Jonathan Mayhew joined Ontrak as chief executive officer in 2021 after serving as Chief Transformation Officer at CVS Health and in leadership roles at Aetna and Cigna.
Why Ontrak? Among the reasons is a passion to improve behavioral health for people with chronic conditions.
Health Evolution interviewed Mayhew about why he calls on all CEOs to offer behavioral health support to their health plan members or employee workforce to lower costs, the personal exposure to the health care system that drives him to succeed, what to expect from Ontrak in the near future, and more.
How does your professional background inform the way you lead Ontrak?
Mayhew: Number one, I have been in health care for my entire career and for me these issues around behavioral health and particularly the connections between behavioral health and chronic disease are some of the most vexing problems that exist in the industry. There’s the stigma. There’s also the industry’s inability or difficulty when it comes to funding behavioral health solutions. I’m looking at these issues continuing to create a cost burden and an access burden and a stigma burden and I just feel compelled to try to take the last section of my career and see if I can make a difference around some of the reported and realized mental health issues. So, I think it’s that insider perspective and knowing a bit about what has worked and what has not worked and what’s been tried and what hasn’t been to improve it.
What is Ontrak’s origin story or the inspiration fueling the company?
Mayhew: Terren Peizer is the founder of the organization. He instilled a founder-mission orientation. I have come to find, like so many people that do endeavor to get into the behavioral health industry, that there’s about one degree of separation from some experience in their life that inspires them to support the behavioral health and mental health industry and Terren’s story has a bit of that. He lost a family member with chronic disease and addiction related issues and I think that became his inspiration.
I’m in that one degree of separation scenario myself. I’m certainly sympathetic to the industry because of my own family circumstances in which my wife and I both developed cancer at the same time. Unfortunately, hers was terminal. We had three small kids. And as she was going into hospice and passed away, I was left trying to figure out how to get small kids sorted out in terms of grieving and bereavement and all of those adjacent issues.
My exposure was to learn that it’s really hard to seek care. How do you find the right providers? How do you even know where to go when you find the right provider? You can’t always get access to them in a timely way. So you end up seeking community-based programs that are funded through non-profit charity organizations. In my particular case they just were not well suited to deal with a four year old, a six year old and a ten year old. That was my first exposure to having anything connected to an emotional behavioral need for family members. And I began to realize that the system is just not set up to support some of the needs that people have and so I’ve brought that sensitivity, if you will, and a recognition of the need to develop resiliency and perseverance. That’s why I want to try and make a difference with Ontrak.
What makes Ontrak stand apart from other behavioral health solutions?
Mayhew: I would say a couple of things. One is that we’re a therapist-led, coach-driven model. Our coaching services are delivered by clinical individuals, certified coaches, nurses, some nurses with psych training and others more generally trained. Our model takes a whole-person approach to engagement to begin to understand the needs of various individuals. The best way to do that is to build trust and influence, so we can help individuals remove barriers, whether those barriers are lack of access, socioeconomic, cultural, related to health literacy, or their confidence in the ability to engage with the system. Once we develop that relationship it helps us to get people engaged with behavioral healthcare. We’re able to match them to the right kind of therapeutic or psychiatric intervention and know if medications are needed. We enable and maintain that engagement through technology and digital solutions. But the thing that really separates us is our ability to engage previously unengaged populations, and sustain that engagement for an industry-leading average of 7 months. Our program instills in people a sense of self-efficacy and to remain engaged with PCPs and specialists to support their chronic disease and overall health.
Jonathan Mayhew, Ontrak
What do you see as the most pressing challenges around behavioral health post pandemic, particularly for health care CEOs?
Mayhew: Many of the problems that existed before COVID-19 have persisted or been exacerbated through the pandemic. However, the rates at which people were seeking behavioral health care early on in the pandemic actually dropped due to reduced access to providers and fears around COVID. Some of this was offset by the drastic rise in the use of telehealth and virtual care. However, there is still a supply and demand imbalance as there are not enough clinicians to support the needs of individuals seeking behavioral health care. And so as those undiagnosed needs reemerge, it’s going to place even more pressure on existing providers. All of those challenges are now going to persist and continue to accelerate. I think that’s really where some of the opportunities for the industry are. We can help individuals get ready for their therapy sessions and help therapists deliver more effective outcomes. We can encourage individuals to schedule their primary care visits. We provide a level of support and assistance that brings more capacity for treating people. We want to continue to develop our coach-driven model to help take some of that capacity strain out of the system. Generally, I would say that a lot of the conditions and dynamics that existed before the pandemic will continue to persist if not accelerate, creating challenges around rising demand, engagement, network capacity, and behavioral and physical health integration.
