Workplace approach reduces depression costs
Corporation saves $1.4 million in first year
Depression costs American businesses millions of dollars in medical costs and lost productivity each year. In 1995, depression cost Pitney Bowes in Stamford, CT, roughly $2.4 million in direct costs and another $2 million in absenteeism and lost productivity. Fortunately, a new strategy for treating depression in the workplace slashed that figure to a little over $1 million, for a net savings of $1.4 million.
"We have an in-house disability management program that works with return-to-work issues. Behavioral health flows into all areas of physical health needs of our employees," says David L. Tucker, MBA, director of health care planning for Pitney Bowes.
Pitney Bowes considered several strategies to reduce its depression-related medical costs, notes Tucker, who recently spoke about his company's experience to managed care executives at the Tenth Annual National Managed Health Care Congress in Atlanta. Some of those strategies included:
o reducing mental health benefits;
o moving to fully capitated plans;
o passing full responsibility for mental health benefits to health plans;
o establishing an integrated model of service delivery.
"We knew that moving to fully capitated plans would limit our control over related issues such as employee interface with the workplace that are essential to keeping people productive," Tucker says. "We thought capitation would restrict our ability to adapt services to meet the needs of our employees. It certainly wasn't in line with our corporate philosophy."
Increasing the employees' benefit
Pitney Bowes developed an internal team to help identify and select a behavioral health plan with a fully integrated employee assistance program (EAP) and behavioral health program. The team selected Integra, a behavioral health company in King of Prussia, PA, on the strength of its unique COMPASS tool that helps measure and monitor employee progress throughout treatment for depression.
In addition, Pitney Bowes increased the employee assistance program (EAP) benefit from three to eight sessions per employee and reduced the employee copayment for mental health benefits. "Employees ended up paying less for treatment. We also inherited an open panel. We invited providers of patients already under treatment into our network, so that employees under treatment didn't have to change their current providers."
Measuring mental health
The COMPASS system uses an assessment tool that recognizes that treatment needs change over time and helps providers and case managers appropriately adjust treatment to meet changing needs, says Patrick F. Donchez, MA, CEAP, vice president of EAP/Integrated Care for Integra. The COMPASS tool measures treatment effectiveness. Integra mails the tool to providersbefore a patient's initial therapy session.
The system provides a questionnaire for the patient to fill out and a separate questionnaire for the provider to complete. Both the provider and patient responses are used to produce a mental health score. The mental health score is a composite of three subscales. Those are:
o well-being assessment;
o current symptoms;
o life functioning.
"We have the benefit of both the provider's view and the patient's view," adds Donchez. (For more on the COMPASS system and samples of system generated reports, see Case Management Advisor, February 1997, pp. 34-38.)
Integra provides 24-hour, 365-day EAP services for Pitney Bowes."The EAP service is answered by master's level counselors. There are no automated attendants, and satisfaction surveys indicate that 90% of all calls are answered by the fourth ring," says Donchez. "There is seamless movement from the employ ee's perspective from the EAP to the managed care benefit. We have a selected provider network. Our counselors refer to providers based on diagnosis. Employees receive appointments for care within 72 hours."
The COMPASS tool measures which providers are most effective for which diagnoses, he adds. "You may have a choice between two therapists. Both are PhD-prepared and credentialed. But their success rates may vary. Therapist A may be quite successful treating patients with anxiety disorders. Therapist B may be more effective with patients suffering from depression. When individuals call us for care, we assess their needs and refer into the network based on clinical data that shows the likelihood of success based on experience with previous patients."
Employees complete the COMPASS tool before, during, and after their treatment. If scores indicate that employees are not progressing, care managers make recommendations for changes in the treatment plan. To ensure employee confidentiality, COMPASS scores stay with Integra, notes Donchez. "The data we present back to Pitney Bowes comes in raw numbers. We provide no identifying information back to the corporation." (For a case study illustrating use of the COMPASS tool, see p. 123.)
[Editor's note: For more information about the COMPASS system, contact: COMPASS Information Services, 1060 First Ave., Suite 410, King of Prussia, PA 19406. Telephone: (610) 992-7060.]
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