Ontrak, Inc, a leading AI-powered and technology-enabled behavioral healthcare company, announces the adoption of the Comprehensive Healthcare Integration (CHI) framework into its care delivery model. This advances Ontrak Health’s commitment to delivering high quality, integrated, whole person care. The CHI model represents the most comprehensive clinical framework for integrating physical health, behavioral health, and social determinants of health within care delivery.
Developed by the National Council for Mental Wellbeing in 2022, the CHI framework provides a robust foundation for implementing and measuring the progress of integrated healthcare services. The CHI white paper explains, “The evidence strongly suggests that people of all ages living with co-occurring PH, BH and SDOH needs have higher health costs yet experience poorer health outcomes. Emerging evidence suggests that more coordinated or integrated oral, mental health and substance use treatment services can increase access to needed care, improve patient outcomes and potentially reduce healthcare costs. The evidence further suggests that populations with co-occurring PH, BH and SDOH needs are likely to benefit from evidence-based integrated interventions in whatever setting they are best engaged, with more complex and high-cost populations generally requiring higher levels of service intensity.”
“With the adoption of the CHI framework we are unlocking the full potential of integrated care through our clinical programs,” said Dr. Judith Feld, Chief Medical Officer of Ontrak Health. “We are proud to champion the evolution of care delivery, harnessing the power of integrated care to improve patient lives.”
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The eight domains of the CHI framework, and the ways in which Ontrak Health applies them to its programs, include:
- Screening, Referral and Follow-up: Ontrak coaches use validated health assessments including the Patient Health Questionnaire 9 (PHQ-9), the Generalized Anxiety Disorder 7 (GAD-7) and Recovering Quality of Life 20 and 10 (ReQoL 20 and ReQoL 10), to guide personalized care and referrals to behavioral health and primary care providers. Additional screeners are applied based on specialized condition programming like substance use disorder. Bidirectional clinical information sharing with treating specialists aligns interventions for optimal outcomes.
- Prevention and Treatment of Common Conditions: Ontrak Health’s care teams employ evidence-based guidelines and standardized workflows to screen, treat, and monitor common physical and behavioral health conditions. Targeted screeners and questionnaires include physical health, biomarkers, gaps in care, substance use, depression, anxiety, and trauma-related issues.
- Continuing Care Management: Ontrak Health care teams provide ongoing care management through specialized coaches, provider network resources, tracking tools, and proactive follow-ups to ensure continuous engagement and treatment progress for each member through our omnichannel communications platform.
- Self-management Support: Ontrak employs evidence-based techniques like motivational interviewing and SMART goal setting to enhance members’ self-management skills, while adapting these approaches to individual health literacy levels. Access to resources and goals tracking are made available through on-demand resources and a mobile application.
- Multidisciplinary Teamwork: Ontrak Health facilitates multidisciplinary teamwork through regular clinical rounds, bidirectional exchange of member treatment information, and ongoing collaboration with health plan’s case management teams and family members when appropriate.
- Systematic Measurement and Quality Improvement: Ontrak implements comprehensive quality improvement measures, including fidelity measurement, standardized outcome tracking, performance dashboards, and regular audits, to continuously enhance care delivery and ensure optimal member outcomes.
- Linkage with Community/Social Services for SDOH: Ontrak Health addresses social determinants of health by utilizing standardized social needs screeners and its extensive knowledge of community resources, and is targeting integration of multiple SDOH platforms directly into the electronic health records, to connect members with appropriate support services.
- Financial Sustainability: Ontrak Health applies value-based financial strategies including payment models putting delivery at risk, performance-based, and shared savings options, committing to optimizing outcomes and reducing costs.
The adoption of the CHI framework underscores Ontrak Health’s commitment to addressing the complex interplay of physical health, behavioral health, and social determinants of health. Our results speak volumes: a guaranteed 2.0x ROI, 62% reduction in inpatient utilization, 32% decrease in ER visits, and 28% net cost savings. These outcomes, coupled with clinically significant improvements in GAD-7 and PHQ-9 scores of 53% and 62% respectively, and an NPS of 68, demonstrate that Ontrak is at the forefront of translating the promise of integrated care into tangible benefits for our members and partners. We’re not just implementing a framework; we’re pioneering a more effective, equitable, and sustainable approach to healthcare delivery.
Source: Businesswire
