View
62
Download
0
Category
Preview:
DESCRIPTION
Findings from a 5-year Research Project on Pathways to Treatment for Substance Use Disorders - Implications for EAPs - Keynote Presentation to the MA/RI EAPA Annual Symposium May 13, 2011
Citation preview
1
Findings from a 5-year Research Project on Pathways to Treatment for Substance Use
Disorders: Implications for EAPsPresenters:
Elizabeth L. Merrick, Ph.D., MSWBernie McCann, M.S., CEAP
Brandeis UniversityVanessa Azzone, Ph.D.
Harvard Medical School
Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment (Funded by the National Institute on Drug Abuse P50 DA010233)
MA/RI Chapter of EAPA Symposium 2011Waltham, MAMay 13, 2011
2
Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment
Substance Abuse Treatment Pathways in Employer-Sponsored Programs: Research Team
Brandeis University:Elizabeth L. Merrick, Ph.D., M.S.W. (Project PI)
Constance M. Horgan, Sc.D. (Center PI)Dominic Hodgkin, Ph.D.
Sharon Reif, Ph.D.Bernard McCann, M.S., CEAP
Harvard University:Thomas G. McGuire, Ph.D.
Vanessa Azzone, Ph.D.
MHN:Deirdre Hiatt, Ph.D.
Arlene Darick, LCSW, CEAP
Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment (Funded by the National Institute on Drug Abuse P50 DA010233)
3
Context
Much unmet need for behavioral health assistance, including substance abuse
Workplace = opportunity to intervene Need to understand facilitators, barriers,
patterns and experience of care in contemporary EAP model
EAPs now frequently provided by managed behavioral health care organizations, sometimes in conjunction with managed behavioral health care benefits
4
Subsidiary of HealthNet, Inc. (NYSE: HNT)
Affiliates: 1100 associates; 45,000 network providers; 1400 hospitals and care facilities
850 clients (Employers, Unions, Insurers, etc.)
Provides services to apx. 5.4M individuals in 50 states
Products include: EAP Managed behavioral health care (MBHC) Integrated EAP/MBHC (Both EAP and MBHC benefits;
goal is seamless transition if both are accessed)
5
EAP-Related Research Questions1. How are EAP benefit features related to access, utilization, and costs?
1a. MBHC versus integrated EAP/MBHC products
1b. EAP benefit generosity within integrated product
2. What purchasing choices in EAP design and workplace services do employers make?
3. How are workplace characteristics and program promotion activities related to utilization?
4. How do EAP users learn about EAP services and what do they use EAP for?
6
Study focused on: Comparisons of service use patterns between MBHC and integrated EAP/MBHC products
Sample: 286,750 enrollees, weighted sample, integrated and MBHC only, 2004
Data source: Administrative benefits and enrollee claims data files
Design/analysis: Cross-sectional; logistic regression, weighted for eligibility and demographics
Q1a – How Does Utilization of Any BH Services Vary Within Integrated Versus
MHBC Only Products?
7
Q1a: Integrated vs. MBHC Products: Any Claim
Integrated MBHC Only
Perc
ent o
f Enr
olle
es
Any behavioralhealth claimAny substanceabuse claim
Integrated includes clinical EAP claims. * Differences between products are significant at p < .01
5.7%* 4.8%
0.21%* 0.17%
8
Q1a: Integrated vs. MBHC Products: Any MBHC Claim
Integrated MBHC Only
Perc
ent o
f Enr
olle
es
Any behavioralMBHC healthclaimAny MBHCsubstanceabuse claim
*Differences between products are significant at p < .01
** p<.05
4.6%** 4.8%
0.19% 0.17%
9
Q1a: Integrated vs. MBHC Products: Outpatient Visits
Integrated MBHC
Perc
ent o
f Enr
olle
es
Any outpatientAny clinical EAPAny outpatient MBHC
*p<.01, significant difference between products
4.4%*5.5%*
2.4%
4.6% 4.6%
0.0%
10
Q1a - Implications
Greater proportion of enrollees use any services in integrated product – consistent with increasing access via EAP benefit
The greater proportion of service users in integrated stems from EAP use; proportion using MBHC is slightly lower in integrated – consistent with concept that EAP may help with earlier intervention
Caveats: Some MBHC enrollees may have EAP outside of MHN. We observed and discuss only plan services
11
Study focused on: Whether the EAP session limit affects utilization and cost of outpatient mental health treatment; i.e., number of sessions and total annual spending
Sample: EAP/outpatient service users, in an EAP/MBHC integrated product during 2005 (n = 26,464)
Data source: Administrative and claims data
Design/analysis: Cross-sectional, generalized linear models with log link
Q1b: Does EAP Benefit Limit Affect the Use and Cost of Outpatient BH Care?
