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Compensation Guidelines in a Recessionary Environment Alfred J. Candrilli | Organizational Consulting Group LLCCliff Cole | The Cliff Cole HR AllianceBill Heck | Harlon GroupAndy Klemm | Klemm & AssociatesBarbara Manny | Benefits and Compensation ResourcesGary Schroeder | Schroeder Associates

The Perceived Value of ‘Free’ Versus Fee-Based Employee Assistance ProgramsDavid A. Sharar, Ph.D. | Chestnut Health Systems John Burke | Burke Consulting

Reward Alignment: High Hopes and Hard FactsDow Scott, Ph.D. | Loyola University ChicagoTom McMullen | Hay GroupJohn Shields, Ph.D. | University of SydneyBill Bowbin, CCP | Hay Group

Effective Rewards Strategies: Necessary, But Not Sufficient for SuccessRobert J. Greene, Ph.D., CCP, CBP, GRP, SPHR, GPHR, Reward Systems Inc.

Successful Cultural Integration During a Merger: The Case of Qiagen and DigeneKatrin Winkler, Ph.D. | QiagenDavid H. Jackson, Ph.D. | Mercer

Beyond Black-Scholes: Are Shareholders Getting Good Value for Employee Stock-Based Incentives?Michael Lennartz and Stephen Zwicker, Watson Wyatt Worldwide; and Gareth Berry

Frontline Workforce Engagement Through Performance Management and Total Rewards: Bridging the Gap Between Strategy and ExecutionKimberly Smithson-Abel | Diamond H Recognition

Engaging Employees Through Performance MarketsWard Mannering, CCP, SPHR and Diana Fischetti, GovSec Consulting Corp.

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21 Fourth Quarter | 2009

Benefits z

David A. Sharar, Ph.D.Chestnut Health Systems

John BurkeBurke Consulting

There has been a clear trend in recent years for

health insurance companies, disability carriers,

group retirement plans and payroll management

organizations to bundle employee assistance program

services into their core products and offer the Employee

Assistance Plan (EAP) as “free” (Burke 2008, Sharar and

Masi 2006, Holman 2003). Under this arrangement, an

insurance plan buys an inexpensive EAP from a vendor

partner or provides an EAP within an affiliated division,

then embeds the EAP in the plan to create product

distinction and a competitive advantage.

Of course, the free EAP is not truly free, but the

minimal cost of the program allows the insurer to easily

absorb the expense into the overall plan fee. Employers

thus pay the EAP premium as part of their insurance

plan fee, but many of them find it convenient to contract

with one provider for two or more insurance products

and not have to pay a separate bill for EAP services.

The free EAP is a variation of the “loss leader” concept

in marketing, with products sold at or below cost to

attract attention to higher-margin products. The original

idea was to use the free EAP offer to differentiate the

The Perceived Value of ‘Free’ Versus Fee-Based Employee Assistance Programs

22 WorldatWork Journal

program in the market and provide an inexpensive perk to an employer (Sharar

and Masi 2006, Holman 2003). However, in the current marketplace, the free EAP

is so commonplace that many insurers recognize their competitors also have free

or low-cost EAPs embedded in their plans (Burke 2008).

How is the trend toward free EAPs understood and viewed from the perspective

of key stakeholders? In this paper, the authors seek to qualitatively describe the

perceptions and observations of three groups of respondents: HR managers; benefits

brokers or consultants; and employee assistance professionals. For readers who are

not familiar with how EAPs work as a main part of their jobs, a brief review is

provided below, followed by a description of the study’s methods and results.

BRIEF REVIEW OF EAPS

Employee Assistance Programs (EAPs), as an employer-sponsored benefit, help

employees and dependents with work, personal and behavioral-health concerns

such as marital, family, emotional, job stress, drug and alcohol, legal and financial

problems. EAPs typically offer some form of professional support, assessment,

brief counseling and referral services using easy access and work performance

issues to drive those in need to seek help at the earliest possible time. EAPs are

a first entry point for millions of U.S. employees seeking professional assistance,

predominantly provided to employers by outsourced vendors.

The outsourced vendors who deliver the bulk of EAP services do so via a

telephone call center as a “central” access point for service requests along with

the decentralized network of subcontracted, professional clinicians for face-

to-face counseling in locations where the EAP vendor has covered employees.

