What’s an EAP to do in the Parity Era?

The Mental Health Parity & Addiction Act of 2008 (and its ensuing Interim Final Rule) dealt a significant blow to employee assistance programs (EAPs) this year in mandating that health plans and issuers abolish the practice of using EAPs as a Gatekeeper unless they weren’t also the EAP in a similar capacity for medical conditions. The question is, what will become of EAPs as a result?

EAPs – with their networks of professional counselors, call centers, case managers, claims processing capabilities, information management, marketing reach and other core functions made very viable candidates for becoming Managed Behavioral Health Organizations (MBHOs) back in the 90’s at the height of carve-outs and managed care. The distance between an EAP and the core functions and features of an MBHO is not especially great so it stood to reason they would make that evolutionary leap. The EAP this author worked in recognized the opportunity and wasted no time maturing into managed care.

Wanting to preserve the role and integrity of an EAP, we all did the most sensible thing and drove traffic first through the EAP on the basis that the visits were free and posed no obstacle for our members. Enticing members with free, early intervention, we were able to absorb the initial cost of care while fashioning plans and next steps otherwise known as referral to treatment. It all seemed so reasonable at the time.

What ensued in many plans around the country was an abuse of this practice involving plan members calling their EAP only to be referred to their primary care physician, side-stepping behavioral healthcare professionals altogether in favor of medications. While they were at it, many MBHOs avoided the economic burden of that care, driving it into the health and prescription drug plans. I’m not suggesting that medications in primary care settings are inherently wrong. I am suggesting that the EAP industry (as opposed to the field) lost its way. The EAP, in many instances became little more than a Gatekeeper and it is true that no health plan requires its members to call an EAP or exhaust an EAP benefit before making medical or surgical care available.

What now?

I suspect most if not all EAP vendors are already mobilizing to re-position their EAP services in the traditional role of HR and employee “service”, no longer as a benefit gatekeeper. That’s the right thing to do now. The distinction is crucial. I think all EAPs need to re-evaluate their roots as a workplace and workforce service that handles everything from workplace crisis and tragedy to last-chance employment agreements related to drug-free workplace policies. The training EAPs provide supervisors is crucial to the well-being of the workplace. When supervisors can appreciably learn to identify concerns, approach them tactfully without violating peoples’ rights and present real solutions, the outcome is positive for all involved. EAPs now assist employees’ families with services related to elder care, child care referrals, financial issues and other personal matters that are complex and painful yet not in the jurisdiction of a mental health benefit. These services are very valuable to employees and to the employer who wants to remain competitive while demonstrating that they understand people have work and life to balance.

Positioning EAP vis a vis Coaching resources maybe also prove attractive and viable. Certainly, addressing workplace stress and resilience is more important than ever before. By itself, stress is the root of unparalleled workplace, personal, health and economic burden and can serve as the fulcrum of any EAP. It may also prove attractive to position EAP as a “recovery support” service that handles all the things a health plan cannot. It can be especially helpful as a “Parenting Resource” and “Relationship Coach” that addresses the non-diagnosable issues.

It makes all the sense in the world right now – given all of the drivers and stressors in our business and economic environments – to leverage EAPs to the fullest of their original capabilities: dealing with workplace and personal concerns that lie outside health and behavioral health plans. EAPs are urged to re-focus on the value they deliver to high performance business interests populated by productive and passionate well-rounded people. Business leaders buy that.