Shifting market forces, a challenging economy and the needs of a constantly changing workforce have broadened the scope and depth of employee assistance programs over the last several years.

The days of an EAP being a benign benefit that sits in the corner and waits for utilization are over. Today, companies are aware that the advantages of an EAP that extend well beyond assistance for alcohol-related problems.

An effective EAP should be a core component of a company's population health management strategy. By capitalizing on integration with an organization's other employee benefits, an EAP can have a positive impact on a company's productivity, efficiency, well-being and health care spend.

The Employee Assistance Workgroup, created in 2007 by the National Business Group on Health, contends that EAPs represent the first-line response to providing prevention, triage and short-term problem resolution services within an organization.

It cites a 2007 Mercer/Marsh study ("Survey of Health, Productivity, and Absence Management Programs, 2007") which found that EAPs that are aligned with a company's overall health and productivity strategy can perform a critical role in identifying individual and organizational risk factors that may decrease performance. To that end, how an organization uses an EAP depends on a variety of factors related to the size and diversity of its employee population.

Differentiation

In order to understand the application of an EAP, it's important to highlight the different types of programs. Not all EAPs are alike and, in truth, many don't address the basic "core technologies" of the employee assistance profession, which are the seven essential components of EAPs as specified by the Employee Assistance Professionals Association.

In order to appreciate the value of EAPs, it's important to have a clear understanding of the three basic types of programs.

* Affinity-style EAPs: "Throw-in" EAPs, such as those offered in conjunction with a disability insurance provider, are no- or low-cost programs intended to convince organizations to purchase the seller's core product.

However, although the disability provider may be marketing the EAP, there is no case-level integration between the EAP and the LTD/STD product. The provider does not arm employers with the strategy, tools or reporting necessary to identify patterns within the workplace or drive awareness of the program.

Core EAP components, such as management consultation, corporate training and crisis intervention services, are rarely made available to client organizations. While affinity-style programs allow companies to offer an EAP at no cost to the organization, the low awareness and usage brings to mind the adage, "You get what you pay for."

* Plan-based EAPs: On the surface, EAPs that are provided through an organization's medical plan often have a framework similar to a stand-alone program. These EAPs offer a wide array of short-term counseling and work-life benefits, along with options for corporate training and crisis intervention services.

However, unlike a stand-alone program, where the resources of the organization are dedicated to the administration of the EAP, resources within a medical plan rarely trickle down to the EAP level.

Although the EAP may carry the same brand as the medical plan, the program is seldom integrated at either a data- or case-management level with the plan's other components. Additionally, most programs don't offer an experienced account manager who is dedicated exclusively to the EAP.

* Stand-alone EAPs: The goal of a stand-alone EAP is to provide client organizations with a benefit whose focus is on organizational and member productivity. Like plan-based EAPs, these programs offer a wide array of behavioral health counseling and work-life services.

However, stand-alone programs also provide consulting services to managers regarding employee performance, serve as behavioral consultants to organizational leaders during times of crisis, and play a key role in organizational development through corporate training.

Most importantly, one of the true differentiators of most stand-alone EAPs is a willingness to integrate the benefit with other components of a client's population health management strategy.

Integration

With an eye on prevention, the goal of most population health management strategies is to engage all employees in some aspect of lifestyle or behavior modification, care management or health maintenance to help them live healthier lives.

Because the majority of health care costs stem from problems caused by poor lifestyle choices, employers constantly refine their PHM strategy to address these behaviors. However, the one component that focuses most on behavior change, the EAP, is usually left out of the conversation.

By including an EAP in its PHM initiative, an organization can achieve lower health care costs, disability expenses, and worker's compensation costs, as well as the indirect benefits of decreased absenteeism, enhanced motivation, and increased productivity.

Pharmacy integration

In 2007, U.S. adults spent more money on antidepressants and other psychotropic drugs than any other drug category. Five out of six users of psychotropic medications are under the care of a general practitioner (Medco, 2008).

Unfortunately, the majority of these physicians are not adequately trained to practice behavioral health; many have no formal training beyond the material marketed with the medication.

Often, the end result is a quality-of-care issue, such as misdiagnosis, over-treatment, or under-treatment. According to the National Alliance on Mental Illness, "There appears to be a serious lack of clinical protocols guiding non-psychiatrists who are authorized to prescribe psychiatric medications regarding when to seek psychiatric supervision."

Most general practitioners are also not able to recognize dependency-related issues associated with the use of these types of medications. These issues lead to higher utilization of emergency room and doctor's visits, which ultimately increases the cost of health care premiums.

Many of these costs can be averted by properly diagnosing and treating individuals who have mental health-related issues. An EAP-based pharmacy intervention program will address most of the aforementioned problems associated with the prescription of psychotropic medication by working with the individual and, if appropriate, the physician to build a course of action that is appropriate for the member's condition.

Disability integration

According to the National Institute of Mental Health, about half of the individuals who filed disability claims in the U.S. also had a mental health-related issue. Annually, disability claims cost employers over $300 billion.