Employee-assistance vendors typically sell this model to employers at a capitated

“per-employee-per-month” (PEPM) rate and then pay subcontracted clinicians

(also know as “affiliates” or “network providers”) at a fixed hourly rate, when

they are used. Employees or dependents who request assistance with a personal

problem place a call to an EAP vendor and provide demographics to a “phone

intake counselor” and, if phone counseling is deemed inappropriate, the client is

given another phone number or transferred to a subcontracted clinician in or near

his/her community of residence.

Many organizations adopt and maintain EAPs out of a widely held perception

that they yield positive results, which may or may not be the case, depending on

the vendor, the EAP model and other variables. The theory of EAP is to provide

help in areas where employee personal problems and employer performance

and productivity concerns overlap. This theory assumes that employee personal

problems which may not necessarily be a diagnosable mental-health disorder, can

progress into a disorder and result in higher medical, disability, workers’ compen-

sation and lost productivity costs over time. If employees (and eligible dependents)

are encouraged and invited to access EAP at the earliest possible time, before the

problem worsens, the organization will mitigate or avoid unnecessary financial


and human capital costs. The goal is to encourage employees to “self-refer” to EAP

before unresolved personal problems affect job performance issues. Since EAPs

are “free” and confidential to covered employees, the absence of co-payments,

deductibles and out-of-pocket expenses makes them attractive to employees who

like “hassle-free” access and do not want to file a claim or pay for services.

Of course, a segment of marginally performing employees who are unresponsive

to normal supervisory action and do not “self-refer” to EAP may have under-

lying personal, family or behavioral-health problems interfering with effective

job performance. These “troubled” employees may begin to face their problems

when constructively confronted with the facts of unsatisfactory performance, a

clear demand for improvement and a sincere offer of help through an EAP referral.

In this situation, supervisors can confront employees on the basis of declining

performance and motivate “in denial” employees or employees who are reluctant

to ask for help to voluntarily pursue the use of a “free and confidential” service.

This “supervisor referral” approach relieves supervisors of inappropriate diagnostic

responsibilities and allows management to deal with employees with unresolved

personal problems fairly and, at the same time, leave the decision to seek help

via the EAP entirely up to the employee.

In both the “self” and the “supervisor” referral, the EAP’s mission is to help

employees, who are distracted by the range of personal problems, to better cope

with these problems, ultimately enhancing job performance, safety and produc-

tivity. The context of EAP intervention is not necessarily the personal restructuring

associated with psychotherapy or addiction treatment, but the effects of prob-

lems on individual coping and occupational life. The theory of EAP intervention

contends that EAPs can and do contribute to expense reduction and effective risk

management, beyond the subjective testimony of improved clients and satisfied HR

managers. Organizations with effectively implemented EAPs should eventually see

such outcomes as reduced absenteeism, decreased medical and disability claims,

fewer disciplinary problems and enhanced productivity.

SAMPLING

The initial selection of HR managers as potential respondents was made by asking

EAP vendors, who were known to the researchers, to submit lists of HR contacts

who replaced traditional EAPs with a free or embedded program that was bundled

with another employee benefits product. A master list was created that contained

approximately 60 potential HR respondents who were contacted via phone or

e-mail. A total of eight HR respondents participated.

The sampling used for benefits consultants and EAP vendors as respondents

was convenient and emergent, meaning it was not entirely determined in advance.

Access to potential benefits consultants and EAP vendors occurred via collegial

networking and introductory e-mails that described the project and included the

appropriate informed consent statements. Participants were asked to identify other


potential participants, and they in turn others, until the data seemed redundant.

A total of seven benefits consultants and 15 EAP vendors were interviewed,

bringing the total of all three groups of respondents to 30. These 30 respondents

were interviewed between October 2008 and March 2009.

INTERVIEW GUIDE

A semi-structured interview guide with some prepared questions was developed

and served as an “agenda” for the conversations. This guide was somewhat tenta-

tive in practice and viewed as a way to generate dialogue rather than a packaged

approach to gather data. Questions were generally open-ended and efforts were

made to encourage a spontaneous flow of conversation.

Probing was used to elicit more detailed information and perceptions.

The researchers also used neutral questioning techniques to minimize the potential

for bias associated with the solicitation of a “correct” or “favored” response.

