Making Life Better: Purchasing Depression Care to Improve Clinical and Work Outcomes

1. Making Life Better: Purchasing Depression Care to Improve Clinical and Work Outcomes Donna Marshall, MBA Kathryn Rost, PhD

2. Overview • Depression in the Workplace • Depression Burden with Usual Care Employee Organization • Reducing Depression Burden to Employees by Purchasing Value Employee Organization

3. Depression in the Workplace Depression is commonin the workforce 7.2% of American employees experience a depressive episode each year

4. More Than Just a Bad Day… Behaviorat Work • negative/irritable • withdrawn • trouble with deadlines • apologizing/shirking • increased mistakes • black humor Clinical Criteria • sad or blue • loss of interest • change in sleep • change in eating • fatigue • self-doubt/guilt • concentration problems • hypo/hyper-activity • self-harm

5. Depression Burden in Usual Care: Employee Depression reduces the individual’s biological, psychological, and social functioning Impairment is so severe that depressed individuals cut back on their usual activities or stay in bed 66.4 days a year.

6. Depression Burden in Usual Care: Organization • Major depression increases absenteeism • Depressed workers report an extra 1.6 days of absenteeism each month • Major depression reduces productivity at work • Depressed workers report 70% of peak productivity

7. BOTTOMLINE Each year depression costs American employers • $36 billion in absenteeism and reduced productivity at work • $27 billion in treatment costs Kessler RC, Akiskal HS, Ames et al. Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. American Journal of Psychiatry, 2006: 163:1561-1568.

8. What’s wrong?

9. Aren’t antidepressant costs rising? Yet….. * 5 of 10 depressed individuals who visit a primary care provider during their episode fail to start any treatment. * 4 of every 10 depressed individuals who start antidepressant medication discontinue taking it before they can realize any clinical benefit.

10. REDUCING DEPRESSION BURDEN PURCHASE VALUE Design health benefits to assure depressed employees receive the treatment shown by research to improve clinical and work outcomes

11. HEALTH BENEFIT 1. Employees complete depression screening each year* 2. Employees who screen positive receive depression management * Some employers identify depressed employees through pharmacy database records

12. Depression Management in the Workforce DMW Care Specially trained nurses confidentially * provide depressed employees education about the disorder and its treatment * systematically monitor employee response to treatment over 24 months * contact PCP to cue treatment change if employee fails to improve or relapses

13. DMW Care: Effects on Remission DMW Care reduces the number of individuals who are depressed by 17.4% on average each year over usual care. Results may vary by employee characteristics, organizational policies and depression management vendor

14. DMW Care: Effects on Impairment DMW Care reduces emotional impairment days by an average of 31.0 days per participant each year over usual care. Results may vary by employee characteristics, organizational policies, and depression management vendor

15. RETURN ON INVESTMENT: EMPLOYEE Organization Pays Additional Dollars to Purchase a New Health Product Employee Receives Additional Clinical Benefit Organization Pays $16 to Purchase DMW Care Depressed Employee Realizes an Additional Day with No Emotional Impairment

16. RETURN ON INVESTMENT: EMPLOYEE 10,000 Employee Transportation Firm Annual reduction in impairment days: 3,627 days Annual cost: $58,500 Annual cost per reduced impairment day: $16 Rost KM, Pyne JM, Dickinson LM, and LoSasso AT (2005). Cost-effectiveness of enhancing primary care depression management on an ongoing basis. Annals of Family Medicine, 3, 7-14.Annals of Family Medicine 3: 7-14, 2005 Results may vary by employee characteristics, organizational policies and depression management vendor

17. DMW Care: Effects on Absenteeism DMW care reduces absenteeism by 6.1 days (28.4%) each year at an annual economic value of $619 per depressed participant. Results may vary by employee characteristics, organizational policies and depression management vendor

18. DMW management improves productivity by 8.2% (18.0 days) each year at an annual economic value of $1982/depressed participant. Results may vary by employee characteristics, organizational policies and depression management vendor DMW Care: Effects on Productivity

19. Return on Investment: Organization Organization Pays Additional Dollars to Purchase a New Product Organization Receives Additional Dollar Value from Product Purchase Organization Pays $1 to Purchase DMW Care Organization Realizes $3 of Additional Work

20. RETURN ON INVESTMENT: ORGANIZATION 10,000 Employee Transportation firm • Annual savings to company: $423,112 • Annual cost to company: $58,500 • Annual return on investment: 3.6:1 Rost KM, Smith JL, and Dickinson LM. The effect of improving primary care depression management on employee absenteeism and productivity: a randomized trial. Medical Care 42: 1202-1210, 2004. Results may vary by employee characteristics, organizational policies and depression management vendor

21. Results potentially vary by…….. • Employee Characteristics willingness to participate • Organizational Policies policies/practices re: missed work • Vendor Selected provision of key components of care participation rates cost

22. Vendor Selection • “Close counts only in horseshoes and hand grenades” • DMW Care – Key Components • PCP Education • Protocolized education • Short-term monitoring • Long-term monitoring* • Protocolized PCP contact if employee • fails to improve or relapses

23. VENDOR CHOICES Vendor Types: • Health Plans • Disease Management Firms • Managed Behavioral Health Organizations • Employee Assistance Programs • Pharmaceutical Benefit Managers

24. TECHNICAL ASSISTANCE What is Technical Assistance? Unbiased and experienced health benefits consultant willing to consult over the next 24 months with companies interested in purchasing depression management What’s the cost? Free to study participants What’s the goal? To aid companies interested in depression management to develop/monitor performance management standards to assure they get the product they pay for

25. “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, that is the only thing that ever has.” Margaret Mead

26. CALCUATING VALUE IN YOUR ORGANIZATION • THE EMPLOYER CALCULATOR • Input: • Workforce size and industry • Policies/practices regarding missed work • Output: • Reduction in impairment/lost work days with DMW Care • Annual cost of DMW Care • Return on investment to employee and organization