Findings from a 5-year Research Project on Pathways to Treatment for Substance Use     Disorders: Implications for EAPs   ...
Brandeis/Harvard Center on Managed Care        and Drug Abuse Treatment  Substance Abuse Treatment Pathways inEmployer-Spo...
Context Much unmet need for behavioral health  assistance, including substance abuse Workplace = opportunity to interven...
 Subsidiary of HealthNet, Inc. (NYSE: HNT) Affiliates: 1100 associates; 45,000 network providers; 1400  hospitals and ca...
EAP-Related Research Questions1. How are EAP benefit features related to access,utilization, and costs?  1a. MBHC versus i...
Q1a – How Does Utilization of Any BH Services Vary Within Integrated Versus         MHBC Only Products? Study focused on:...
Q1a: Integrated vs. MBHC Products:                                    Any Claim                              5.7%         ...
Q1a: Integrated vs. MBHC Products:                                Any MBHC Claim                        4.6%**            ...
Q1a: Integrated vs. MBHC Products:          Outpatient Visits                       5.5%*                                 ...
Q1a - Implications Greater proportion of enrollees use any services in  integrated product – consistent with increasing  ...
Q1b: Does EAP Benefit Limit Affect the  Use and Cost of Outpatient BH Care? Study focused on: Whether the EAP session   l...
Q1b: Study SampleGender: Female - 58% Male - 42%Status: Employee - 49% Spouse/dependent - 51%EAP session benefit:  3 sessi...
Q1b: Findings – Use of OP Sessions  Effect of EAP benefit on regular OP sessions* 3 EAP sessions/year 4 EAP sessions/year ...
Q1b: Findings – Cost  Effect of EAP benefit on regular OP payments*3 EAP sessions/year4 EAP sessions/year                 ...
Q1b - Implications Within an integrated product, increasing a minimal  EAP benefit to a more generous level is associated...
Discussion/Q & A                   16
Q2 – What Choices in EAP Design andWorksite Services Do Employers Make? Study focused on: Employer size, industry,  organ...
Data SourcesAccount Manager Questionnaire – Distributed to  MHN Account Managers, this 25 item questionnaire  addressed pu...
Q2: Employer Choices in EAP Limits          Percent of Employers  34%                                          45%      3-...
Q2 - Employer Choices - Findings 84% of employers set limits per issue/incident;  15% per benefit year; 2% no limits. 72...
Q2 - Employer Choices - Findings          EAP Worksite Activities & Services: 53% hosted onsite mental health and wellnes...
Q2: Implications Employers do have a number of similarities in   preferences when purchasing EAP products; such   as numb...
Q3 – How do Organizational andWorkplace Factors affect EAP Utilization? Study focused on: Four factors - level of   workp...
Q3 - Organizational Factors and      EAP Utilization - Findings When EAP Utilization is linked to Workplace Factors… Highe...
Q3: Implications Raising program visibility through employer  promotion and conducting EAP worksite  may be key to increa...
Discussion/Q & A                   26
Q4: What Are Employee User         Perspectives on EAPs? Study Focus: Facilitators, barriers and experiences with  EAP se...
Q4: EAP users                                                    Black                                                    ...
Q4: EAP users               Employment                           Supervisory                 status*                      ...
Q4: EAP users            Fair/Poor Health          8%                 Past yearstatus                          risky drink...
Q4: EAP Users’ Information Sources About the EAP  From posters/Flyers/HR  communications                                  ...
Q4: EAP Users’ Beliefs About the EAP   Believes EAP can help with:   Family & relationship issues                         ...
Q4: Reasons for Accessing EAP    Family issues/                                                          82%Personal conce...
Q4: Who Influenced Decision to Use EAP?                 Employer/                 Supervisor    Healthcare            14% ...
Q4: EAP Services Users ReceivedIn-person sessions only                50%       Telephone only            24%Telephone & i...
Q4: How Much EAP Helped Users With Concerns                    Not at all                        4%                 11%   ...
Q4: Summary Findings EAP assistance with family/personal and mental  health issues is most common, but 1/3 of users  repo...
Q4: Implications Ensuring that EAP providers are well-versed in   addressing job stress and workplace issues   remains cr...
SA Treatment Non-Users’ Likely       Source of Assistance100%           23%             24%             27%80%            ...
Limitations of Our Findings We cannot determine causality from the  collected data -- given the various studies’  observa...
Next Steps Linking employee survey findings to   actual claims data; e.g., how responses   of service users relate to ser...
For more on methods & findings cited:Q1a: Merrick EL, Hodgkin D, Horgan CM, Hiatt D, McCann B, Azzone V, Zolotusky G, Ritt...
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Findings from a 5-yr Research Project on Pathways to Treatment for Substance Use Disorders

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Keynote Address: MA & RI Chapter of EAPA May, 2011

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Findings from a 5-yr Research Project on Pathways to Treatment for Substance Use Disorders