Since all participants were busy professionals, interviews were generally limited

to about 30 minutes and were conducted over the telephone.

ANALYSIS

Data were recorded by taking copious notes and then evaluated through a process

of content analysis and the identification of emerging themes. A template was

constructed by examining notes and responses to questions or probes. The two

researchers examined sentences and word segments in response to questions, iden-

tified particular themes and reached a consensus regarding the themes. Chunks of

data were sorted and clustered around these nonredundant themes.

Methodological rigor was enhanced by: (a) quickly debriefing with respondents

after the interview to verify that the researchers had captured their views; and

(b) using reflective analysis to identify the researchers’ personal bias or precon-

ceived assumptions that may have interfered with data analysis.

The researchers contend the themes and findings represent a reasonably accurate

and grounded reconstruction of the key issues related to the free EAP.

LIMITATIONS

Prolonged engagement seen in other qualitative studies was not possible because

this study employed a one-time telephone conversation of short duration and there

was no in-person contact. There was also no direct and repeat involvement with

respondents through the testing and retesting of inferences about what respon-

dents said during interviews.

This study also examined perceptions that may or may not reflect actual behavior

or practice. Environmental stressors and disruptions can inflate perceptions of a

controversial issue that may not be related to actual practice, particularly for a

field that is in the midst of flux, extreme competition and change. Studies using

this type of qualitative interview risk the possibility that self-report can be linked


with a type of strategic bias, meaning respondents have an incentive to shape

their responses when they think their answers may affect them or influence

public perception.

Finally, the sample was not random and only a small number of respondents

were interviewed. There is no way to know with this method if the sample is truly

representative of the general population of HR managers, benefits consultants and

EAP vendors who are involved with or affected by the free EAP. Therefore, caution

needs to be exercised when generalizing to the larger population.

GENERAL POPULATION THEMES

The three populations surveyed agreed with each other more often than not.

First and foremost, they recognize that free EAPs are a market reality and indica-

tive of forces that influence all industry sectors. They also see the following

factors at work:

Cost and the economy. z Cost is a significant factor, and likely the primary factor,

for many employers when considering a free or embedded EAP. This trend is

being driven by budget cuts, the administrative efficiencies of using a single

vendor for multiple services and the reduction in time required for a benefits of

HR manager to provide oversight of the service.

Perceived or realized value.z The value, either perceived or realized, that an

employer derives from an EAP was the dominant discussion point in the survey.

High EAP value is associated with efficient and effective vendor responsiveness,

innovative approaches to meeting the needs of employers and quantifying the

results of the services provided. Low value is associated with low utilization,

limited visibility and minimal involvement with management or those responsible

for EAP oversight.

Large versus small employers.z Small employers (fewer than 500 workers) are

more likely to embed or opt for a free EAP. Their financial and human resources

are more limited and, while they sometimes appreciate value, cost drives their

decisions. For larger employers, economics is a factor, but value is more likely

to be the driving force.

Visibility and knowledge.z Although EAPs have become common within U.S.

organizations, employers report that management and workers have limited aware-

ness of them and lack a deep understanding of the full scope of EAP services.

Free and fee-based services.z Employers are generally familiar with the primary

services offered through an EAP and know that typical utilization ranges from

5 percent to 10 percent. When examining descriptions of the services provided

by a free EAP as compared to those of a fee-based EAP, the programs appear

very similar if not identical. The survey found, however, that fee-based EAPs

provide the services advertised and achieve expected utilization rates, while the

typical free or embedded EAP provides limited services and achieves utilization

rates of 1 percent or less.


Future trends.z Employers, consultants and providers all forecast the continu-

ation of free or embedded EAPs. Employers have multiple factors to consider,

including perceived value, cost and desired outcomes when determining the best

arrangement for an EAP. Many EAP providers understand these factors and are

contracting with insurance companies to provide the free EAP portion of the

insurance plan.

THEMES AMONG BROKERS AND CONSULTANTS

Consultants interviewed in this study generally recognize EAPs as a viable and

essential service for employers. At the same time, they feel that many employers

are oblivious to the full benefits of an EAP or see it as somewhat redundant

to an outpatient mental-health counseling benefit. As one consultant remarked,

“Being a strong advocate of an EAP does not necessarily translate to the effective

implementation and oversight of an EAP.”

