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Linking Workplace Polices and Programs with Treatment Utilization:

Preliminary Findings

Presenters:

Brandeis University:Bernie McCann, M.S., CEAP

MHN:Deirdre Hiatt, Ph.D.

Addiction Health Services Research ConferenceBoston, MA

October 21, 2008

Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment (Funded by the National Institute on Drug Abuse 3P50 DA010233)

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Substance Abuse Treatment Pathways in Employer-Sponsored Programs: Research Team

Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment

Brandeis University:Elizabeth L. Merrick, Ph.D., M.S.W.

Constance M. Horgan, Sc.D.Dominic Hodgkin, Ph.D.

Sharon Reif, Ph.D.Bernard McCann, M.S., CEAP

Harvard University:Thomas G. McGuire, Ph.D.

Vanessa Azzone, Ph.D.

MHN: Deirdre Hiatt, Ph.D.

Center for Survey Research, UMass – Boston:Mary Ellen Colten, Ph.D.

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Context and Background

Employee Assistance Programs and Managed Behavioral Healthcare benefits are commonly available to employer-insured populations – in either stand-alone or integrated product types.

The focus of the Pathways research effort is to examine substance abuse treatment within these plan types, and identify factors related to better access and engagement.

This presentation reports preliminary findings regarding associations between the workplace environment, employer policies and behavioral health treatment utilization in a privately-insured, multi-employer population.

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Overview of MHN, Inc.

Subsidiary of HealthNet, Inc.

Founded in 1974

1100 associates; 45,000 network providers; 1400 hospitals and care facilities

850 clients (Employers, Unions, Insurers, etc.)

Products: Employee Assistance Programs, Work Life Services, Managed Behavioral Healthcare, Wellness & Prevention programs

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Product Impact on Pathways to Treatment

Individual’s decision to seek mental health or substance abuse treatment

Contact EAP

EAP visits

Specialty Visits

Contact Integrated

EAP Integrated MBHC

EAP visits

Specialty visits

Contact MBHC

Specialty visits

Observable in MHN data

Not observable*Other sources = general medical providers, self-help, & other sources

Other sources*

Other sources*

Other sources*

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Multiple Data Sources

Administrative and Claims data Purchaser product type, client demographics, benefit

eligibility, and behavioral health claims

Employer/Worksite information Account Manager Questionnaire: Drug-free workplace

laws/regs., employer substance abuse policies, level of unionization, health benefits eligibility, workplace focus on health promotion, level of worksite stress

Account Activities Database: EAP worksite activities: worksite orientations, presentations, trainings, and supervisory consultations

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Employer Policies & Workplace Activities

• Health benefits/Behavioral health product type

• Policies for substance abuse violations

• Workplace focus on health promotion

• EAP worksite activities

• Supervisory training & consultation

Organizational Characteristics

• Industry sector

• Level of unionization

• Subject to federal drug free workplace laws/regulations• Level of worksite stress

Behavioral Health

Treatment(Any claim)

Predictors of Behavioral Health Treatment

Client Demographics• Age

• Gender

• Region of residence

• Relationship to subscriber

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Study Sample/Approach

Focus of investigation is the relationship of organizational factors, employer policies/activities, and enrollee demographics to evidence of behavioral health utilization (dependent variable = anyclaim).

Sample population of 691,389 enrollees from EAP* and Integrated (EAP + MBHC) product accounts (n = 69) of employers with <1000 employees.

Data was analyzed using logistic regression to identify predictors of any claim.

