficult to find amongst the population as they may not have a behavioral health diagnosis previously. They may have a multitude of reasons – health system resource barriers; social determinants; and/or individual patient medical or emotional challenges – that make engagement challenging. Even if engaged, successfully retaining these members in treatment and creating positive, lasting behavioral change is often difficult. 

The pandemic also has stretched some resources thin, limiting the field work care coordinators and coaches are able to perform and hampering the ability to establish strong connections with members. Analytics resources may not be sufficient to identify rising risk. As a result, payers are even more challenged to proactively find and engage members before their conditions become chronic and much more costly. 

 Ontrak offers a proven three-step solution.  

  1. Identify: The program begins with an advanced analytics model to accurately identify patients with untreated behavioral health issues complicated by other co-morbid conditions, have a high avoidable cost profile, and who are likely to benefit from interventions. This typically represents 3-5% of a plan’s total population.
  2. Engage: Our dedicated engagement specialists and coaches use persistent and omni-channel outreach with motivational interviewing techniques to build trust with members, establishing personalized goals that encourage more meaningful participation and enhanced retention. Our community care coordinators anticipate and help clear barriers to accessing care including access and availability. 
  3. Treat: Once members enroll in the program, we offer up 52-weeks of evidenced-based therapist-led/coach-driven care that is tailored to each individual’s needs. Goals for graduation include durable behavior changes in line with a member’s stated goals; ongoing engagement with their PCPs, behavioral health providers, and the health plan; and removal of barriers to accessing care. 
Our combination of identifying, engaging and treating members works. Ontrak has enrolled an industry-leading 30% of targeted members into the program on average. Average time in the program until graduation is over 7 months―far longer than many competitor programs, and long enough to truly have a lasting and meaningful impact on the underlying behavioral health conditions that generate avoidable costs. Our health plan partners are seeing up to 40% in medical cost savings in the targeted populations. 

Simply put, and as our company name reflects, we help members with previously unaddressed behavioral health conditions get and stay on track toward better health. 

Would you like to learn more about how Ontrak can help your health plan identify, engage and treat your most difficult to reach behavioral health populations? Please contact us today or send us an email at [email protected] – we’d love to talk to you. 

1 National Center for Health Statistics, “Mental health: Household Pulse Survey,” Centers for Disease Control and Prevention, reviewed July 29, 2020, cdc.com.

National Center for Health Statistics, “Mental health: Household Pulse Survey,” Centers for Disease Control and Prevention, reviewed July 15, 2020, cdc.com.