12
Gender: Female - 58% Male - 42%
Status: Employee - 49% Spouse/dependent - 51%
EAP session benefit: 3 sessions/year - 31%4-5 sessions/year - 7%3 sessions/incident - 15%4-5 sessions/incident - 46%
Mean # of OP visits: 5.83 (7.86 SD)
Mean OP session payments: $467 ($699 SD)
Q1b: Study Sample
13
0% 50% 100%
4-5 EAPsessions/incident
3 EAPsessions/incident
4 EAP sessions/year
3 EAP sessions/year
17%
12%
7%
*Controlled for: gender, region, age, status, diagnosis & enrollment duration
Q1b: Findings – Use of OP SessionsEffect of EAP benefit on regular OP sessions*
14
0% 50% 100%
4-5 EAPsessions/incident
3 EAPsessions/incident
4 EAP sessions/year
3 EAP sessions/year
15%
17%
3%
*Controlled for: gender, region, age, status, diagnosis & enrollment duration
Q1b: Findings – CostEffect of EAP benefit on regular OP payments*
15
Q1b - Implications
Within an integrated product, increasing a minimal EAP benefit to a more generous level is associated with lower utilization and costs for subsequent non-EAP outpatient sessions
Thus, when an EAP feature is included within an integrated EAP/MBHC benefit, it is not simply an added expense to employers
Users do seem to perceive some differences between EAP sessions and non-EAP outpatient sessions. This suggests that EAP sessions are not merely duplicating outpatient sessions, but are used differently
16
Discussion/Q & A
17
Study focused on: Employer size, industry, organizational type, workplace substance abuse policies, and level of health insurance benefits.
Sample: 103 purchasers each with 1,000+ covered employees, EAP-only product.
Data sources: EAP administrative data, EAP workplace activity data and results from Account Manager questionnaires.
Design/analysis: Cross-sectional; bivariate tests of association
Q2 – What Choices in EAP Design and Worksite Services Do Employers Make?
18
Account Manager Questionnaire – Distributed to MHN Account Managers, this 25 item questionnaire addressed purchasers’ workplace substance abuse policies, drug testing practices, level of unionization, nature/ extent of health coverage, EAP program features, benefits eligibility of workforce, workplace focus on health promotion, level of worksite stress.
Account Activities Database - Number and type of EAP worksite activities; i.e., employee orientations, mental health and wellness presentations, substance abuse prevention and policy presentations, supervisory training, and management consultations.
Data Sources
19
Q2: Employer Choices in EAP Limits
34%
21%
45%3-4 sessions
8+ sessions
5-7 sessions
N = 103 employers
Percent of Employers
20
Q2 - Employer Choices - Findings
84% of employers set limits per issue/incident; 15% per benefit year; 2% no limits.
72% selected a flexible service delivery mode with the option for enrollees of either in-person EAP sessions or telephone counseling.
Employers in the mining, manufacturing, transportation and utilities industries were more likely to provide enrollees with a more generous EAP benefit (higher number of sessions, per concern/incident rather than annual limit).
