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National Behavioral Consortium

In this comprehensive discussion led by Tom Bjornson, Founder & CEO of Claremont Behavioral Services, we delve into the evolving landscape of Employee Assistance Programs (EAPs). Addressing key objectives, counseling benefits, and productivity tools, this session emphasizes the importance of outcome metrics over traditional process metrics. We explore various versions of EAPs, their value to employees and organizations, and best practices for implementation. Key topics also include case management, crisis response, and strategies for promoting EAP utilization and stakeholder engagement.

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National Behavioral Consortium

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Presentation Transcript

  1. National Behavioral Consortium PRICING STRATEGIES AND VALUE Discussion Leader: Tom Bjornson Founder & CEO, Claremont Behavioral Services January 23 , 2008

  2. What’s an EAP? Objectives? Place at Table? • Counseling Benefit? • Productivity Tool? • Focus on Outcome Metrics vs. Process

  3. Versions of EAP: • Disability Plan Sponsored • Ceridian • Health Plan Sponsored • Blue Cross of California • Aetna • Cigna • Large MBHO • Magellan • Value Options • Regional MBHO • NBC Founders • Agency-based • Family Services • Regional EAP • Chestnut • Claremont • Internal Staff Models • Medical • Human Resources

  4. EAP Best Practices Employees & Family Members Managers, HR, Labor Leaders Promotion, Awareness, and Perceived Value Self Referral Problem Identification and Referral Triggers Disease Management Case Consultations Health Promotion & Wellness Initial Response & Case Handling Coordination EAP Case Management and Advocacy EAP Counseling Life Management Critical Incident As Needed, Behavioral Health Benefits and On-Going Care Case Closure

  5. Best Practices, AA& Legal Compliance Ameliorating employee complaints regarding employment practices like harassment and supervisory methods Benefit Admin. & Disease Management Employee Retention & Turnover Organizational ChangeSupport Minimizing negative employee impacts of mergers, downsizing, acquisitions, major policy changes Identifying depression, stress, anxiety, physical conditions (high blood pressure, back conditions); then managing improvement Focusing on retaining the top 20% of the workforce and managing improvement in the bottom 20% Work Performance Management Absence Management Internal Security & Threat Management Critical Incidents & Trauma Response Execution of progressive discipline programs to address work performance problems; and facilitating a skillful management response DFW & Drug Testing Proactively and routinely identifying and handling employee threats of violence or other disruptive behaviors Responding to traumatic events, co-worker accidents, robberies, natural disasters Addressing causes of time away from work, including issues of co-morbidity; and engaging conditions requiring commitment to change Identifying, treating & managing substance abuse cases to clear outcomes Workers’ Comp & Safety Prevention, early intervention, case-finding & return-to-work support Summary of Internal Referral Triggers Administrative Financial Events Responding to wage garnishments, early access to retirement accounts, tax liens and other financial crises Labor-Management Collaboration Labor contract administration, handling grievances and finding ways to collaboratively resolve work issues and discipline situations

  6. Goals for EAP Relationship • Cost Transparency & Alignment of Motives for Increasing Utilization • Embedding Stakeholder Use of Referral Triggers • Interface – Disease Management, Health Promotion & Behavioral Benefits

  7. Capitation Conflicts with EAP Role • Capitation = Taking risk against program use • Misaligned Motives & Commodity Services • Declining Utilization by At Risk Individuals • Management Services – “Lost in Translation” • Low Expectations & Cynicism = Lack of Internal Support • Cost of Treating vs. Cost of Not Treating

  8. Performance Based Pricing Models • Case Rate: Variability Based on Utilization • e.g. $500 per clinical case and $125 per work life case • Claremont’s Model: Capitated Retainer, plus Fee for Service Counseling Visits • e.g. $1.75 PEPM for all program services, plus $85 per visit actually used - Performance Guarantee: Management Referrals Risk Sharing: Based on Employer Metrics & Outcomes

  9. Claremont’s Performance Rate Rate Comparison with Current EAP Vendor * Claremont’s Utilization Goal Current Vendor’s Rate & Results

  10. Performance Guarantee Performance Guarantee for Management Referrals: Apre-determined number employees will be referred to EAP by management each year. A refund of $400 for each “case” below this guaranteed level will be made, if required: • Number of guaranteed management referrals is generally 1% of the employee population; • Performance Guarantee only available if the group selects Performance Pricing.

  11. Pricing Implications • Basis for Role Change and Market Perception of Value • Market Need & Cost Impacts Well Documented • Different Value Story for Benefits’-Overcome Cynicism & Practices EAP Clinical Outcomes • For what? • How many? • To what outcomes? EAP & Employer Metrics Need for Internal Ownership, Planning & Stakeholder Engagement

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