By Alan Goforth | BenefitsPRO
and implemented employee assistance plans can provide significant benefits to
both workers and employers.
mental health issues often go unreported and unnoticed. The cost to employee
health and employer productivity, however, can be every bit as substantial as
that caused by physical illness.
“When a person is experiencing a
personal issue outside of work, it often spills over into the workplace and
influences other employees’ productivity and morale,” says Bert Alicea,
executive vice president of EAP+Work/Life Services for Health Advocate in
Plymouth Meeting, Pennsylvania. The company offers a range of employee
assistance programs (EAPs) and wellness benefits.
“For example, if an employee is
experiencing substance abuse in their family and needs to make frequent phone
calls during the workday to address the issue, the employees around them may
also feel distracted, stressed or upset by the situation at hand,” he says.
Braswell also sees a link between mental and physical health problems. Braswell
is vice president, business development, for Behavioral Health Systems Inc. in
Birmingham, Alabama, which administers a comprehensive suite of behavioral
programs for employers nationwide.
bears out the correlations between behavioral health issues and attendance,
productivity and safety,” she says. “There is high comorbidity of behavioral
health issues and chronic medical conditions, long recognized by employers as
having an impact on workplace productivity and health care costs. A behavioral
health program that can reduce non-compliance, provide education and actively
engage members impacts not only the success and cost of those services but also
physical health, prescription costs and workers compensation claims.”
show that a well-designed and implemented EAP can provide significant benefits
to both workers and employers, says Rahul Mehra, M.D., CEO and chief physician
executive for the National Center for Performance Health in Tampa.
larger, self-insured employer groups, a robust and responsive EAP can help save
at least 30 percent in mental health claims, reduce emergency visits and reduce
medical and pharmacy claims,” he says.
in the road
leads to an obvious question: If mental health is such a pressing issue and
EAPs are part of the solution, why are they often not as effective as they
could be? Mehra has three general answers:
which is improving but still faces huge hurdles.
of awareness and education, such as health care literacy in mental health.
issues. Only 55 percent of practicing psychiatrists take private health
insurance, which is the lowest number of any physician specialty.
The structure of many EAPs, which are
embedded in medical plans, is another part of the problem, Alicea says. “While
some people with mental health or substance abuse issues may utilize the
service, those with temporary setbacks in life may not reach out for assistance.
The medical benefit may be viewed as something to use only in the instance of a
serious problem. If employees view the service as something that is only
available for issues on the severe end of the spectrum, they may not reach out
in the earlier stages when it is possible to address issues before they
points out that before medical parity, most health plans covered mental health
and substance abuse on a limited basis, often capping exposure at a set dollar
amount for outpatient and number of days for inpatient care.
began to reduce their cost, and competition resulted in very low cost for
services on a capitated, per-employee, per-month fee,” she says. “That also
resulted in little to no promotion or employee communications, limited network
options or services provided by a limited number of providers employed by the
EAP. As a result, they are very underutilized. Some companies felt the
program’s low utilization meant they had no value in the workplace, with no
return on investment from the capitated cost. While some companies continue
with EAPs and accept this as just the way it is, others elected to not provide
good news is that many employers are gaining a better understanding of the
benefits of mental health EAPs.
are beginning to see a shift in employers recognizing the need for behavioral
health services in the workplace beyond a poster with an 800 number,” Braswell
says. “With mental health and substance abuse benefits now on the same
cost-sharing structure as physical health benefits, and with arbitrary limits
removed, employers are recognizing the need to provide services to assist in
earlier problem identification, easy access to quality providers and workplace
support, such as management consultation on problem employees, critical
incident response and development of effective communication campaigns.”
One of the biggest challenges for
brokers and employers is the stigma often attached to engaging mental health
services. Employees who would not think twice about seeing a doctor for an
illness or injury often are reluctant to seek help with depression or a
stressful situation at home. Alicea recommends shifting the focus to temporary
“Position the EAP as an educational
resource with mental health and substance abuse components without focusing
entirely on mental health,” he says. “This can help employees feel more
comfortable reaching out for help by not putting a label on what they may be
as with any other benefit, communication is essential. “EAP utilization is
driven by communications that are relevant and at the point the member is
experiencing difficulty,” Braswell says. “Management acceptance and their
knowledge about EAPs is a major factor in utilization by employees. Supervisors
who are supportive of seeking assistance and know how the process works help
dispel the myth that we shouldn’t need assistance. Normalizing seeking
assistance for personal problems by integrating it in wellness initiatives can
be very helpful.”
should position mental health benefits as part of an overall health and
“It is important to recognize that
mental health issues do not happen in a silo,” Alicea says. “By integrating the
EAP with other services, including advocacy and wellness, it not only makes
managing benefits programs simpler for employers, but it can also help to
identify issues much earlier.
“We’ve found that a large percentage of
referrals to our EAP originate from a medical issue with underlying emotional
concerns. While the member may not have originally reached out for EAP support,
it was still possible to connect them to services that could help them
holistically address the issue at hand.”
can do several things to help their clients maximize their return on a mental
the homework. “Brokers
who have an understanding of the components of the EAP are better able to match
employers to the program that can best meet their needs,” Braswell says. “It’s
helpful for brokers to at least know how account management is handled; who
takes the calls and makes the referrals; how much flexibility exists in plan
design; what the capacity is for training and communication campaigns; if that
is driven by the company or if the EAP works with company personnel to monitor
events that may warrant education; and if utilization trends are considered.
also important to know if the company values the cost savings and flexibility
that come from self-insuring or the budget consistency of a capitated program
that must clearly define what is included in the plan and set a rate that will
cover the cost of delivering all of the services that could be utilized, even
if they are not.”
“If you have 5 percent utilization for EAP services, it is possible to achieve
a 10-to-1 return on investment, which does not take into account services
beyond clinical utilization, including manager consultations, on-site training
and support, and more,” Alicea says. “Look at other aspects of the EAP and not
solely clinical utilization in order to appreciate and understand the true
it specific. “There are
a number of EAP models,” Braswell says, “including assess and refer, where a
treatment plan is developed and the member is referred for the treatment within
their insurance or as private pay; those that allow members to use all sessions
available before referral; those that offer access to a network; those that
allow access only to their employed staff; programs that offer access only to
mental health professionals; those that also include psychologists and
psychiatrists; models that allow access only for non-clinical issues, such as
grief, marital and family but not clinical issues such as eating disorders and
manic depression; as well as variances in communication and training
“We have found that making it easier for people to access EAP resources from
anywhere helps drive utilization,” Alicea says. “Employees want to know that
when they access the EAP, it is confidential and their privacy is protected.
For example, offering videos, self-assessment tools, webinars and more enables
them to get the information they need from the comfort of home or anywhere,
really. This also extends to how employees access live support, including chat
functionality on EAP websites, to protect their privacy and make the experience
visible. Mehra and his
team make a conscious effort to be the face of the EAP.
attend open enrollment meetings, do lunch-and-learns and educate HR staff of
supervisory referrals,” he says. “We also provide responsive on-site crisis
counseling related to traumatic events in the workplace. NCPH also meets with
senior management. A lot of effort is spent in building trust with the
leadership of the organization such that a culture is created that supports
“EAPs can be a valuable partner to HR, managers and employees and dependents they serve if they have a seat at the table and are a visible presence,” Braswell says.
Engaging employees in effective mental health EAPs is simply the right thing to do from a human perspective. It also is a smart choice for employers trying to boost productivity and brokers looking to expand their product portfolios.