In some cases, the psychological and life-altering effect of an employee having a severe medical condition can prolong the time the employee is out on disability. In other cases, it was observed that while some employees were able to return to work, they tended to have higher recurrence of returning to disability because of further complications.

By linking disability benefits to an EAP, an employer can reduce an employee's time out on disability and minimize the likelihood of that employee going on disability again.

The resources available through an EAP can help employees deal with their conditions, which makes them more likely to follow through with their medical treatment. An EAP can also help both the employee and the employer manage an effective transition back to the workplace when the time comes.

Health and wellness integration

Wellness is a behavioral condition, not a physical one. It's an active process that begins with a conscious decision to make positive choices in creating and maintaining a healthy lifestyle. Many companies are incorporating wellness components, such as health coaching and disease management programs, into their PHM strategies in an effort to curb escalating health care rates.

These programs educate employee on healthy lifestyle behaviors and motivate them to get healthy. But where many of these programs fall short is in failing to adequately address the root behavioral cause of these physical issues.

An EAP can be integrated with a company's health coaching or disease management program as a resource for referring members with co-morbid behavioral conditions and addressing the root causes of their health problems.

An EAP can also be integrated with a health risk assessment. By intervening immediately after the completion of an HRA, an EAP can have a positive impact on organizational productivity by referring members with anxiety or depression to the most appropriate resource for their individual condition.

According to a 2007 Meritain Health analysis of HRA responses, 12.8% of HRA test-takers suffered from anxiety, depression or physical conditions related to anxiety and depression - which led to a projected productivity loss of 1.67 work days per employee.

Mental health parity rules

The Mental Health Parity and Addiction Equity Act of 2008 mandates equity between mental health and substance abuse benefits and medical or surgical benefits for group health plans with more than 50 employees.

The law requires parity in treatment limitations, such as frequency of treatment, number of visits or days of coverage, between mental health/substance abuse benefits and medical or surgical benefits.

Employers may, however, still use a number of techniques to manage the delivery of mental health/substance abuse benefits in order to control costs and ensure that participants receive effective treatment.

Over 90% of employer-sponsored health plans include coverage for MH/SA services, according to the Employee Assistance Professionals Association. Should these employers and plans opt to maintain their mental health and substance abuse benefits, an EAP that is integrated with some or all of the available managed behavioral health components can enhance the value of the program.

What does the future hold?

In order for the value of EAPs to be maximized in the future, the benefit will need to be seen as an important resource for boosting efficiency and productivity.

For many employers, the stigma associated with an EAP - both from the company's employees and plan sponsors - prohibits the program from maximizing its value. Employers must understand that marketing the full scope of EAP benefits and promoting the preventive nature of the program will reduce this stigma.

As employees begin to realize that the EAP is a confidential resource to help them address challenges in their lives, awareness and acceptance will increase, and the value of the benefit will rise accordingly.

When implemented and delivered effectively, EAPs can have a positive impact on every member in an organization. Today, EAPs are among the best kept secrets in health benefits. However, as time goes on, more organizations are counting on their EAPs to affect organizational costs and productivity.

Still, according to Helen Darling, president of the Washington Business Group on Health, acceptance of employee assistance programs has not yet reached critical mass.

"As we seek new ways to improve outcomes, increase productivity and enhance the quality of life from our enormous investment in health care, I believe employee assistance programs and services will be a the front of the line of effective solutions to the health care cost crisis. EAPs play a major role in reducing health care expenses and could provide even more benefits if their services were better known and understood, she notes.

The EAP value proposition

Generally, EAPs provide value in three ways:

EAPs leverage the value of the organization's investment in its workforce by:

* Encouraging employee engagement

* Improving abilities of employees and dependents to successfully respond to life's challenges

* Offering employees short-term problem-resolution services or referring employees and dependents to mental health treatment services when indicated

* Developing employee and manager competencies in managing workplace stress and improving work team performance

EAPs address the costs of doing business by:

* Reducing workplace absenteeism and unplanned absences

* Decreasing workplace accidents* Lowering employee turnover and related replacement costs

* Facilitating safe, timely and effective return-to-work for employees after short-term and extended absences* Reducing health care costs

* Improving the value of organizational investments in wellness and health promotion, self-care management, continuity of care and work-related efforts

* Increasing efficient use of health care through early identification, care management and recovery efforts

EAPs mitigate business risks by:

* Reducing the likelihood of workplace violence and other safety risks

* Managing the effect of such disruptive incidents as workplace violence, injury or other crises and facilitating a swift return-to-work after adverse workplace events

* Supporting disaster and emergency preparedness and minimizing disruption after such events

* Smoothing the adjustment to mergers, acquisitions, site closures or other workforce change events

* Reducing the likelihood of legal action or liability

* Promoting and supporting drug- and alcohol-free workplace policies and programs

PODCAST: Attorney Cheryl Risley Hughes explains how to ensure compliance with the mental health parity act regulations now in effect. Go to eba.benefitnews.com/podcasts.