Ontrak - Q1 2024

Executive Summary

• Q1 2024 revenue was $2.68M, up 6% year over year but down sequentially from Q4 2023 ($3.54M); adjusted EBITDA loss improved 38% YoY to $(3.37)M and operating loss improved 41% YoY to $(4.27)M.
• Management guided Q2 2024 revenue to $2.4–$2.8M and noted enrolled members declined net 237 in Q1 due to a customer non-renewal, with gross margin stable at 63.6% (vs. 64.6% in Q4).
• Strategic wins: AHCA approval to serve Community Care Plan’s adult Medicaid population and expansions with Sentara Health (commercial and ASO); pipeline ~26 prospects representing ~15M members; NPS 77 and demonstrated clinical/utilization outcomes (ER visits −32%, inpatient −62%, medical costs −43%).
• Financing/liquidity: $6.4M cash at quarter-end; subsequent $3.0M demand note draws and ~$2.0M warrant exercises post-quarter bolstered capital; Nasdaq minimum bid price exception granted contingent on a reverse split by Sept. 23, 2024 and sustained compliance by Oct. 7, 2024.

What Went Well and What Went Wrong

What Went Well

• AHCA approval and Community Care Plan launch expected to expand outreach pool by ~10%, with statewide Medicaid re-procurement positioning for multi-year membership growth opportunities.
• Operating metrics and unit economics: Adjusted EBITDA loss improved 38% YoY to $(3.37)M; operating loss improved 41% YoY to $(4.27)M, reflecting cost discipline and process efficiencies.
• Clinical and utilization outcomes underpin ROI: NPS 77; GAD-7/PHQ-9 improvements through 9 months; ER visits −32%, inpatient admissions −62%, medical costs −43%—a compelling value proposition for payers.

Management quotes:

• “We are thrilled to announce our approval by the Florida Agency for Health Care Administration…to serve its adult Medicaid population.” — Brandon LaVerne, CEO/COO.
• “We reduced emergency room visits by 32%, inpatient admissions by 62% and overall medical costs by 43%.” — Brandon LaVerne.

What Went Wrong

• Sequential revenue decline and net member attrition: revenue fell from $3.54M in Q4 to $2.68M; net enrollment decreased by 237, with average monthly disenrollment rate 22% in Q1 (would have been ~11% absent the customer non-renewal).
• Revenue per enrolled member per month dropped to ~$504 (from $546 in Q4), indicating mix/engagement/pricing headwinds despite YoY growth in average enrolled members.
• Nasdaq compliance risk persists: Company granted a temporary exception contingent on shareholder approval and reverse split by September; failure to comply results in delisting—an overhang for the equity story.

Transcript

Operator (participant)

Good day, and thank you for standing by. Welcome to the Ontrak Health First Quarter 2024 Call. At this time, all participants are in listen-only mode. After the speaker's presentation, there will be a question-and-answer session. To ask a question during the session, you will need to press star one one on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star one one again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Ryan Halsted. Please go ahead.

Ryan Halsted (Head of Investor Relations)

Thank you, operator, and thank you all for participating in today's call. Joining me today are Brandon LaVerne, Chief Executive Officer and Chief Operating Officer, Mary Louise Osborne, President and Chief Commercial Officer, and James Park, Chief Financial Officer. Earlier today, Ontrak released financial results for the quarter ending March 31, 2024. A copy of the press release is available on the company's website. Before we begin, I'd like to make the following remarks concerning forward-looking statements. All statements in this conference call other than historical facts, are forward-looking statements. The words anticipate, believes, estimates, expects, intends, guidance, confidence, targets, projects, and some other expressions typically are used to identify forward-looking statements. These forward-looking statements are not guarantees of future performance, but may involve and are subject to certain risks and uncertainties.

Other factors that may affect Ontrak's business, financial condition, and other operating results, which include, but are not limited to, the risk factors described in the Risk Factors sections of the Form 10-K and Form 10-Q as filed with the SEC. Therefore, actual outcomes and results may differ materially from those expressed or implied by these forward-looking statements. Ontrak expressly disclaims any intent or obligation to update these forward-looking statements. With that, I'd like to turn the call over to Brandon.

Brandon LaVerne (CEO and COO)

Thank you, Ryan, and thank you everyone for joining our call today. I'd like to start with some great news about our newest customer, Community Care Plan. As we have mentioned, the Florida Agency for Health Care Administration, otherwise known as AHCA, has approved Ontrak as a subcontractor for Community Care Plan, a South Florida-based health plan to serve its adult Medicaid population. We are deep into implementation and expect to initiate outreach to new eligible members of Community Care Plan in the next 30-60 days. With the addition of Community Care Plan, our overall outreach pool of eligible members for our Whole Health Plus program is estimated to grow by upwards of 10%. I would also like to highlight the significant opportunity for us to grow along with this new customer within the Florida Medicaid population.

