Articles | April 24, 2023
Behavioral health solutions, including digital health solutions that treat mental health conditions and/or substance use have proliferated in recent years as technology has evolved and venture-capital backing has grown. There are now approximately 20,000 different products that focus on mental health and substance use disorders for all ages, including programs targeting nutrition/well-being, addiction and recovery peer support.
The sheer number of behavioral health solutions in today’s marketplace makes it difficult for sponsors of group health plans to:
Fortunately, we have a systematic strategy for accomplishing these goals.
When evaluating behavioral health solutions for your organization, consider these five areas:
This article discusses each consideration.
The first step in evaluating specialized behavioral health solutions is to review the multiple sources of your participant data, including summary reporting for employee assistance programs (EAPs), prescription drug benefit managers (PBM), clinical management vendors and health plan claims. Once you have this information, you can better ascertain the relevance of purported marketplace solutions. Be wary of vendors that contact you about their solution that address a problem you may not need to fix. Any plan design changes you’re considering should be based on your data.
Consider reviewing the past three years of your EAP, health plan and PBM claims, clinical management and even PTO, life, disability and workers' compensation data to identify both trends and gaps in services. Potential red flags include an increase in paid time off, life, disability and workers’ compensation claims, acute care episodes, low medication adherence rates and absence of post-discharge engagement in outpatient services. Sometimes the lack of EAP utilization is also telling. Investigating the sources of lost productivity and rising expenses revealed by claims, treatment patterns and even stakeholder surveys can be a strategically powerful investment of plan resources. Addressing gaps and ineffective treatment patterns within mental health networks and services demonstrates the organization’s commitment to meeting its people’s needs. In the spirit of benefit equity and inclusion, this sends a powerful message.
If you cover dependents, don’t forget that children may not live in the same physical locations/states as the subscriber. Think of the children of divorced parents and college-age children. That means you need coverage options beyond your locality.
If you have a workplace safety program, consider both how it currently coordinates with behavioral health benefits and how new behavioral health solutions could be integrated into the program and its protocols. More solutions vendors are now offering use of their professionals and platforms for customized trainings, benefit orientations and moderating peer-group workshops.
Knowing your pain points and coverage gaps will help you select solutions for verified needs.
At some organizations, behavioral health benefits are offered to “check a box” and match what other organizations provide. If that’s true of your organization, you and your benefits team can make a compelling case for offering new behavioral health solutions by looking at objective potential outcomes, like dollars or lives saved.
You might spotlight participants’ historical behavioral health and prescription drug claims data. Use of maintenance medications, outpatient and inpatient services, and post-discharge engagement for chronic issues provide important insights about which vendors may best complement the health plan.
This data-driven approach will help you make your case and get buy in from decision-makers.
Another important aspect of organizational readiness for new behavioral health solutions to consider are any social barriers that could hinder use of even the best of programs. To evaluate social barriers, answer these questions:
If all or most answers are “yes,” your organization is well positioned to benefit from new behavioral health solutions. “No” or “don’t know” responses are an indication that you need to work first on dismantling social barriers. Consider sharing these insights with your benefits communications partners so they can address them in future communications.
The migration to remote-care technologies and increased demand for them means EAPs and health plans are now sharing some providers. Consequently, provider exclusivity contracts have become rare and it is no longer the case that the largest network ensures the best appointment availability.
To meet increasing demand despite persistent shortages of behavioral health professionals, vendors are cobbling together services using traditional independent practitioners, telehealth networks and cognitive behavior therapy tools. The scramble to fill gaps in access using telehealth/video/chat, particularly in specialties like pediatrics and substance use disorders, has resulted in a disjointed clinical approach to the continuum of care and varying degrees of quality. Without investigation, the quality of networks remains questionable.
There are many factors to consider when assessing vendor quality:
If you’re satisfied with the quality of your current vendors, ask what more they can do for you. EAPs have enhanced services to educate and provide clinical assessments for substance misuse and treatment of substance use disorders. Tobacco-cessation programs can expand to include alcohol and other substances.
Moreover, there may be other options worth exploring, like innovative self-monitoring and assessment tools and centers of excellence.
For behavioral health solutions to be effective, participants first need to understand why the solutions can help. To ensure your messaging resonates, consider your people, including their backgrounds and mindsets, before promoting your mental health resources.
Although the attention that the COVID-19 pandemic brought to mental health issues helped dissipate the stigma associated with mental health, that stigma may linger for some participants, preventing them from exploring mental health resources. (Read about how one organization countered the stigmas associated with seeking mental health treatment though a “Stronger You, Stronger Us” campaign, which emphasized how making mental health a priority benefited loved ones.)
In general, participants will have a range of questions about a new behavioral health benefit. The following box lists 10 typical questions. Consider addressing these questions head-on in FAQs you include in promotional communications announcing the new benefit.
Keep in mind that participants will be hesitant to use healthcare services unless they know exactly how to access them easily and how much it will cost them to do so. If services are available at no cost to them, advertise that clearly!
Demos and instructional videos can be helpful to ensure proficiency of use with remote technologies and user platforms. A product that requires multiple logins and referrals for different types of care, in the case of patched-together services, will likely not meet engagement goals.
If you’re adding a resource to supplement existing services, such as a point solution for caregivers, pediatric mental health or substance use disorder recovery support, you’ll also want to help participants understand which resource to use when. Decision trees that show where to go for care are a terrific way to help people figure out where to seek help based on their needs. These tools identify a feeling, emotion or situation and then point members to the appropriate resource.
It’s important to educate peers, supervisors and other influential people about available resources, how to recognize when someone is struggling and how to connect them to resources. Manager guides with scripted talking points are a wonderful way to help leaders and managers know where to direct people when they show signs of stress. (Read more about them in “5 Ways to Support Your Managers — So They Can Support Your Well-Being and Benefits Efforts.”) Consider how you will embed training and awareness more systematically into your ongoing new hire and new manager/supervisor trainings. Also, keep in mind that most EAP and mental health products come with a bank of hours for training and orientation that are often unused. In addition, EAPs can deploy professionals following a traumatic incident. After the initial rollout of a new behavioral health solution, consider promoting it regularly going forward. This will keep it top of mind, so participants remember to use it as issues emerge in their lives or the lives of their families.
As with any vendor, it’s important to monitor the performance of vendors of behavioral health solutions. Both the vendor’s performance and the impact of its behavioral health solution(s) should be measurable.
To measure results, consider creating a pre- and post-program dashboard of outcomes. Examining your utilization data can show the program’s impact. Segal’s Health Analysis of Plan Experience (SHAPE), our proprietary data-mining tool, can help you perform these analytics.
It’s also worthwhile to measure pre- and post-program engagement. This can be done by comparing claims or utilization reporting before the change and then again about a year later. Additionally, you can review the impact of your communications on program usage and engagement. Your findings may provide you with insights into how you can improve your strategy or messaging going forward.
Note that high-quality behavioral health solutions will impact more than just behavioral health claims. They will have a positive effect on worksite culture, behavior, medical claims, absenteeism, disability and more.
While it’s exciting that there are now more and easier ways for people to access behavioral health providers and receive care, the ever-expanding universe of behavioral health solutions can be overwhelming.
By considering the five areas described in this article, you can ensure your organization offers data-driven solutions that your people will use effectively.
This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.
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