The question of what to do with employee assistance programs or EAP when Parity legislation drastically expands behavioral health coverage is not new. We have been dealing with this question for more than a decade. The questions take on several different flavors:
- Is it true that mental health and substance abuse coverage will be so enhanced that employers who are concerned about costs will consider terminating their EAP? Yes. That’s already begun to happen.
- Is it true that many EAPs are already a function of the managed behavioral health organization (MBHO) carve-out tasked with managing Parity implementation and coverage? Yes. All of the largest MBHOs covering well over 100 million lives also provide or are capable of providing EAP services. Most of them were EAPs long before they were MBHOs.
- Is there a reason to keep EAP services in place after Parity takes effect? This author believes the answer is “yes” however, some people will think “it depends” is a better answer.
It Depends
First of all, the question of whether or not to keep an EAP in place or to expand its role misses an important point: EAP and mental benefits exist for different purposes. They are different forms of coverage serving different functions. To say that the EAP is expendable because behavioral health coverage is expanding fails to recognize that EAP typically provides services that fall far outside that coverage and meet important workplace needs:
- EAP provides counseling services for a wide range of issues. One of the most important functions an EAP serves is too address workplace issues that are not diagnosis related. These are situational concerns involving conflict, poor performance, family concerns (such as the burden of elder care), and early intervention where other behavioral health needs are concerned.
- EAP is not just a service for employees. The workplace or employer avails themselves of very important services as well. EAP professionals provide Critical Incident Debriefing services; HR support in difficult situations; executive consulting and coaching; training in everything from dealing with team dynamics to confronting addiction; employee communications including newsletters, web sites and presentations; and the staple service of Assess & Refer. The EAP offers a limited number of sessions designed to professionally evaluate the nature of a problem and make a well-informed referral to the most appropriate local provider.
- EAP is often a very close partner to the HR department and intimately involved post-accident, post-crisis and in the case of employee drug and alcohol abuse. The EAP often serves as a Case Manager to assure that employees who are experiencing difficulty do not fall through the cracks of the mental health care system and become an OSHA, ADA, Work Comp or other liability.
- EAP provides a 24x7x365 Hotline to address emergencies, suicidality and workplace violence.
Cost Concerns?
EAP is frankly not an expensive service to provide. I can remember most programs costing my clients between $1.00 and $5.00 per employee per month. Far less than the cost of coffee.
EAP as Gatekeeper
Can the EAP serve as a mental health benefit “Gatekeeper” by expanding its Assess & Refer role? Yes, of course. And most vendors are already fully capable and doing just that. Does it make sense to evaluate clients in a different system (the EAP) and then refer them into the health plan’s mental health system based on that assessment? Well, that depends. Arguing for referral in 100% of cases ignores the fact that in some cases, an employee will have established rapport with their EAP counselor. EAP professionals are almost always qualified and participating in health plan networks. Having invested in 4-5 EAP counseling sessions, it may make perfect sense to allow the employee to continue seeing their counselor under their Parity plan/benefits once their EAP benefits have been exhausted. Why re-create that wheel? Why duplicate those sessions with another counselor and disrupt the process and continuity of care? However, this assumes that the counselor is not self-serving and self-referring for the case of their own pocketbook. That’s a tough call. Counselors can be greedy too.
Economics Will Prevail
My guess is that those employers who truly understand the financing of their plans and the HR importance of EAP will leave EAP intact – recognizing its various roles and low price-point. Others will not see the value or will have been taken advantage of by unscrupulous EAP vendors and will abandon their EAP in favor of what they are mandated to do. Others will work it out with their MBHO vendor and carry on as though little has changed with the advent of Parity.
Stressing EAP
As a former EAP executive, I would encourage employers to keep what they value most and remember the wide range of employee issues that inevitably become a very real dynamic in the workplace. People cannot and do not leave their problems at home anymore than they can leave their cancer or diabetes at home. Nearly 1 in 5 employees suffer from untreated mental health and addictive disorders and more than 60% suffer from unmitigated stress. Do the math on stress in your medical plan and you cannot deny that EAP is crucial. Your vendor had better measure up and deliver, however!
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