Community Care Plan is one of five health plans to be awarded a contract by AHCA for the statewide Medicaid Managed Care Reprocurement, which concluded in April 2024 and goes into effect in 2025 for the next six years. Community Care Plan will be expanding its reach to five of the nine AHCA regions across the state, representing 19 aligned counties, which is a significant expansion from its current service area of just one region with one aligned county. Additionally, the number of payers awarded under this reprocurement was reduced from nine under the prior contract to five, competing for approximately 1.3 million Medicaid members losing their prior plan coverage beginning in 2025. This presents Community Care Plan with a unique opportunity to significantly expand health plan membership and will enable Ontrak to expand our targeted outreach pool organically.

Ontrak is proud of the value of the products we offer and of the increased efficiencies and higher ROI generated. Here's how we do it. First, our Net promoter score is a consistent indication of our ability to deliver a superior patient experience. Ontrak is an industry leader with a net promoter score of 77, which ranks higher than the healthcare benchmark NPS score of 58. Next, our enrollment success consistently highlights the effectiveness of our experience interacting with members. With Whole Health Plus, Ontrak engages the right member at the right time. Through our AI and predictive analytics, we accurately identify the appropriate members for outreach, ensuring efficiency, effectiveness, and engagement in a member-friendly way. As a result, over 60% of Ontrak enrollees of our Whole Health Plus program enrolled after only one conversation. Member retention is the next key element in our success.

Flexibility and customization of Whole Health Plus allows us to vary the length of the program to optimally match the needs of the member. 60% of Ontrak enrollees participated in program for at least six months, with an average length of enrollment of 7.6 months, and Ontrak's flexible graduation can accommodate the unique needs of each enrollee. On average, it takes 12 weeks to progress through the various stages of behavior change. With our program averaging significantly longer, members are far more likely to achieve durable outcomes with lasting behavior change. Identifying new mental health diagnoses is another key component of our Whole Health Plus program. Ontrak's program helps our health plan partners more effectively identify and engage members and deliver beneficial behavior changes.

Across Ontrak's current book of business, 28% of behavioral health diagnoses identified during enrollment in our Whole Health Plus program were not present in claims during the 12 months prior to enrollment. Undiagnosed or undertreated symptoms can negatively influence behaviors that impact overall physical health. By addressing those behavioral health symptoms, individuals can improve their quality of life, general health, and reduce the risk of developing or worsening physical health problems. In addition, proper coding of these diagnoses into members' record increases reimbursement rates for payers, generating incremental ROI opportunities for our health plan partners. Further, in using GAD-7 and PHQ-9 patient health questionnaires, we continually assess our effectiveness in treating anxiety and depression.

For example, in our Medicaid line of business, during these follow-up assessments, 38% and 46% of enrollees completing the three-month follow-up in their GAD-7 and PHQ-9 assessments, respectively, had a clinically significant improvement of five or more points of a reduction in their symptoms. Similarly, 42% and 49% of Medicaid enrollees completing a six-month follow-up in their GAD-7 and PHQ-9 assessments, and 58% and 64% of Medicaid enrollees completing a nine-month follow-up in these assessments, had a clinically significant improvement in their symptoms. Each of our lines of business, whether commercial, Medicare Advantage, or Medicaid, saw further improvement as members progressed through three, six, and nine months of the program, further showing the durability of our program. We are also delivering significant health utilization outcomes.

Ontrak's Whole Health Plus program delivers proven health outcomes while reducing costs and increasing engagement, leading to increased quality scores. We reduce emergency room visits by 32%, inpatient admissions by 62%, and overall medical costs by 43%. We achieve these results through empowering enrollees and enhancing self-efficacy through the removal of social risk barriers, improving health literacy, facilitating appropriate care navigation, and offering coaching for behavioral change. The increased efficiencies and ROIs that Ontrak's Whole Health Plus program offers to its health plan partners is more important than ever, given the challenging environment faced by Medicare Advantage plans. We deliver improved health outcomes and reduced medical costs while increasing member engagement, leading to these higher quality scores. With that, I'll turn it over to our President and Chief Commercial Officer, Mary Lou Osborne. Mary Lou?

Mary Louise Osborne (President and Chief Commercial Officer)

Thank you, Brandon. I am thrilled to provide a few additional updates on our new Medicaid health plan customer, Community Care Plan, based in Sunrise, Florida. It is a privilege to partner with Community Care Plan, whose mission is to be the driving force, ensuring that every community has access to equitable, high-quality, affordable health care. We are full speed ahead with the Ontrak implementation, which is advancing on schedule. Ontrak will be providing community care members with Whole Health Plus, Ontrak Engage, Ontrak Access, a member portal, and quality support for HEDIS measures. I will briefly highlight each product. Whole Health Plus. This is our AI-infused, targeted solution for high-cost, high-acuity members. Ontrak will identify members with chronic comorbidities and unaddressed behavioral health conditions.

