CONTROLLING MENTAL HEALTH COSTS THROUGH EAP PROGRAMS. Sean Fogarty, Curalinc Healthcare

Size: px

Start display at page:

Download "CONTROLLING MENTAL HEALTH COSTS THROUGH EAP PROGRAMS. Sean Fogarty, Curalinc Healthcare"

Francis Baker
6 years ago
Views:

1 CONTROLLING MENTAL HEALTH COSTS THROUGH EAP PROGRAMS Sean Fogarty, Curalinc Healthcare

2 Using EAPs to Control the Cost of Mental Health April 5, 2016

3 Introduction Sean Fogarty, President and CEO, CuraLinc Healthcare Chicago-Based Global Service Provider Over 600 Clients and 480,000 Covered Lives as of January 1, 2016 Provide Comprehensive Suite of Behavioral Health and Wellness Programs to Direct Employer Groups, Plan Administrators, Medical Management Providers and Associations Highlighted by an Innovative Employee Assistance Program (EAP) 3

4 Anatomy of an EAP Short-Term Counseling Work-Life Benefits Organizational Resources Worksite Services Technology 4

5 Three Types of EAPs Understand the Advantages and Limitations of Each Type of EAP 1. Embedded / Affinity Thrown In for Free With Another Line of Coverage LTD, LI, MEC, etc. Average Annualized Utilization Rate of 0.25% 2. Carrier BUCA In-House Programs No Coordination with Other Programming No Incentive to Resolve Cases within EAP 3. Specialty / Third-Party Over 1,000 Providers in the US Mix of Small and Large Companies; Local, Regional and Global Embedded EAP Usage per 1,000 Employees 5

6 EAP Value Proposition Helps Employees Address Personal and Work-Related Concerns Addictive Behaviors Anxiety Anger Management Depression Family & Marital Problems Grief Organizational Change Stress Management Substance Abuse Helps Employers Increase the Value of Their Workforce Productivity Supervisor Competency Engagement Impacts Human Capital Costs and Health Care Costs Core Component of a Client s Health Management Strategy 6

7 Walk-Away Goals 7

8 Building the Business Case Card Slide? 8

Building the Business Case Prevalence in the U.S. Obesity 1 35.

2% Smoking Illicit Drug Use Diabetes Cancer CHF 1 1 3 4 1 16.8% 9.4% 9.3% 4.5% 1.

0% 1 in 4 Americans has a diagnosable mental health disorder.

9 Building the Business Case Prevalence in the U.S. Obesity % Mental Illness % Smoking Illicit Drug Use Diabetes Cancer CHF % 9.4% 9.3% 4.5% 1.5% 0.0% 10.0% 20.0% 30.0% 40.0% 1 in 4 Americans has a diagnosable mental health disorder. Mood Disorders (Depression, Bipolar) Anxiety Disorders (Panic, PTSD, OCD, Phobias) Other Disorders (Anorexia, Bulimia, Schizophrenia, etc.) Sources: 1 CDC, 2 NIMH, 3 Nat l Diabetes Statistics Report, 4 American Cancer Society 9

10 Building the Business Case After using the EAP, the average time away from work caused by an employee s behavioral health concern(s) decreased by an average of 8.87 hours within 30 days. - CuraLinc Healthcare Almost 19% of HRA participants were at risk for anxiety, depression, stress, or alcoholrelated behavioral health conditions. - Marquee Health Employees using the EAP returned to work twice as often at the conclusion of their disability claim than employees who did not access their EAP. - The Hartford The presence of diabetes doubles the odds of comorbid depression. - American Diabetes Association Five-in-six users of psychotropic meds are under the care of a general practitioner. - Medco The average outpatient MHSA claim lasts just over six sessions and costs a self-funded plan $ CuraLinc Healthcare 1 in 4 Americans suffers from a serious mental health problem every year. - Nat l Institute of Mental Health By 2020, mental health and substance abuse (MHSA) disorders will surpass all physical diseases as the leading cause of disability worldwide. - SAMHSA Behavioral health accounts for 7.3% ($135 billion) of the $1.85 trillion spent on health care every year nearly as much as the total spent on heart disease and cancer treatment combined. - SAMHSA Personal problems (which can be addressed by an EAP) account for 125 hours of lost productivity, per employee per year. - Yankelovich Research 10

