The mental health impact

Today’s turbulent economy is sending a wave of stress through the workplace: workers are worrying about their companies, their jobs, their expenses, their coworkers and their family and friends. This cascades into stress on and off the job, greater benefit costs and less productivity.

There are some specific actions employers can take to manage how stress and depression impact their employees and cut into the company’s bottom line. Some actions are defensive, like monitoring incidental absences and disability claims to watch for increases in lost time and “discretionary disabilities.” But there are also many proactive steps employers can take to enhance their company’s Employee Assistance Program (EAP) and behavioral health (BH) services to help manage costs associated with stress and depression.

Ensure a rapid response with your EAP

More than four fifths of large employers (82%) offer an EAP¹  to help address employees’ emotional and personal needs. In today’s challenging times, an EAP can be especially valuable in managing the impact of stress and depression in the workplace. Strategies to better utilize your EAP include:

• Market your EAP around nontraditional benefits, like financial and legal consultation or dependant care resource and referral to reduce stigma associated with calling the EAP,
• Require that your EAP develop an annual calendar of training topics which should include
  • Coping with financial stress
  • Recognizing and handling employees who are showing signs of stress (for managers)
  • Sessions tailored to the demographics of your workforce
• Consider expanding the number of in-person EAP visits:
  • A six-visit model has been shown to have the best ROI
  • lowering BH claims costs and improving productivity.
  • Some employers with high deductible health plans are adopting an eight-visit model to reduce financial barriers and improve access to short term counseling for symptoms of stress and depression.
• Require that your EAP perform a holistic assessment of callers to identify relevant services in addition to addressing the primary reason for their call.
• Evaluate your current EAP utilization and pricing during each renewal period to identify potential cost savings.
  • Ensure pricing is consistent with market benchmarks and program specific utilization.
  • Establish performance guarantees to improve utilization.
• Reinforce integration and coordination with your behavioral health, physical health and wellness vendors to ensure timely cross-referrals.
  • Members who screen positive for stress and depression on an Health Assessments are referred to the EAP.
  • All members going out on disability are educated regarding the full range of EAP benefits.
  • Members participating in chronic condition coaching or receiving disability benefits and who screen positive for stress or depression should be warm transferred to the EAP whenever possible.

Optimizing your benefit and program design

At the same time that stress is pushing medical and behavioral health (BH) costs higher, the new Mental Health Parity and Substance Abuse Equity Act could mean richer behavioral health benefits for plan years beginning after October 3, 2009. As a result, this is the perfect time to evaluate the effectiveness of your BH management program. Best in class BH programs provide optimal value by improving access to quality services in an efficient cost-effective manner.

Some ways in which you can help ensure your BH benefit administrator is structured to impact your direct and indirect health care costs:

• Require regular reports on BH utilization and costs and assess the true “value” of your behavioral program through analysis of service utilization and costs against national norms
• Consider whether, with the removal of day and visit limits under parity, your plan administrator uses best in class managed care protocols. For example:
  • All levels of care, including outpatient, are subject to some type of review
  • Data-driven algorithms are used to identify and manage case or provider outliers on quality and cost
  • Protocols address both in- and out-of-network outpatient utilization
  • A sufficient number of outpatient cases/providers are “touched” with meaningful outreach
  • A management strategy is in place that addresses high volume out-of-network providers
• Assess whether BH network discounts are competitive under your current administrator.
  • Have fee schedules been developed using established national databases?
  • Are outpatient fee schedules tiered to allow for differential reimbursement for physicians, psychologists and master’s prepared counselors?
  • Are inpatient BH per diems at contracted facilities aggressively negotiated?
• Design your behavioral health program to coordinate services with your EAP and physical health and disability carriers.
  • Encourage members to access pre-paid EAP benefits.
  • Target high-risk medical populations with BH conditions or risk factors and establish formal business rules for screening, referral and co-management.
  • Implement specialized care management and return to work programs for members going out on psychiatric disability.
• Monitor for increased cost due to the overlap of services across your behavioral health, disease management, disability management, absence and wellness program vendors.

Your EAP and behavioral health programs are powerful tools that you can and should use to affect cost and productivity. Contact your Mercer consultant for effective rapid-response strategies and cost-saving opportunities.

1 Mercer National Survey of Employer-Sponsored Health Plans, 2008 Survey Report