We will reach out to the members and enroll them into the Whole Health Plus program, which consists of up to 52 weeks of whole-person, evidence-based care coaching, plus access to behavioral health providers as needed. Ontrak Engage. This program is for members across the acuity spectrum. Ontrak will provide inbound and outbound care coaching. For inbound care coaching, members can access a care coach by calling a dedicated toll-free number. For outbound care coaching, care coaches will be calling members with a diagnosis of serious mental illness to help support their whole person care. Ontrak Access. Ontrak is an accredited credentials verification organization by the National Committee for Quality Assurance, and has contracts with behavioral health providers in Florida available to the health plan when needed for access and availability. Member Portal. This is a dedicated portal available to all members.

It includes links to well-being sites and articles to help members better manage their physical and behavioral health and well-being. Quality support for HEDIS measures. Ontrak will collaborate with Community Care Plan and support specific HEDIS measures for the members that Ontrak is serving in the program. We are thrilled that Community Care Plan was awarded five regions in the most recent Florida Statewide Medicaid Managed Care Contract reprocurement, extending for six years. This Medicaid award is an incredible accomplishment. Community Care Plan has a tremendous opportunity to grow in the state of Florida, and Ontrak is prepared to support Community Care Plan with its membership growth and expansion. Also, there are potential future expansion opportunities with this new customer for additional populations they serve beyond the Medicaid line of business in the state of Florida.

In addition to this exciting new customer contract and implementation, we remain in the final contracting phase with two prominent health plans, representing over 2 million lives across all lines of business. Both health plans are interested in beginning a pilot partnership, one for our Medicare Advantage members and the other for Medicaid members. Both health plans have approved Ontrak's financial proposals and have received Ontrak's statement of work, which are in final review and approval. Both health plans have stated once clinical and financial outcomes are achieved, there is an intent to expand to a larger membership cohort and across other lines of business. Our pipeline remains strong, with approximately 26 active prospects representing 15 million members across all lines of business. Finally, we are happy with our continued progress in expanding current customer relationships.

As we reported in our last earnings call, we have expanded our behavioral health products with Sentara Health, a long-standing health plan customer. Sentara is offering Whole Health Plus to a broader commercial population and to a new ASO population. This represents a 6.5x increase in the number of Sentara members eligible for the Whole Health Plus program. Additionally, we have executed a new Medicaid amendment to offer Whole Health Plus to Sentara Medicaid members. We are currently finalizing the number of eligible Medicaid members and go-live date, which we expect in the next 60-90 days or sooner. We are proud of our accomplishments for Q1, beginning with Florida's Agency for Health Care Administration's approval to begin implementation for Community Care Plan and our new Medicaid health plan customer.

In addition, we have executed multiple new Sentara Health amendments for an expansion of Whole Health Plus to a broader commercial population and ASO membership, as well as Sentara's Medicaid line of business. We look forward to delivering durable health and financial outcomes for all the health plans and members we currently serve, as well as new customers. Now I'd like to turn the call over to our Chief Financial Officer, James Park.

James Park (CFO)

Thanks, Mary Lou. During the first quarter, we recorded revenue of $2.7 million, a 6% year-over-year increase, due primarily to a 15% increase in total average enrolled members during the first quarter of 2024, compared to the same period in 2023. At the beginning of the quarter, we had 1,758 enrolled members and ended with 1,521 at the end of the quarter, or a simple average of 1,640. That equates to revenue of about $504 per health plan enrolled member per month for the quarter, a decrease from $546 per health plan enrolled member per month in Q4 of 2023, and a decrease from $528 in Q1 of 2023.

Regarding our Q1 member metrics, we enrolled a total of 925 members during the quarter, compared to 654 in Q4 of 2023 and 825 in Q1 of 2023. Dividing Q1 gross enrollment by our outreach pool, which averaged 3,417 for the quarter, it annualized to a 108% annualized enrollment rate, compared to 63% enrollment rate in Q4 of 2023 and 62% in Q1 of 2023. The elevated enrollment rate was driven by new members in our outreach pool as a result of expansion with Sentara. Any period that we have new members in our outreach pool, we'll experience higher than average annualized enrollment rates for a short period of time, as these are new members who are being reached for the first time.

As Brandon indicated, we've seen upwards of 60% of members enrolling on their first call. Our average monthly disenrollment was, a disenrollment rate was 22% in the current quarter, compared to 16% in Q4 of 2023 and 12% in Q1 of 2023. The current quarter had more disenrollments due to the customer that did not renew their contract beyond Q1 of 2024. Without the impact of these members, our monthly disenrollment rate for the first quarter would have been approximately 11%. Further, we graduated 194 enrolled members during the quarter. This equates to about 11% of the enrolled members in the program at the beginning of the quarter, which is slightly higher than prior periods. The impact of all this was a net enrollment decrease of 237 members in the first quarter.