11 Building the Business Case Population Health Management Today Programs Focused Primarily on Addressing Physical Health Concerns No/Limited Integration with the One Benefit Built to Address Behavioral Health Issues Wellness Coaching Onsite Clinics Telemedicine Disease Management EAP Biometric Screenings Health Risk Ass t Advocacy Physical Health Behavioral Health 11

12 Anatomy of an EAP Short-Term Counseling Face-to-Face Counseling; Nationwide Network of Clinicians Work-Life Benefits Legal Consultation, Financial Consultation, Dependent Care and Concierge Referrals, Identity Theft Recovery Assistance Organizational Resources Management, HR and Policy Consultation, Formal Referral Coordination Worksite Services Critical Event Responses, Onsite OD/Training Technology Website, Mobile App, Distance Counseling Platform 12

13 CuraLinc Healthcare Differentiators Superior Intake and Assessment Model 24/7 Live Answer by Licensed and Experienced Masters- and PhD-Level Clinicians Empowered to Conduct Thorough Behavioral Health Assessment Proprietary Tool to Establish Baseline for Impact (Clinical Outcomes) CuraLinc Uses an Evidence-Driven Mechanism to Track the Impact of the EAP on Productivity, Absenteeism, and Acute Clinical Concerns (Depression and Substance Abuse) Cross-Trained to ID and Refer Members with Comorbid Health Conditions Referral to EAP Network Clinicians Who Also Participate in the Client s MHSA Network Clinical Case Management and Outcomes Tracking Clinical Follow-Up with Participant and Network Counselor Throughout the Course of Treatment Post-Case Coordination with Health Plan MHSA or Community-Based Resources Scheduled 30-, 60- and 90-Day Outreach to Track Clinical Outcomes 13

14 CuraLinc Healthcare Differentiators Three-Pronged Approach to Employee Engagement Use Promotion Culturally-Relevant Promotional Strategy, Tailored to the Client Remove the Stigma of Seeking Treatment ( Support for everyday issues. Every day. ) Use Technology Leverage Mobile and Web Platforms to Provide Resources and Connect Employees to the EAP Use Other Providers ( Marketing Integration ) Train Other Health Management Programs to Market and Refer to the EAP EAP 14

15 Innovation econnect Behavioral Telehealth econnect Mobile App Stress Management Module Mindfulness Toolkit Impaired Professionals Program (IPP) Client Services CuraLinc Healthcare Differentiators Dedicated Service Team for Each Client Facilitates Internal Coordination of Resources Facilitates Integration with Other PHM Components Capacity and Willingness to Integrate Seat at the Table When Clients, Advisors and Vendors Discuss PHM 15

CuraLinc Healthcare Driving Value Through Integration Integrate EAP Services Within the Client s Health Mgm t Strategy Address Behavioral Health as Both a Primary and a Comorbid Condition Case

Psychosocial Condition of Member on Extended Leave Onsite Clinic Leverage Worksite Docs as Referral Resource for Members with Presenting or Comorbid BH Condition STD EAP Intervention Lowers Length of

Member Holistically Disease Mgm t Co-Morbid Referrals from Nurse to EAP Clinician Treat Behavioral Conditions Associated with Chronic Diseases PBM Allow EAP to Assess and Engage When Psychotropic

