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Employer Perspectives Related to the Expense of Behavioral Health, and Substance Abuse. Behavioral Screening and Intervention August 25, 2010. Jeff Kluever [email protected]. About Journal Communications. - PowerPoint PPT Presentation
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Employer Perspectives Related to the Expense of Behavioral Health, and Substance Abuse
Behavioral Screening and Intervention
August 25, 2010
Jeff [email protected]
About Journal Communications
2800 employees, 1,000 pre-Medicare and Medicare-eligible participants nationally.
Our strategic plan focuses on providing quality benefits while maintaining shareholder value.
Like other employers, we struggle with managing: Affordable coverage (employer and retiree) The impact of medical inflation on our budget The health status of medical plan participants
JOURNAL OUTCOMES
Impacting Medical Plan Trends
Medical Per Member Per Month (PMPM) increased 8.4% from 2008 – 2009
Medical PMPM decreased 5.8% including high cost claimants from 2009-2010
Medical PMPM decreased 20.6% excluding high cost claimants from 2009-2010
Prevalence of Behavioral Risk Factors
BRFSS, 2008 SAMHSA NSDUH 2006-2007
Our Experience 2006-2009
Pharmacy Inpatient Outpatient Total Paid
2006 $301,456 $ 86,463 $184,245 $572,165
2007 $265,367 $ 73,857 $145,984 $485,208
2008 $247,945 $ 36,781 $136,652 $421,378
2009 $207,843 $ 21,214 $ 64,738 $293,795
Based on Plan Year April 1– March 31
Behavioral Health
Our Experience 2006-2009
Pharmacy Inpatient Outpatient Total Paid
2006 $ 337 $ 3,670 $ 8,684 $12,691
2007 $1,086 $14,571 $16,820 $32,476
2008 $1,285 $16,946 $22,768 $40,999
2009 $ 0 $47,009 $31,910 $78,919
Based on Plan Year April 1– March 31
Substance Abuse
Our Experience
Strategy for all
Offer medical plans requiring engagement;
PCP – coaching opportunity
Living Well – pharmacist coaching
Reduce barriers;
Give participants with chronic diseases tools and support to manage their condition. Increase compliance for disease-specific medications; and
Provide wellness program that gives feedback
Coordination and Support for the Patient
Tools:
1.Employee Assistance Plan – evaluation and referral
2.Medical Benefits – asses, medication and treatment
3.Living Well Program - face-to-face coaching and medication management
4.Wellness Program – telephonic or online support for lifestyle changes
Remove Barrier #1 – Benefit Limitations
Implement behavioral health Parity Removed day/visit limits Remove lifetime limits
Waive the HSA deductible for “preventive prescriptions” as defined by the IRS
Remove Barrier #2 – Lack of Primary Self-Care Provide preventive examinations at 100%
Encourage relationship with PCP Screening and early diagnosis of behavioral health
concerns, tobacco cessation, excessive drinking, and drug use
Tobacco Cessation medications and coaching covered at 100%
Increase reward for members who participate in HumanaBeginnings for early diagnosis of post-partum depression
Health Care Provider Form
13
Remove Barrier #3 – Complexity Integrated EAP (5 visits)
Same network as Medical Plan
Available to all employees, spouses and dependents
PHQ9 administered by health coaches Connect STD and FMLA administration to
Medical Refer patients to Personal Nurse and Disease
Management
Manage co-morbid health conditions
Behavioral health, tobacco use, excessive drinking and drug abuse is costly to the workplace Lost Productivity
Absenteeism Presenteeism Turnover and Training Costs
Co- morbidity with other Diseases Overall Healthcare Costs Disability Worker’s Compensation Expense
Studies Show Treatment Improves Work Performance Nearly 86% of employees treated with
depression with antidepressant medications reported improved work performance.
80% of those treated for mental illness report “high levels of work efficacy and satisfaction.”
Studies prove that treatment of depression results about a 40-60% reduction in absenteeism/presenteeism.
Source: Finkelstein SN et al: Improvement in Subjective Work Performance after Treatment of Chronic Depression: Psychopharmacology Bulletin, Vol 32,1996, pp 33-40. Therapy in America 2004: Poll shows Mental Health Treatment Goes Mainstream. Dunlop, DD Am J Pub Health 2005. Wag, PS am J Psych 2004. Simon, GE Gen Hosp Psych 2000, Claxton, AJ JOEM, 1999. Courtesy of Clare I Miller, Partnership for Workplace Mental Health.
Understanding Co-Morbidity
Implemented Living Well (Base on Asheville Project) Provide members with a personal health coach (from a
network of specially-trained pharmacists); Coordinate with the patient’s physician or other healthcare
providers to help effectively manage their condition: Diabetes High Blood Pressure Cholesterol Asthma Depression
Provide medication and supplies without deductible and reduced copays.
Address Co-morbidity with other diseases Individuals with depression consume two to four times the
healthcare resources of other enrollees. Chronic medical illnesses increase prevalence of major
depression. 45% of people with asthma and 27% of people with diabetes
have co-occurring depression Individuals with depression are twice as likely to develop
CAD, twice as likely to have a stroke and more than four times as likely to die within six months from a myocardial infarction.
Many chronic medical conditions are adversely affected by behavioral health conditions. Co-morbidity increases impairment in functioning and decreases adherence to prescribed regimens.
An employer’s Guide to Behavioral Health Services, National Business Group on Health December 2005. Pincus HA. J Clin Psychiatry. 2001;62 Suppl 6:5-9; Schatzberg AF. J Clin Psychiatry. 2004;65 Suppl 12;3-4. Sederer Li et al: Integrating Care for Medical and Mental Illnesses. Preventing Chronic Disease, April 2006.
Patient Incentives – Living Well Program Face-to-face coaching
Improved reliability via direct observation Interpersonal connection Strengthens the patient-physician relationship
HSA Medical plan deductible waived for preventive RX 100% coverage diabetes medication, test strips and
supplies Reduce copays by 50% for medication
Cholesterol Asthma
Blood Pressure Depression
Free Glucometers & Insulin Pumps
Traditional Interventions are Limited
Employees ride below the radar EAP – most employees with behavioral
health, alcohol and drug disorders do not receive services
Health Risk Assessments (HRA) – provide promotions only to those that self-report an issue or concern.
Supervisors are not trained to recognize the symptoms or do not know how to approach.
The Bottom Line
Behavioral health, excessive drinking, tobacco and drug use is prevalent in working populations and frequently co-morbid with other health conditions.
Treatment works. Face-to-face coaching is cost effective. Primary Care Physicians have the opportunity
to improve effectiveness of care.
Resources - Connections
Center for Health Value Innovation Cyndy Nayer 314-422-4385, [email protected]
LifeSync Grant Lee 469-759-4312, [email protected]
Piedmont Pharmaceutical Care Network Larry S. Long RPh, 336-202-7146, [email protected]
Quality Health Solutions Brian J. Thomas, 888-747-0708 ext 102,