Our gross margin for the first quarter was 63.6%, which decreased slightly from 64.6% in Q4 of 2023, and 66.5% in the first quarter of last year. We have been able to maintain our gross margin at these levels due to the efficiencies in our operational processes. We expect margins to remain at these levels, but can fluctuate in periods where we have large number of enrolled members as we hire our members, member-facing employees in advance in periods where we have significant increases in our members enrolled. Turning to the balance sheet and cash flow. Our cash flow from operation in the first quarter was negative $3.3 million, compared to -$5 million in the first quarter of last year, and -$3.6 million in Q4 of 2023.

The end of the quarter with cash of $6.4 million, down from $9.7 million at the end of last year. As previously announced, in March of 2024, we completed an amendment of the key pool agreement that gives us access to $15 million of senior secured demand notes, which is set up as monthly drawdowns over the next year, subject to approval at the time of the draw. Subsequent to our quarter end, in each of April and May, we drew down $1.5 million of demand notes, or an additional $3 million. In addition, we received cash proceeds of $2 million from exercise of warrants during April, which continues to build our capital to execute on our pipeline.

While we can't predict if and when the remaining warrants will be exercised, the total amount of warrants at the exercise price would equate to an additional $15.9 million in cash. For Q2 2024, we anticipate revenue in the range of $2.4 million-$2.8 million. Now, we will open up for questions. Thank you.

Operator (participant)

Thank you. At this time, we will conduct a question and answer session. As a reminder, to ask a question, you need to press star one one on your telephone, wait for your name to be announced. To withdraw your question, please press star one one again. Please stand by while we compile the Q&A roster. Our first question comes from the line of Jonathan Aschoff of Roth MKM. Your line is now open.

Brandon LaVerne (CEO and COO)

Hi, Jonathan.

Jonathan Aschoff (Managing Director)

Oh, I'm sorry. I'm on mute. Sorry about that. I was curious, at what sort of annual revenue do you think you could attain with Community Care Plan?

Brandon LaVerne (CEO and COO)

So I would say that we are, we're trying to avoid specific customer revenues, but Community Care Plan, as we had indicated, you know, we're launching in one particular county, and so it's a relatively small plan. But what we don't know is how many members can ultimately come in over the course of 2025, as you know, 1.3 million members in Florida have to choose, you know, one of the other five plans out there. And so for now, you know, it's relatively small. I would say, James, correct me, less than $1 million. However, it could ultimately end up being much larger than that in the future.

Jonathan Aschoff (Managing Director)

Okay. Thanks. I was curious, how many potential customers comprise your current pipeline? Can you help us out with that?

Brandon LaVerne (CEO and COO)

Mary Lou?

Mary Louise Osborne (President and Chief Commercial Officer)

Our health plan customers right now, we have three health plan customers, but within those customers, there are multiple lines of businesses that we are offered to.

Jonathan Aschoff (Managing Director)

Okay. So where do you believe you may be able to add—I mean, I'm sorry, when do you believe you might be able to add the next new client?

Mary Louise Osborne (President and Chief Commercial Officer)

So we are closing in as our, as we reported in our Earnings Call, two prominent healthcare plans are in final stages. Both are finally reviewing our statement of work. We expect to receive customers' comments within the next 30-60 days. And then shortly thereafter, there would be an execution of signature, and we would be able to launch within 30-60 days once the signatures are finalized.

Jonathan Aschoff (Managing Director)

Okay. That's, that's helpful. Thank you. Lastly, is all of the disenrollment fallout from Medicaid losses gone now, or do you expect to see more of this near term?

Brandon LaVerne (CEO and COO)

From what I've seen, you know, and. Go ahead, Mary Lou. Were you gonna say something?

Mary Louise Osborne (President and Chief Commercial Officer)

No, no, go ahead, Brandon.

Brandon LaVerne (CEO and COO)

I was just gonna say, from what we've heard, you know, the vast majority seems to be behind us. I don't know that it's complete. I know that some states have expanded the timeline beyond June. And so from what we've seen, we did see significant reductions throughout the last 12 months and, you know, it seems to have slowed significantly.

Jonathan Aschoff (Managing Director)

Okay. Thank you very much, guys. That was it.

Brandon LaVerne (CEO and COO)

Thank you.

Operator (participant)

Thank you. Thank you. I'm showing no further questions at this time. I'd now like to turn it back to Brandon LaVerne for closing remarks.

Brandon LaVerne (CEO and COO)

Thank you, Marvin. I'd like to thank everyone at Ontrak Health for their hard work and dedication to our cause, and also thank all those who participated on the call today. Have a great day.

Operator (participant)

Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.