21
Q2 - Employer Choices - FindingsEAP Worksite Activities & Services:
53% hosted onsite mental health and wellness educational presentations (Average annual hrs per worksite = 8.2)
48% scheduled workplace substance abuse prevention or policy training (Average annual hrs per worksite = 6.9)
37% received advanced training or organizational consultation for management or supervisors (Average annual hrs per worksite = 8)
Non-commercial & not-for-profit employers (i.e., health care, government agencies, public education) had the highest user rate of any worksite activities/services
22
Q2: Implications
Employers do have a number of similarities in preferences when purchasing EAP products; such as number and allotment of “free” sessions, and for modes of delivery, but variations in demand for worksite services do occur – e.g. by industry, organizational type.
Understanding what each particular purchaser’s preferences and its unique workforce needs are valuable in selecting the right menu of program features and services, and thus to maximize its benefit to the organization.
23
Study focused on: Four factors - level of workplace stress; overall level of employer focus on wellness/health; extent of employer EAP/MBHC promotion; level of workplace EAP activities
Sample = 742,937 enrollee (weighted) in EAP-only or integrated product (26 employers), 2005
Data sources: EAP administrative data including claims and eligibility files, results from Account Manager questionnaires, and EAP workplace activity data.
Design/analysis: Cross-sectional; generalized estimating equations
Q3 – How do Organizational and Workplace Factors affect EAP Utilization?
24
0.86**
0.96**
1.09*
1.14*
1Odds Ratio (98% CI) *p<.01; **p<.05
Higher Employer EAP Promotion
Q3 - Organizational Factors andEAP Utilization - Findings
EAP WorksiteActivities
Higher Workplace Stress
Higher Employer Focus on Wellness
When EAP Utilization is linked to Workplace Factors…
0
25
Q3: Implications
Raising program visibility through employer promotion and conducting EAP worksite may be key to increasing utilization.
However, when experiencing major stresses or critical incidents, our finding of an association with lower rates of utilization suggests it may be necessary to increase or better target these outreach efforts and worksite activities to encourage those in need.
26
Discussion/Q & A
27
Study Focus: Facilitators, barriers and experiences with EAP services.
Sample: 361 employee users of EAP-only product who had EAP claim past year and self-reported as an EAP user.
Data Source: Telephone survey of a stratified random sample of employees covered by MHN’s stand-alone EAP, conducted in 2009-10. EAP users were queried regarding beliefs, knowledge and experience with services in past year. Among potential respondents with current available phone numbers, 57% participated in survey.
Design/Analysis: Cross-sectional; descriptive statistics
Q4: What Are Employee User Perspectives on EAPs?
28
18-34 14%
35-44 32%45-54
39%
55+ 15%
Age
Q4: EAP users
N = 361 employee users
Black 6% Asian
5%Other
6%
Race
White82%
Female 56%
Male 44%
Gender
29
Q4: EAP users
Yes 30%
No 70%
*N = 361 employee users **N= 335 employee users
Not employed
7%
Salaried 45%
Hourly 47%
Employment status*
Supervisory role?**
30
Q4: EAP users
Excellent 27%
Very good 42%
Good22%
Fair/Poor 8%
10+ days 11%
1‐5 days 25%
6‐10 days 6%
None 58%
N = 361 employee users
Current smoker?
Yes 12%
No88%
Past yearrisky drinking?
Healthstatus
31
Q4: EAP Users’ Information Sources About the EAP
From employee orientation/ Training session/workshop
13%
33%
38%
58%
77%
71%From employer website
From posters/Flyers/HR communications
From coworker
From Union
From supervisor
N = 361 employee users
32
Q4: EAP Users’ Beliefs About the EAP
Alcohol or drug use
Family & relationship issues
Believes EAP can help with:
Child/elder care & work/life*
Believes EAP is confidential:
Work stress & job performance
Mental health issues
100%
98%
95%
95%
96%
82%
N = 361 Employee users *N = 357 Employee users with W/L benefits
33
Q4: Reasons for Accessing EAP
Family issues/Personal concerns
2%
3%
34%
48%
82%
Mental health/Emotional issues
Job stress/Workplace issues
Alcohol or drug use issues
None of above
N = 361 Employee users
34
Q4: Who Influenced Decision to Use EAP?
