Use your claims data to assess needs

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.

Determine if your organization is ready for new behavioral health solutions

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:

• Is engaging in a behavioral health resource positioned as a performance enhancer (rather than a crutch)?
• Is behavioral health talked about and supported at all levels of the organization, from leadership to frontline supervisors?
• Are behavioral health resources mentioned prominently in health plan resources?
• Do participants know that their interactions with a behavioral health provider are private?

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.

Identify high-quality vendors

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:

• Providers — Ask about recruiting standards and provider reimbursement levels. Compare hourly rates for providers in key areas. To a certain extent, the rates reflect caliber and availability of providers.
• Program(s) and procedures — Examine whether the program(s) offered and the operating procedures (e.g., prohibiting providers from taking patient calls from their cars) adhere to evidence-based care. A clinical consultant can assess this during the vendor evaluation and selection process.
• Access — Nationwide, there are provider shortages for certain patient demographic profiles, such as BIPOC and children, as well as by specialty and region (i.e., in some suburban and rural areas). That’s why you need to assess access, including what a vendor has done to help eliminate access gaps in challenged markets.
• Resources — Review the vendor’s self-education material to determine whether it is evidence based, targeted and relevant to users. If demos and trial offers for coaching or therapy are available, look at them.
• Outcomes — Request objective outcome-improvement scores. For example, participants’ scores on the Patient Health Questionnaire-9, which is used for rating depression, should improve after they receive treatment.
• Compliance — Check what certifications and processes are in place to ensure services are provided in accordance with state and federal laws concerning mental health parity, patient privacy, consent (for minors) and security of information.
• User experience — Ask for a login so you can test the vendor’s system from the patient’s perspective.
• Customer satisfaction — Look closely at the results of patient surveys. Consider using an independent survey tool to validate results of programs you implement.

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.

Monitor and measure results

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.