Thought Leadership

Lost, then found: Engaging members who may be ‘lost to care’

A conversation with Jaime Prieto, Chief Marketing Officer, Ontrak Health.

Health plans can struggle to engage members who are ‘lost to care.’ We wanted to better understand this phenomenon–and ways health plans can help solve it. So, the editorial staff recently sat down with Ontrak Chief Marketing Officer, Jaime Prieto, who is responsible for Member Outreach and Enrollment.

What follows is a lightly edited transcript of that conversation.

Editorial Staff, Ontrak Health
Ontrak uses this term quite a lot: ‘Lost to care.’ What do you mean by that term, ‘lost to care?’

Jaime Prieto, Chief Marketing Officer, Ontrak Health
You know, ‘lost to care’ is a way to describe a significant population of people who have health coverage, either through their commercial health plan or through one of the government programs.

But they aren’t accessing care in an optimal way. Through no fault of their own, by the way.

Often, we see lots of people who, because of all sorts of barriers and social determinants of health—this is what we’re talking about, right? They maybe can’t get off work. Maybe they don’t know how to navigate the healthcare system. Maybe they’re hesitant to reach out or they just don’t understand the resources available to help them. Maybe they might see one physical condition in a vacuum and not realize that there are other issues affecting them.

We talk about this as ‘lost to care.’ These are people that we can help. But they need to be reached to be helped.

Staff
What makes this problem so tricky for health plans?

Jaime
The main issue is volume, just the sheer number of people that might be enrolled in a health plan. The plans know that this issue exists. Roughly 5 percent of health plan members represent about 45 percent of their costs. So, members lost to care have both social and financial costs.

And that’s because there are people who have physical comorbidities and underlying behavioral health issues. They drive a disproportionate number of costs for the plan.

Health plans understand that addressing behavioral health is really important. But often it just comes down to a question of resources.

Staff
How does Ontrak ‘find’ members who are lost to care?

Jaime
So, this is sort of Ontrak’s secret sauce, so to speak. Through our proprietary algorithms, we will look at a health plan’s claims data over the course of the previous 12 months. Then, by applying various criteria filters and looking at a multitude of factors, we can actually uncover the propensity of behavioral health conditions and chronic physical comorbidities.

In addition to that, the other thing is that we can impute the data and usually about 30 percent of the people that we identify for our program is through imputed data. So, they don’t have behavioral health claims per se. But we can infer that they do have underlying behavioral health issues.

Staff
Wait, let’s stop there for a minute. So, it’s not just looking at claims data alone? The team—and I guess the algorithms—can find members lost to care, who may be living with behavioral health conditions, but who have never gotten treatment for that. Is that right?

Jaime
That’s exactly right. And that’s the true power of AI-infused data analysis. Finding members who are lost to care means we can’t rely on claims data by itself.

And so, 30 percent is, you know, a pretty good number to uncover. These are folks that aren’t obvious candidates for behavioral health intervention. That is, when you just look at claims data on its own.

So that’s kind of the very, very first step and that that’s of great value to a health plan because now we’re identifying those folks who are lost to care that aren’t there at the first pass of looking at the data.

Staff
Okay, that’s clear. So, you find identify possible candidates for targeted intervention. Then what?

Jaime
Then we come in with our enrollment specialists and start to contact these folks. And get them engaged to participate in the Ontrak Whole Health Plus program.

Each outreach specialist is making about 150 calls a day. They’ll reach about 10 percent over the phone—and then we’ll enroll nearly 50 percent of those we reach. So, we have a very good track record across every line of business—whether that’s Medicaid, Medicare, or commercial.

Staff
What do you attribute that high enrollment rate to? What do you think makes Ontrak outreach specialists so successful engaging members who might otherwise be lost to care?

Jaime
You know, we work hard to get the right data. We look at data on everything from the best time to call, to demographic factors, geographic factors, conditions, comorbidities. Any insight that can help us perform more efficient outreach.

And then it all comes down to listening. We tell the team: Be all ears—all the time.I’ve listened to many of these calls. They’re very moving. People do want help, they appreciate someone reaching out to them and saying, ‘how are you feeling?

What’s going on in your in your life? How can we help you?’

Remember, these are folks lost to care. They’re not seeing a therapist. They’re not getting personalized attention from a registered nurse or primary care physician. So, the very act of doing the outreach in an empathetic way can be truly life-changing on its own.

The key is that we don’t use those regimented, long scripts. You know the kind you hear when telemarketers call? Yeah, we don’t do that. Our outreach specialists have some very basic guidelines, but we encourage them to guide the conversation based on where the member is and what they want to talk about.

So, you get somebody on the phone. The call might be 15 minutes and that person says ‘I’m not ready to go. But maybe call me back in a week.’ Or it might be 45 minutes where the agent really gets to understand the member’s point of view.

Staff
It sounds like your agents have a high degree of autonomy and discretion to do to their jobs effectively. How do you get there? Does that require any kind of specific training or credentialing? How do you prepare your team to do this work?

Jaime
Interestingly, we like people who come from a sales background. But we screen them very carefully! True sales is about problem solving. You’re not selling, you’re solving. You’re giving that person a better option—and a new opportunity.

And like problem solving, good sales is also all about listening. Taking time to discover that person’s challenges, what they’re struggling with, what they need help with.

I know people tend to think of sales, like, car dealerships or The Wolf of Wall Street stockbroker types. But if you have a good product that truly helps people, then sales is about helping people live better.

Staff
Okay, very insightful. So, that’s the philosophy behind it. What about the training?

Jaime
When we find potential candidates who we think might be good at outreach, then we do both extensive onboard training and ongoing monthly training. Our training is very focused—motivational interviewing and other evidence-based techniques. And of course, learning and understanding both the program that we run and the kinds of issues that members might face.

But, again, I can’t emphasize this enough. It’s about listening. This is the first time some of these members have been heard—ever. We have a chance to be there for them.

We also, and I think this is important, invest significantly in ethnic and racial diversity. Empathetic listening means being attentive to cultural codes and experiences. Sharing that understanding can make a big difference to building those connections with members.

So, bottom line, outreach is about building those human relationships. It’s not just clinical.

Staff
You’re building relationships.

Jaime
Yes, exactly. We’re building relationships.

Staff
How long does it typically take to enroll an eligible member into the program?

Jaime
So, looking at the data, 1/3 of people will enroll right then on that first call. That’s remarkable, in my view. That attests to the sincere, hard work of our outreach specialists.

It also attests to the reality of the members we talk to. They’re hungry for an opportunity to treat their behavioral needs. They want to live fuller, healthier lives.

For others it’s a second call, a third call, a fourth, or fifth. Again, we will call people back. We’re persistent, but not pushy. We call it ‘polite persistence.’

If they’re not ready the first time, that’s okay. We kind of agree on a time to call them back.

But we don’t give up. You know why? Because every phone call is a chance to truly change someone’s life. That’s what we’re here for. We’re here to change lives.