  1. 1. Findings from a 5-year Research Project on Pathways to Treatment for Substance Use Disorders: Implications for EAPs Presenters: Elizabeth L. Merrick, Ph.D., MSW Bernie McCann, M.S., CEAP Brandeis University Vanessa Azzone, Ph.D. Harvard Medical School MA/RI Chapter of EAPA Symposium 2011 Waltham, MA May 13, 2011Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment (Funded by the National Institute on Drug Abuse P50 DA010233) 1
  2. 2. Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment Substance Abuse Treatment Pathways inEmployer-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) 2
  3. 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 3
  4. 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) 4
  5. 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 product2. 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? 5
  6. 6. Q1a – How Does Utilization of Any BH Services Vary Within Integrated Versus MHBC Only Products? 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 6
  7. 7. Q1a: Integrated vs. MBHC Products: Any Claim 5.7% * 4.8%Percent of Enrollees Any behavioral health claim Any substance abuse claim 0.21%* 0.17% Integrated MBHC Only Integrated includes clinical EAP claims. * Differences between products are significant at p < .01 7
  8. 8. Q1a: Integrated vs. MBHC Products: Any MBHC Claim 4.6%** 4.8%Percent of Enrollees Any behavioral MBHC health claim Any MBHC substance abuse claim 0.19% 0.17% Integrated MBHC Only *Differences between products are significant at p < .01 ** p<.05 8
  9. 9. Q1a: Integrated vs. MBHC Products: Outpatient Visits 5.5%* 4.6% 4.6%Percent of Enrollees 4.4%* 2.4% 0.0% Integrated MBHC Any outpatient Any clinical EAP Any outpatient MBHC *p<.01, significant difference between products 9
  10. 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 10
  11. 11. Q1b: Does EAP Benefit Limit Affect the Use and Cost of Outpatient BH Care? 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 11
  12. 12. Q1b: Study SampleGender: 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) 12
  13. 13. Q1b: Findings – Use of OP Sessions Effect of EAP benefit on regular OP sessions* 3 EAP sessions/year 4 EAP sessions/year 7% 3 EAP sessions/incident 12% 4-5 EAP sessions/incident 17% 0% 50% 100% *Controlled for: gender, region, age, status, diagnosis & enrollment duration 13
  14. 14. Q1b: Findings – Cost Effect of EAP benefit on regular OP payments*3 EAP sessions/year4 EAP sessions/year 3% 3 EAP sessions/incident 17% 4-5 EAP sessions/incident 15% 0% 50% 100% *Controlled for: gender, region, age, status, diagnosis & enrollment duration 14
  15. 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 15
  16. 16. Discussion/Q & A 16
  17. 17. Q2 – What Choices in EAP Design andWorksite Services Do Employers Make? 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 17
  18. 18. Data SourcesAccount 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. 18
  19. 19. Q2: Employer Choices in EAP Limits Percent of Employers 34% 45% 3-4 sessions 5-7 sessions 8+ sessions 21% N = 103 employers 19
  20. 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). 20
  21. 21. Q2 - Employer Choices - Findings EAP 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 21
  22. 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. 22
  23. 23. Q3 – How do Organizational andWorkplace Factors affect EAP Utilization? 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 23
  24. 24. Q3 - Organizational Factors and EAP Utilization - Findings When EAP Utilization is linked to Workplace Factors… Higher Employer 1.14* EAP Promotion EAP Worksite 1.09* Activities Higher 0.96** Workplace StressHigher EmployerFocus on Wellness 0.86** 0 1 Odds Ratio (98% CI) *p<.01; **p<.05 24
  25. 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. 25
  26. 26. Discussion/Q & A 26
  27. 27. Q4: What Are Employee User Perspectives on EAPs? 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 27
  28. 28. Q4: EAP users Black 6% AsianGender 5% Race Other 6% Male  Female  56% 44% White 82% 55+ 18-34 15% 14% Age 45-54 35-44 39% 32% N = 361 employee users 28
  29. 29. Q4: EAP users Employment Supervisory status* role?** Salaried  Yes  45% 30% Not  No  Hourly employed  47% 70% 7% *N = 361 employee users **N= 335 employee users 29
  30. 30. Q4: EAP users Fair/Poor Health 8% Past yearstatus risky drinking? 10+ days  11% Good Excellent  22% 27% None  1‐5 days  58% 25% Very good  42% 6‐10 days  6% Yes 12% Current smoker? No 88%N = 361 employee users 30
  31. 31. Q4: EAP Users’ Information Sources About the EAP From posters/Flyers/HR communications 77% From employer website 71%From employee orientation/ 58%Training session/workshop From supervisor 38% From coworker 33% From Union 13% N = 361 employee users 31
  32. 32. Q4: EAP Users’ Beliefs About the EAP Believes EAP can help with: Family & relationship issues 100% Mental health issues 98% Alcohol or drug use 95% Work stress & job performance 95% Child/elder care & work/life* 82%Believes EAP is confidential: 96% N = 361 Employee users *N = 357 Employee users with W/L benefits 32
  33. 33. Q4: Reasons for Accessing EAP Family issues/ 82%Personal concerns Mental health/ 48% Emotional issues Job stress/ 34%Workplace issues Alcohol or drug 3% use issues None of above 2% N = 361 Employee users 33
  34. 34. Q4: Who Influenced Decision to Use EAP? Employer/ Supervisor Healthcare 14% provider 5% 56% None of 25% these Family or Friends N = 229 users with initial scheduled EAP session 34
  35. 35. Q4: EAP Services Users ReceivedIn-person sessions only 50% Telephone only 24%Telephone & in-person 24%Had scheduled EAP 74%sessionEAP referred to mentalhealth services 78%EAP was 1st behavioralhealth service used 86% *N = 361 Employee users 35
  36. 36. Q4: How Much EAP Helped Users With Concerns Not at all 4% 11% A little 60% 25% A lot Some N = 228 users with initial scheduled EAP session 36
  37. 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. 37
  38. 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. 38
  39. 39. SA Treatment Non-Users’ Likely Source of Assistance100% 23% 24% 27%80% 38% 50% 17%60% 32% 33%40% 35% 60% 36%20% 44% 40% 27% 14% 0% Family/Friends SA/MH General med EAP Self-help professional provider support group Not likely Somewhat likely Very likely N = 133 non-users of SA treatment 39
  40. 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. 40
  41. 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. 41
  42. 42. 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 ProcessQ4: 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.edu mccannbag@gmail.com azzone@hcp.med.harvard.edu 43

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