16 CuraLinc Healthcare Driving Value Through Integration Integrate EAP Services Within the Client s Health Mgm t Strategy Address Behavioral Health as Both a Primary and a Comorbid Condition Case Integration, Data Integration, and Marketing Integration UM/CM Immediate Coordination with UM/CM when a Member is Referred to Plan for Acute MH/SA Condition LTD and FMLA EAP Intervention Impacts Psychosocial Condition of Member on Extended Leave Onsite Clinic Leverage Worksite Docs as Referral Resource for Members with Presenting or Comorbid BH Condition STD EAP Intervention Lowers Length of Time Member is on Short-Term Disability Dental Coordinate Referrals to EAP for Members with TMJ (Stress, Anxiety) Wellness Coaching Co-Morbid Referrals Between Health Coach & EAP Clinician Help Treat Member Holistically Disease Mgm t Co-Morbid Referrals from Nurse to EAP Clinician Treat Behavioral Conditions Associated with Chronic Diseases PBM Allow EAP to Assess and Engage When Psychotropic Meds are Prescribed by General Practitioner Health Plan EAPs Can Reduce O/P Claims by Acting as a Parity- Compliant First Stop for All MH/SA Conditions Health Risk Assm t High-Risk Behavioral Cases ID d Through Health Risk Assessments Sent to EAP for Outreach EAP Integration Opportunities 16

17 Results Case Study: Outcomes and Impact Evaluated Assessment and Outcomes Data From Over 1,900 EAP Cases Decreased Absenteeism: 8.8 Fewer Hours per Participant Missed After EAP Participation Increased Productivity: SPS-6 Increase from 23.6 to 26.1 After Using EAP Improved Health and Reduced Acuity for Substance Abuse and Depression Case Study: Financial Impact of Integrated Behavioral Health 30.1% Reduction in MHSA Outpatient Claims (Dollars) 22.9% Reduction in MHSA Claims (Cases) 60.7% Reduction in Out-of-Network MHSA Utilization 17

Results Financial Offset Dashboard Estimates ROI of EAP for

com/dashboard Medical Cost Savings: MHSA Claims Human Capital

Employee Turnover Average ROI of All CuraLinc Clients: 4.

18 Results Financial Offset Dashboard Estimates ROI of EAP for Prospective and Current Clients curalinc.com/dashboard Medical Cost Savings: MHSA Claims Human Capital Cost Savings: Absenteeism, Productivity, Disability Costs, Employee Turnover Average ROI of All CuraLinc Clients: 4.9-to-1 Higher ROI for Clients That Follow Best Practice Recommendations 2015 ROI for All Cypress Clients: 7.4-to-1 18

19 Best Practices 1. Integrate the EAP as a core population health management component. Facilitate case, data, and marketing integration with other programs. Make sure the EAP has a seat at the table when discussing strategies that impact the health and well-being of employees. 2. Leverage promotion, technology, and other benefits providers to connect employees to the EAP. People can t use the EAP if they don t know about it. Make sure the engagement strategy is tailored to suit the cultural profile of the client. 19

20 Best Practices 3. Position the EAP as a Parity-compliant entry point into the MHSA component of the health plan. List the phone number and guidance language on the insurance card. 4. In most cases, choose a 5-session EAP model. 73% of CuraLinc s EAP clients have a 5-session model (100% of Cypress clients). 92% of cases are resolved in this model (77% in a 3-session model). 5. Hold the provider accountable. Accountability is a two-way street, though. The average outpatient MHSA case lasts 6.1 sessions and costs a selffunded plan $

Contact Information Sean Fogarty CuraLinc Healthcare Phone 224.534.2901 Email sfogarty@curalinc.

21 Contact Information Sean Fogarty CuraLinc Healthcare Phone Web Addresses the Need for Behavioral Health in a Population Health Management Strategy Enhances Employee Productivity, Lowers Employee Absenteeism Reduces Unnecessary MHSA Claims and Increases Plan (MHSA) Utilization Efficiency Impacts the Well-Being of Employees with Depression, Anxiety, Relationship Issues 21

Using Innovation to Maximize Behavioral Health Accommodations. Regions Hospital Case Study

Using Innovation to Maximize Behavioral Health Accommodations Regions Hospital Case Study DISCLAIMER The following slides are provided for informational purposes only and do not constitute legal advice.