14%
5%
25%
56%
Family or Friends
N = 229 users with initial scheduled EAP session
None of these
Healthcare provider
Employer/ Supervisor
35
Q4: EAP Services Users Received
In-person sessions only
86%
78%
74%
24%
50%
24%Telephone only
Telephone & in-person
EAP referred to mental health services
EAP was 1st behavioral health service used
*N = 361 Employee users
Had scheduled EAP session
36
Q4: How Much EAP Helped Users With Concerns
4%
11%
25%60%
Some
N = 228 users with initial scheduled EAP session
Not at all
A lot
A little
37
Q4: Summary Findings
EAP assistance with family/personal and mental health issues is most common, but 1/3 of users reported EAP helped with job stress/workplace issues; indicates EAP provides a workplace-focused benefit to a significant number of users.
Obtaining EAP help for drug/alcohol issues was not frequently reported by enrollees; may be masked.
Employer communications, including via internal website, were a key source of information on EAP benefits.
Most employees who used clinical EAP services reported they helped a lot and were a valued benefit.
38
Q4: Implications
Ensuring that EAP providers are well-versed in addressing job stress and workplace issues remains critical, even in today’s broad-brush, network-based programs.
Enhancing employer communications regarding EAPs is important, since so many employees learn about the EAP and its services in that way.
Focusing on additional ways to identify risky drinking and other substance use disorders is a challenge and an opportunity for EAPs.
39
17%32% 33%
35%36%60%
44% 40%27%
14%
23% 24% 27%38%
50%
0%
20%
40%
60%
80%
100%
Family/Friends SA/MHprofessional
General medprovider
EAP Self-helpsupport group
Not likely Somewhat likely Very likely
SA Treatment Non-Users’ Likely Source of Assistance
N = 133 non-users of SA treatment
40
Limitations of Our Findings
We cannot determine causality from the collected data -- given the various studies’ observational, cross-sectional and non-experimental design.
We cannot generalize our findings to all EAP or behavioral healthcare service users, given that our sample and data came from only one large EAP/MBHO provider.
41
Next Steps
Linking employee survey findings to actual claims data; e.g., how responses of service users relate to service utilization patterns.
Investigating the full range of behavioral health-related services used by clients, both in and out of covered health plan benefits.
43
For more on methods & findings cited:Q1a: Merrick EL, Hodgkin D, Horgan CM, Hiatt D, McCann B, Azzone V, Zolotusky G, Ritter G, Reif S,
and McGuire TG. (2009) Integrated employee assistance program/managed behavioral healthcare benefits: Relationship with access and client characteristics. Administration and Policy in Mental Health 36(6):416-423.
Q1b: Hodgkin D, Merrick EL, Hiatt D, Horgan CM, McGuire T. (2010) The effect of employee assistance plan benefits on the use of outpatient behavioral health care. Journal of Mental Health Policy and Economics. 13(4):167-174.
Q2: McCann B, Azzone V, Merrick EL, Hiatt D, Hodgkin D, Horgan CM. (2010) Employer choices in EAP design and worksite services. Journal of Workplace Behavioral Health. 25(2):89-106.
Q3: Azzone V, McCann B, Merrick EL, Hiatt D, Hodgkin D, Horgan CM. Workplace stress, organizational factors and EAP utilization. Journal of Workplace Behavioral Health 2009; 24(3):344-356. PMC Journal – In Process
Q4: Merrick EL, Hodgkin D, Hiatt D, McCann B, Horgan CM. (2011) EAP service use in a managed behavioral health care organization: From the employee perspective. Journal of Workplace Behavioral Health. [Forthcoming]
MORE INFO: merrick@brandeis.edumccannbag@gmail.comazzone@hcp.med.harvard.edu
Recommended