What place do you think telehealth or virtual apps have in addressing behavioral health issues?
Mayhew: They help with access to some degree. They may not be the perfect solution for the kind of individuals Ontrak is primarily positioned to support. We work with persistent mental illness that is usually connected to some underlying set of chronic conditions. These are people with a lot of disease burden who probably are not accessing both the medical or behavioral health care they need to help themselves. We use digital technology to improve that interaction with high acuity people. Telehealth and digital tools are well positioned to provide care to people with lower acuity needs, maybe mild anxiety or mild but not persistent depression. Things like that. Digital tools are helpful for direct access and allow people to engage in the ways that work best for them, they’re generally inexpensive and they can scale because they don’t have a lot of human interaction and they enable asynchronous interactions. What we’re finding is that many of those digital platforms are putting human clinicians behind your tool. So if people have support needs they can click through and develop a chat session or schedule a therapeutic appointment or encounter, there are programs that can sit behind it and help support some of the digital platforms that exist. I think you’ll continue to see platforms develop because of their ability to scale and help take some of the pressure off the human-based therapies. You’ll see the human-based therapies be able to sit behind in a coordinated way with the digital platform.
What should existing and prospective clients expect from Ontrak in the next 18-24 months?
Mayhew: We will continue to evolve our clinical and digital capabilities. We have a world-class group of amazing clinicians who could not be more compassionate or passionate about the support they provide in a non-judgmental way. Our organization has a net promoter score of 74, and when individuals are in treatment, they give their coach a net promoter score of 84. These are some of the highest satisfaction rates that exist across any industry and I’m sure they’re among the highest in health care, which is notoriously low in net promoter scores. We will continue to support our clinicians with enhanced capabilities for the environment and the platform that they work on as well as our ability to help drive engagement with digital capabilities to be able to increasingly expand into government programs. Our program is particularly effective in addressing the chronic disease burden across lines of business, and is increasingly oriented to value-based care. Our ability to help drive confidence, satisfaction, and engagement in the value-based care delivery models helps our health plan customers earn higher levels of reimbursement from government programs. We plan to continue to grow our support to drive down health care costs by removing some of the unnecessary and expensive utilization that occurs around hospital and emergency room settings. We will continue to build on the engagement capabilities in the coaching support requirements for our clinicians.
The last thing is building on our experience with identification and enrollment models with advanced machine learning and predictive analytics. We’re training our models with data about people who have successfully completed treatment to understand all the variables that help determine success so that the people we’re putting into the program have an increasing likelihood of succeeding. Integrating AI will help us drive more value for our customers and ultimately be able to help them enroll more people into programs.
What about three to five years? What should we expect from Ontrak in that timeframe?
Mayhew: What you’ll see from us and the industry is the continued convergence of digital and human capabilities to serve lower acuity needs people seeking asynchronous interactions on web-based platforms. I think you’ll start to see a convergence of those digital engagement platforms with real collaborative care models that include primary care physicians, specialist coaches, and a treating therapist. We live right at the crossroads of how those things should develop and as we continue to learn more about the severity and conditions we can drive increasingly improved outcomes for, we’ll be able to see that modeling come through on how people are asked to engage with a digital platform. So, I would really expect that you’ll see that convergence and perhaps consolidation occur over the next two to three years.
What is the best career advice that you ever received or what advice do you have for other CEOs and innovators?
Mayhew: Move quickly. We live in a dynamic industry. Health care is a dynamic world and I think sometimes progress gets measured in weeks and months, not years, relative to the rate of change and development. So “move quickly” seems to be maybe not a unique piece of advice but one that’s always top of mind. In terms of my advice to other CEOs — and this a bit of a pitch and play to make sure there’s sensitivity and support around their employees’ and health plan members’ emotional and behavioral health and well-being — is that there is increasing evidence that offering behavioral health support lowers health care costs. By focusing on people’s emotional and behavioral needs , CEOs can help drive down health care spend. The more executives can get that message out, the more that we in the industry can develop verifiable empirical evidence to support health care cost reduction and productivity improvement. I think CEOs are well served to better support everyone’s behavioral health.
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