Integrating a comprehensive behavioral health plan into the medical health plan your company sponsors is a win-win. Employees are able to improve their health mentally and physically, and the employer can track cost savings related to direct health care costs and indirect costs through more productive, healthy employees.
“One out of every four adults will experience a mental health disorder in a given year,” says Tom Albert, manager, Behavioral Health Services at HealthLink. “I think few people, in general, realize the rates are that high.”
Smart Business spoke with Albert about how integrating behavioral and medical health allows employers to better coordinate their members’ care.
How do behavioral and medical health impact employers?
The rate of one in four adults experiencing a mental health disorder annually goes even higher for those with chronic medical problems. Furthermore, employees with untreated psychiatric or substance use disorders can be at a higher risk of on-the-job injuries. This can lead to missed time from work, expensive treatment and a decrease in quality of life for the individual.
Absenteeism is not the only concern for employers. Presenteeism, or the loss in productivity of employees who come to work sick, can also be costly for employers. The Institute for Health and Productivity Studies at Cornell University found that depression and other mental health problems are among the illnesses that have the most significant decrease to productivity.
What’s the advantage of integrating behavioral and medical health management?
Ninety-three percent of Americans believe a health care plan should cover behavioral health treatment, according to a National Association of Psychiatric Health Systems survey. Some workplaces don’t cover behavioral health. Other employer groups cover it but carve out the management, which makes it difficult to coordinate care.
Having one organization manage both medical and behavioral health benefits is gaining popularity among employers. With integration, the health plan’s medical and behavioral clinicians collaborate and ensure that individuals and their families have access to care that best meets their needs.
What are the overall goals of utilization and case management for behavioral health?
Utilization management ensures that health plan members have access to the care they need; that care is delivered in the right setting; that the quality of care meets high standards; and that resources are used efficiently in order to help control costs.
Case management involves case managers communicating directly with members and their families to assist them in navigating the health care system; addressing any obstacles to accessing treatment; and empowering members and their families to maintain an optimal level of health and functioning.
Case management helps the member to stay well so he or she doesn’t have to keep using the same services and missing work.
What is the Mental Health Parity Act?
The Mental Health Parity and Addiction Equity Act of 2008 doesn’t mandate that employers of 50 or more employees offer behavioral health coverage, but it does require that if the health plan covers behavioral health services, the financial requirements and treatment limitations are no more restrictive than medical and surgical benefits.
Prior to parity, employer groups often relied on treatment limits to control costs by limiting the number of days in a hospital or the number of visits for outpatient mental health treatment. Parity is good because the limits often were arbitrary, but it does mean the best way to control costs is to ensure care is only approved when medically necessary.
What are the results of formalized behavioral health management and review?
A Milliman case study of a large private manufacturer found a 10 percent reduction in members with chronic medical and psychological conditions saved $1 million annually and another $750,000 from reduced absenteeism, fewer and shorter disabilities, and increased productivity. An effective behavioral health management organization ensures members receive the right treatment in the least restrictive setting, which reduces costs and time missed from work, while improving overall health.
Tom Albert is manager, Behavioral Health Services, at HealthLink. Reach him at (314) 923-6288 or Thomas.Albert@wellpoint.com.
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Most consumers don’t think of mental health as separate from physical health; when they don’t feel well, they simply want to take steps to feel better.
Now, due to ongoing legislation and changes in thinking, more providers and employers are beginning to view mental health as being on a continuum of medical care, not as something separate, says Peter Ambrose Jr., Ph.D., M.B.A., regional vice president — Behavioral Health Operations at HealthLink®.
“When the behavioral heath care benefit is integrated with the medical benefit, it benefits the consumer,” says Ambrose. “They are two sides of the same coin, and integrating them allows health care consumers to see the appropriate providers and do everything they can to improve their health both physically and mentally.”
Smart Business spoke with Ambrose about how offering a behavioral health benefit can improve both productivity and your company’s bottom line.
How does a behavioral health component of health care coverage benefit both members and the employer?
For an employer, the advantage to having an integrated benefit is that, if employees don’t receive the appropriate treatment for mental health or substance abuse issues, they are likely to experience higher medical claims, poor productivity, increased absenteeism, short- and long-term disability claims and FMLA claims. All of a sudden, you are facing myriad productivity and financial ramifications due to poor access to specialized providers.
If you own a business in which, for example, you have someone on a ladder every day and that person has a substance abuse issue, and is not getting treated properly because the benefit isn’t good enough, the odds are good that that person is going to fall off the ladder eventually. That is a worksite liability for you as an employer, as well as a health care issue.
What would you say to an employer who says the company can’t afford to cover behavioral health issues?
Practically speaking, you can’t exclude behavioral health conditions, because the cost is going to show up somewhere in the total medical cost of care. Depressed employees will go to a primary care physician and say they are upset, are depressed or are anxious. Even if your plan excludes adequate behavioral health benefits, the employee will be treated for anxiety or depression but may not necessarily be treated correctly.
Mental health patients don’t just go away; they still show up elsewhere in the medical system. If employees have substance abuse problems, they’ll show up in neurology, in primary care or in emergency rooms. The result is that people with specific conditions are being forced to see professionals who are not specialists in the area in which they need help. As an employer, you’re still paying for it, but it’s not being addressed correctly.
Think of depression as an ‘emotional flu.’ If you have diabetes and you have to watch your diet, take insulin and exercise three times a week, but you feel like you have the flu, you’re not going to exercise as much as you should. Depression saps your energy and mitigates thinking patterns, which, as a result, can have an adverse impact on the physical problem.
Mental health represents 3 to 5 percent of premium coverage in terms of cost to the employer. The bang for your buck, however, far exceeds that. Studies show that if someone has a medical condition that costs them $1 over the course of a year, if the exact same person also has bipolar illness, that person will spend $1.25 to $1.30 per year on the exact same illness, excluding psychiatric care costs. The bipolar illness impacts compliance that results in poor health and increased costs.
As an employer, if you don’t help employees take care of behavioral health issues, it’s going to impact everything else that goes on with that person. When the employee really needs it, you’re not giving that person the expertise he or she requires and you’re going to pay dearly covering other issues that result.
How can employers encourage employees to overcome the stigma of behavioral health issues and get the help they need?
Although the stigma is not what it used to be, it still exists. You have to educate people that regardless of their health condition, if they are in pain, it makes sense to treat it and, more important, if you are going to go out of your way to get it treated, go to the right professional to get it treated correctly.
The majority of all antidepressants are prescribed by primary care doctors. A large portion of those are given inappropriately, either for too short a period of time or in too low a dosage. If that’s the case, the patient is taking a drug but not getting the benefit he or she needs. You wouldn’t go to a podiatrist if you have a toothache, so if someone has a mental illness or a substance abuse problem, you want that person to go to a psychiatrist, psychologist, social worker or other mental health professional.
How can an employer get started implementing a plan that integrates behavioral health with medical health?
Oftentimes, employers have concerns but don’t know who to talk to. When it comes to behavioral health, call your account representative and say, ‘I don’t even know the right question to ask, but I want to talk about how to improve our medical benefits.’
Under health care reform, the rules are not clear, and many employers don’t understand what they can and can’t do. They are worried about liability, both financial and legal. And sometimes they suffer from paralysis, either from too much or too little information.
But you have to treat it like any other business decision. Health care costs are eating at the bottom line and you have to address them. You can no longer ignore them because doing so will affect your ability to add employees and diversify your company.
Peter Ambrose Jr., Ph.D., M.B.A, is regional vice president — Behavioral Health Operations at HealthLink. Reach him at (314) 923-8325 or Peter.Ambrose@wellpoint.com.