Total Life Assistance™
Including the
Pharmacy Intervention Protocol (PIP)
patent pending
Over the past few years, many self-funded
employers have controlled their behavioral healthcare costs by limiting
benefits for mental health treatment. Unfortunately, this has resulted in
a significant proportion of individuals with behavioral health problems
being treated in the general medical setting, which has become the
“de-facto mental healthcare system.” Furthermore, significant quality
problems have been found with general medical providers’ screening,
treatment, and monitoring practices (e.g., pharmacological management is
frequently the sole treatment modality).1 Aggressive marketing
by pharmaceutical companies to both consumers and medical doctors has only
compounded the problem.
Total Life Assistance™ (TLA), provided by Interface EAP, has been developed to
identify those participants experiencing symptoms of stress, anxiety, and
depression; and motivate them to seek effective and appropriate
treatment.
More than just an Employee Assistance Program
(EAP), TLA has several components for the self-funded health
plan. By integrating the EAP with our Behavioral Healthcare Management (BHM)
program and
Pharmacy Intervention Protocol patent pending, the value and Return on Investment for
TLA is maximized.
Why?
In the
past five years, healthcare costs have risen more than 50 percent and
pharmaceutical costs have skyrocketed. Disability claims for stress and
depression are on the rise and productivity is being negatively impacted.
Drug trend reports underscore the problem:
antidepressants are one of the most-utilized classes of all prescription
drugs and a top drug expenditure category for most employers.
The Facts:
Ø
Pharmaceutical costs for
depression increased 452.5% from 1990 to 2000 while during the same
period, inpatient costs decreased 33.6% and outpatient costs increased
46.9% (for depression).2
Ø
Many patients seek treatment for
a short-term problem and end up with long-term drug therapy.3
Ø
The best treatment for major
depression is a combination of drug therapy and psychotherapy, but many
patients receive pills alone. Depression management programs should
coordinate services through employee assistance programs and healthcare
plans.3
Ø
In an 18-month study of 84,500
patients by Medco Health Solutions, Inc., nearly half of all patients
taking antidepressants did not see a health care provider for follow-up
care, and only 17% ever saw a mental healthcare provider.4
Ø
A study published by the Health
Enhancement Research Organization surveyed over 46,000 workers at six
major U.S. employers and over 20 percent of all employees screened as
highly stressed or depressed. As a group, their medical claims averaged
almost 49% more than the other 80 percent (not in the group).5
Many employers ask, “how can I reduce mental
health claims?” The real question should be, “how can I address the
quality of care issue existing today with behavioral healthcare
treatment?” Most employers are experiencing upwards of 20 percent of
their employees and dependents having acquired a prescription for a
psychotropic drug in the past 12 months. This is impacting not only drug
and healthcare costs, but also absenteeism, disability, workers comp,
presenteeism, and overall productivity.
The Solution: Total Life Assistance (TLA) ™
It starts with identifying those in need of
assistance. This is accomplished in several ways, beginning with our Pharmacy Intervention Protocol (PIP) patent pending.
Coordinated with the PBM, participants who acquire certain identified
medications using their prescription drug plan are financially motivated
to contact Interface EAP for a screening. Once contact with Interface is
made, an assessment of their situation is completed to determine if
psychotherapy or other behavioral healthcare services would assist with
improving their condition. If it is determined they would not
benefit from our program, there is no further intervention and their
co-pay remains at the regular level. If it is determined they would
benefit, they are offered a free referral to the PIP
program, which includes an Employee Assistance Program (EAP), the
foundation of TLA. Employers may use either an incentive
or penalty approach with this program by raising/lowering the
participant’s co-pay dependent on compliance/non-compliance. As they
enroll in the program, a percentage of participants (through interactions
with PIP Care Coordinators) will begin switching from name brand to
generic prescriptions (when medically appropriate) for the period of time
they remain on the medication. Next, a significant percentage will reduce
and/or eliminate their medication after improving their condition. The
majority of cases will be resolved using the EAP benefit (the greater the
number of EAP sessions available, the greater the percentage of cases
resolved under the EAP). Those needing treatment beyond the EAP are
referred to benefits under the health plan. The net result is a win-win
with employers reducing pharmacy and medical costs, and employees becoming
healthier and non-drug dependent for mild to moderate mental health
issues.
To enhance TLA, the EAP may be
integrated with the self-funded health plan to create our
Behavioral
Healthcare Management (BHM) program. Through plan design, Interface
becomes the “gatekeeper” for behavioral health benefits under the health
plan. This integration is another process by which participants are
motivated to access effective care, as they must contact Interface prior
to seeking behavioral health treatment under the health plan or incur a
reduction (or loss) of benefits. As a result, EAP utilization is
increased along with the number of cases resolved under the EAP without
utilizing the health plan benefits. For those requiring treatment beyond
the EAP, the BHM program coordinates the treatment for each case utilizing
a step-down approach. By authorizing successively less restrictive levels
of treatment as appropriate, not only are costs controlled but also
positive outcomes are increased.
The value and need for Total Life
Assistance™ (TLA) is easily determined
through a review of summary drug data (no PHI). It is back and white,
either the scripts are there or they are not. And if they are, there is a
significant quality of care issue occurring for the employer and their
employees/dependents.
References
-
An Employer’s
Guide To Behavioral Health Services.
National Business Group on Health; (2005)
-
Cost to Treat a
Depression Case Falls. Wall
Street Journal; (2003)
-
Prozac Nation.
Employee Benefit News; (2002)
-
Antidepressant
monitoring falls short: Medco Study.
Business Insurance; (2006)
Big
Study Shows Workers Under Stress Likely to Have Higher Health-Care Costs.
Wall Street Journal; (1998
For additional
information, or a custom proposal, please contact us.
It' s all about employees;
always has been, always
will be.
Providers
interested in joining our network, Click Here
Corporate Headquarters
10370 Richmond Ave. | Suite 1100 | Houston, Texas 77042
Phone: (713) 781-3364 | Fax: (713) 784-0425
Email: info@ieap.com