*EAP accounts with unmanaged eligibility were excluded

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Sample Demographics

Product Type EAP Integrated

Gender: Female 46.7% 50.9%

Male 53.3% 49.1%

Age: < 18 19.8% 29.2%

18-35 38.7% 25.4%

36-55 34.4% 33.1%

> 55 7.1% 12.3%

Product Type EAP Integrated

Enrollee: Employee 64.7% 43.3%

Spouse 11.9% 21.6%

Dependent 23.4% 35.1%

Region: Northeast 8.3% 12.3%

Midwest 9.8% 12.8%

South 27.3% 36.2%

West 54.7% 38.8%

Percent of enrollees (N = 697,389 enrollees)

For EAP enrollees, n = 129,639 For Integrated enrollees, n = 567,750

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Environmental Factors

Percent of Enrollees by Product Type* EAP Integrated

Industry sector: Service 33.4% 18.9%

Blue collar (Construction; Transportation & Manufacturing) 44.6% 48.7%

White collar (Sales, Information/Financial & Government) 21.9% 32.3%

No union presence in workforce 58.5% 58.3%

Less than 50% union membership in workforce 25.3% 21.9%

More than 50% union membership in workforce 16.2% 19.8%

Employer is subject to Federal Drug-Free Workplace Act 7.9% 15.6%

Any employee is subject to Federal Agency Drug Test regs 48% 56.1%

Experienced unusual or high level of stress in last year 44.4% 49.7%

(N = 697,389 enrollees)

*Data gathered for benefit year 2005

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Employer Policies

Percent of Enrollees by Product Type* EAP Integrated

Majority of employees have access to health benefits 87.4% 95.8%

Employer focus on workplace health & wellness = low 10% 5.8%

Employer focus on workplace health & wellness = medium 35.4% 28.5%

Employer focus on workplace health & wellness = high 54.6% 67.7%

Employer has written workplace substance abuse policy 91.9% 96% Substance abuse policy has zero tolerance for violations 7.2% 2% Substance abuse policy requires treatment for violations 84.7% 94%

Conducted EAP Worksite activities (orientations, classes, etc.) 39.9% 23.2%

Employer level of workplace behav hlth product promotion = low 10.7% 14.8%

Employer level of workplace behav hlth product promotion = med 63.5% 32.7%

Employer level of workplace behav hlth product promotion = high 25.9% 52.5%

(N = 697,389 enrollees)

*Data gathered for benefit year 2005

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Predictors of Any Claim: Covariates

Enrollee type

[ref = Dependent]

Gender [ref = Male] Female

Employee

< 18

Age group[ref = 36-55] 18-35

> 55

EAP product

0.42*

0.88*

0.68*

1.09*

1.39*

0.55**

0.68*

0.76

1.92*

1.23**

1Integrated product

*Values significant P <.01; **P<.05

Logistic regression odds ratios; N = 697,389 enrollees

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Predictors of Any Claim: Environmental Factors

Industry sector [ref = White Collar]

Logistic regression odds ratios; N = 697,389 enrollees

Blue Collar

Any union

Subj to DFWA/Fed

drug test regs

Govt DFW mandates [ref = none]

Level of unionization [ref = none]

*Values significant P <.01; **P<.05

Past year worksite stress

[ref = none]

Unusual/Significant 0.98

0.57*

0.95**

0.53*

0.31*

0.44*

0.51*

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2.56*

EAP product Integrated product

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Predictors of Any Claim: Employer Policies/Workplace Activity

Zero tolerance for policy violation

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Conducted any worksite

EAP activities?

[ref = None]

Substance abuse policy details

[ref = Treatment required for policy

violations]

Conducted EAP worksite

activities

No written SA policy

EAP product Integrated product

* Values significant P <.01; **P<.05

Logistic regression odds ratios; N = 697,389 enrollees

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Findings: Discussion & Next Steps

Within this linked sample of EAP/Integrated enrollees:

For the EAP-only product, logistic regression indicates that: females; white collar employees; those aged 36-55; in workplaces with some unionization; and in workplaces which conducted EAP activities are associated with higher levels of any behavioral health claim.

For enrollees in the Integrated product, logistic regression reveals mostly similar findings, however the effects are generally less.

Some other findings are unexpected/counterintuitive.

Next steps:

Continue multivariate analysis focused specifically on substance abuse claims rate.