The need to improve access to mental health care was clear to employers before the pandemic, but over the last two years it has become the top priority for many, especially very large employers. Mercer’s Tracy Watts recently invited Mary Kay Gilhooly, the Director of Well-being at Adobe in San Francisco, and Mercer mental health specialist Carrie Bergen to discuss how employer plan sponsors are modernizing mental health benefits. This post hits the highlights of their very interesting conversation, but it’s well worth listening to the entire discussion.
A new philosophy for supporting workforce mental health
Viewing emotional well-being as an ecosystem, Adobe seeks to provide a full spectrum of emotional and mental support for employees, and starting with prevention and early intervention, to support, treatment and resilience. According to Mary Kay, while it’s certainly important to offer the right programs through third party vendors, Adobe believes it’s essential to have a strong culture and ecosystem so that any solution offered is well-positioned to make a real difference. Ensuring that programs are embedded within a continuum of support is key to giving employees a clear pathway to the support that they need, from an early stage intervention to more critical mental health services to back-end support.
As Carrie added, culture is key because as employees start to feel more comfortable and competent talking about mental health, they're more likely to understand the resources available to them. It’s important to avoid a “band aid approach” when considering adding solutions or programs. Rather, a comprehensive mental health strategy needs to address the full spectrum of needs from stress reduction and resiliency to treatment and recovery support. That way, the program can engage all employees and not just certain parts of the population. In addition, making regular effective communications part of the strategy will generate a greater return on the organization's investment than if the mental health program is promoted only during open enrollment and never heard of again.
Reimagining the EAP
The rising demand for mental health services has led to employers asking their EAPs to do more, in three key areas.
Access to care. Too often employers hear of members trying to see a mental health provider and finding that providers aren't taking new patients, or don’t call back, or are no longer in service. Where the traditional EAP might seek to offer the broadest possible list of providers, today’s modern EAP works to develop a curated network so that they can assess provider availability and ensure that members are referred only to providers who can assist them. Access points are also changing. Historically, with telephone intake, an individual would call the EAP 800 number, get a list of providers, and start calling. Now EAPs offer online assessments and use clinically validated tools to assess the clinical need and then offer online scheduling. This way the member knows they have an appointment with a provider that they've been matched with based on clinical need and their own preferences, including for virtual treatment.
Option for longer-term support. Where the traditional EAP might offer three or six sessions for short term care, the reimagined EAP is offering, where needed, much more time with the provider – 10 sessions has become common but some offer up to 25. In some cases, the EAP is partnering with the health plan –augmenting the health plan’s medical network of behavioral health providers with additional providers offering quality clinical care. This allows an individual to start within the EAP and then have a seamless transition into the health plan. The member cost sharing kicks in, but they can continue with the same provider if the issue wasn't resolved within the EAP sessions. This is another important step away from the old band-aid approach and towards a continuum of care in which people get the right level of care, for example, coaching rather than therapy. Quality is a big part of this. The reimagined EAP verifies that their providers use only evidence-based treatment and are able to report on clinical outcomes, so they can demonstrate not just that a member has been referred to a therapist, but that they are actually improving their symptoms and resolving their clinical issues.
Employee experience. Are the benefits easy to learn about? Can people understand how to navigate them? Is there follow up, to ensure the member has gotten the care they need? What if they didn’t like the therapist they were referred to? Follow up is critical to ensure the member doesn’t fall through the cracks. We're seeing more of this closed circle, start-to-finish approach through the reimagined EAPs.
Digging into the data to understand employee engagement
As Mary Kay describes, getting actionable reporting from program vendors is important – but not a given. A typical vendor report provides information on participation, which is not enough. Even if they do provide some metrics around engagement, it can be hard to know what is really behind the numbers. If someone is counted as “engaged,” does it mean they clicked on a website? Engaged with a coach? Was referred to another resource? While all those things may be important, the essential question is whether people are getting the help they need to feel better. Key metrics are not only whether an individual has made an appointment with a therapist, but whether they actually had that appointment, and if there was feedback afterwards. In looking at program data, it’s important to be very clear on what is meant by participation and engagement.
Carrie elaborated on the types and sources of data that plan sponsors should be collecting specific to mental health services. Where data collection had traditionally focused on satisfaction, absenteeism, and productivity, we're now seeing a push to get data on wait times for care. That gives you the ability to compare the experience of calling in versus going online to schedule an appointment with a provider and get into care with that provider. Data on clinical outcomes improvement is also valuable. Are people just going to see a therapist and dropping out, or are they actually accomplishing the goal of therapy and resolving the issues they sought help with? With this data, vendors can start to report on return on investment. Overall, data is telling a better story about what's happening in therapy and what's happening for the individuals who are going. This allows us to look for trends that can help inform strategy. For example, if we see that alcohol use is really high in a population, we can consider a communication to promote a targeted service. With more granular and detailed data, plan sponsors can continuously refine their emotional well-being strategy, rather than waiting three years to assess a long-term strategy or a vendor’s performance. Now a vendor can really become a strategic partner by keeping up with changes in your population, anticipating their needs and making recommendations for the organization based on the story that the data is telling.
Getting started with a modernized mental health program
Mary Kay’s biggest piece of advice for employers getting started is to really listen to your employees. They are your customer and they're there to tell you how you're doing. Remember there really is no silver bullet, so when you find a new vendor or a new solution, it’s got to fit into a bigger solution, a bigger ecosystem and ultimately with your culture. You will need training for your managers and training your employees. It needs to resonate with your culture, you need to promote continuously and maintain a relationship with the vendor to ensure they really understand your culture and what you're trying to accomplish.
Carrie adds that if the organization’s leadership embraces and promotes the culture of emotional well-being and makes it acceptable to talk about mental health, then their people will feel more comfortable to reach out for resources. As a client once said, our goal should be for people to talk about mental health services the same way they talk about yoga: I'm going to my therapist today and to yoga tonight.