For Employers and Providers Alike, Mental Health Is All About Integration
Employee mental health initiatives are driving expanded program integration as employers and vendors build on the model developed for employee health and productivity initiatives.
Program integration has become an accepted best practice in the world of employee health and productivity. For example, giving employees one claim intake point and essentially one return-to-work (RTW) process, regardless of the type of claim, is now embraced by many employers. Even if benefits remain in separate silos, these program innovations help reduce disability durations for many employees.
Employers enjoy even greater advantages when integrating or coordinating program silos. Employers have increased leave management efficiency and shortened leave durations by integrating short-term disability (STD) and Family and Medical Leave Act (FMLA) programs. To secure those advantages, 86% of organizations that outsource FMLA management also outsource STD management to the same vendor.1
STD and FMLA are the most frequently integrated benefits, but many benefits or programs are being integrated or coordinated. The Americans with Disabilities Act (ADA) overlaps many benefits, including workers’ compensation (WC). Several benefits require RTW transitional duty work, on a template very similar to an ADA accommodation, making the ADA another integration driver.
As a result, health and productivity initiatives may integrate or coordinate a long list of programs: FMLA/unpaid leave, sick leave, STD, state disability insurance, long-term disability, WC, wellness, ADA management, employee assistance programs (EAP), paid time off, health plans, and now paid parental leave or paid family leave. Nearly all of these benefits must be coordinated closely with an organization’s payroll department and human resources information system (HRIS).
Employee mental health can directly impact utilization of all the benefits above, making it another integration driver. In response, 41% of employers integrate other benefits with the company EAP through outsourcing.1
Integrated absence management professionals know that the design of an organization’s program can create barriers to effectiveness. These program barriers can be compounded by personal psychosocial traits that create built-in personal barriers to accessing mental health services for many individual employees. These traits tend to follow generational patterns. The two largest generations that together represent nearly 70% of the U.S. workforce carry their own significant barriers to access.
- Millennials (now aged 20 to 36 years) despite tolerant attitudes about mental health issues, have a very low rate of scheduling preventive health services — only 7%.2 “According to many sources, institutional-averse Millennials see the entire healthcare system as yet another dysfunctional collusion,” notes Terri Rhodes, DMEC CEO. Because many Millennials avoid healthcare and disability insurance, they have little or no safety net in the event of a mental health episode.
- Baby Boomers (aged 53 to 71 years) are likely to stigmatize mental health issues. To hide their mental health needs, they may avoid treatment, self-medicate with alcohol or drugs, or visit a primary care provider (rather than a mental health specialist) seeking a prescription. These approaches delay effective treatment and make them vulnerable to more significant problems.
Personal barriers to access create difficulties for employees even when they do seek treatment. According to the Cigna white paper, Integrating Behavioral and Medical Health: A More Holistic Approach to Health,3 approximately 80% of people with behavioral needs visit facilities lacking the skills or capacity to address their needs (such as emergency rooms or primary care clinics).4 Although an estimated 70% of primary care provider (PCP) visits are related to psychosocial issues, only 20% to 30% of these patients inform their PCP about their concerns.5
To promote employee mental health, the existing model for integrating or coordinating program silos is not adequate. One important area to enhance is communication and education to reduce the impact of institutional aversion on the part of Millennials and mental health stigma with Boomers. Success in this area helps reduce the internal access barriers in these populations, which supports better and earlier access to mental health services when needed.
Toward this goal, several communication and education tools are appropriate:
- Challenging stigma through positive communications about mental health being like any other disease rather than a moral failing or a “weak personality” and instilling the value of early treatment
- Challenging an aversion to institutions through positive communications about personalized care for every individual, emphasizing the level of control available to patients
- Websites and other private venues where employees can anonymously learn about various mental health conditions, available treatment, costs, and convenient gateways to assistance such as the company EAP
- Mental health champions who publicly acknowledge their own challenges with mental health or addiction, making themselves available to answer questions and encourage co-workers to seek care as needed.
Communications must be backed up by an environment that delivers on promises about privacy, protection of rights, convenience, and the advantages of seeking treatment early. Some examples are:
- Supervisors and managers are trained in supporting employees with mental health needs, including handoffs for FMLA or other leaves, and prepared to engage in the ADA interactive process.
- All privacy protections operate effectively.
- Handoffs from EAP to mental health specialists are efficient, and employees have access to treatment without delays (requiring adequate capacity in the health plan).
Providers must also integrate programs to ensure that people with mental health issues receive appropriate care early and efficiently. Historically, behavioral services focused on cases with obvious needs. Today, we know that those are the tip of the iceberg and that addressing only those cases means late and ineffective intervention for many other cases.
Medical and behavioral conditions have high rates of co-morbidity, particularly with chronic medical conditions such as diabetes.4,5 Rather than treating co-morbid conditions separately and sequentially, a smart care system integrates care to improve patient experience and outcomes. Several tools can help health plans increase integration:4,5
- Ask the health plan to validate that medical providers (particularly PCPs) are trained to screen for behavioral conditions, and provide a first layer of treatment and/or refer to behavioral providers, as appropriate.
- Train behavioral practitioners to identify co-morbid medical conditions and to effectively work in a medical setting.
- Leverage the expertise of behavioral providers, social workers, and health plans to provide training and services (i.e., care management), to enable PCPs, specialists, and other medical practitioners to more effectively treat their patients.
- Embed behavioral providers in primary care settings (and vice versa) to address immediate needs and offer onsite consultations, referrals, and treatment.
The more we know about employee health and productivity, the more we see the value of program integration. Especially when employees are reluctant to pursue early treatment for mental health needs — or any treatment at all — they need a web of connected programs providing a safety net to promote and support their participation.
- 2016 DMEC Employer Leave Management Survey White Paper. Exhibit 5, Outsourced Programs. Retrieved from http://dmec.org/2017/03/02/2016-dmec-leave-management-survey-white-paper/
- Why Americans Are Dropping Out of Healthcare. ZocDoc survey report. June 2015. Retrieved from https://www.zocdoc.com/about/news/new-study-why-americans-are-dropping-out-of-healthcare/
- Cigna. Integrating Behavioral and Medical Health: A More Holistic Approach to Health white paper. Retrieved from https://www.cigna.com/assets/docs/about-cigna/thn-white-papers/behavioral-medical-integration-white-paper.pdf
- Klein S, M Hostetter. In Focus: Integrating Behavioral Health and Primary Care. The Commonwealth Fund. 2014.
- Health Integration in the Era of the Affordable Care Act. Association for Behavioral Health and Wellness. July 2015.