Most consultants pointed to the need for EAP providers to better demonstrate and

quantify their programs’ value. They recognize that utilization rates are increasing

as EAPs are promoted as a resource in difficult economic times, and they under-

stand that EAPs are routinely called upon when employers experience a critical

issue in the workplace. They also see a linkage with total health and productivity

management, but do not always understand it or routinely take advantage of it.

Consultants view the EAP marketplace as extremely competitive and see EAP

providers continually lowering prices to retain business. However, service expec-

tations are remaining the same or increasing, creating an untenable position for

EAP providers. The lack of quantitative performance impact data has led to a

perception among employers of marginal EAP value, which directly correlates to

diminishing price points. Consultants generally recommend that EAP providers

retool or expand their services beyond a simple “employee-counseling model” into

a broader health and productivity framework.

Consultants see large employers (more than 5,000 employees) as value purchasers

and report that the majority of them recognize the service limitations of a free

EAP and intuitively understand they will gain more value from an EAP that

builds internal relationships, actively promotes services, customizes services to

meet unique needs, consults with all levels of management, provides routine

data reports and generates case utilization in the 5 percent to 10 percent range.

Consultants recommend a free EAP when it appears to be the most likely way an

employer will agree to retain the program when faced with mandated expense

reductions. They predict free EAPs will continue to be marketed for the foreseeable

future but could diminish as progressive EAP providers begin to better demon-

strate and quantify their value.

Consultants recognize that integrating and embedding services are significant

trends. Employers theoretically gain from these trends by having a single vendor,

gaining favorable pricing and improving outcomes by establishing communication


linkages between the various benefit silos. At the same time, being a component

of a much larger plan can result in an EAP being easily overlooked and even

invisible. A few consultants cautioned about the potential for service dilution or

the tendency to reduce or weaken the core components of EAP by mixing EAP

with other products. As one consultant stated: “The embedded program runs the

risk of less focus than was historically provided by the prior fee-based, stand-alone

program, so the actual results of the free EAP as embedded in the overall plan

don’t match up to the claims.”

Consultants also noted that when an EAP is incorporated into a specific benefits

offering, such as a disability management program, the EAP can become limited

in scope. In this example, the focus of the EAP can become strictly limited to

“disability” cases and not the broader needs of the entire workforce.

THEMES AMONG HR AND BENEFITS MANAGERS

HR managers seem to recognize an EAP as a standard offering for employees and

their dependents, but their expectations of service offerings differ significantly

when comparing large employers with small or midsize businesses. HR managers

in small and midsize organizations seem less sophisticated when examining the

differences between fee-based and free programs.

A small percentage of HR managers see EAPs as an essential part of the fabric

of an organization; others view them as “an evil but necessary part of the benefit

plan.” With so many HR departments understaffed or overburdened and lacking

specific expertise in EAP, most HR managers end up focusing on cost savings and

ease of administration.

Indeed, cost is the defining issue and at the forefront of decision-making about

EAPs. The cost of an EAP is a tiny and insignificant part of the total benefits

budget, but employers still want perceived value for what they spend. EAPs that

have limited visibility, minimal management support and low utilization get little

or no attention.

HR managers indicated that fee-based EAPs they had canceled were usually

quietly responsive and beneficial, but not really evaluated or monitored. These

HR managers had been satisfied with the fee-based EAP, but not in such a way

that would dissuade them from moving to a cheaper or free embedded program.

They did not ardently advocate for retaining their fee-based EAP when faced with

the free alternative.

In today’s cost-cutting environment, the option of a free EAP can be particularly

enticing. The opportunity to embed the EAP within a larger plan and have only

one provider to manage creates an even greater motivation to switch. Many small

employers do not know where to go to explore EAP service options, so when

a health or disability plan proposes an embedded offering that will reduce a

benefits expense, the small employer’s decision can be automatic. Although some

HR managers expressed concern about switching to a free EAP, most made the


choice without much attention to or awareness of the differences between the free

program and the fee-based program.

Despite the distinct differences in service levels between fee-based and free

EAPs, one free EAP was reported by an HR manager to have a much higher level

of service and better levels of accountability. Others who switched from a fee-

based to a free program noticed some negative differences with the free program

but seemed content to stay with it since an EAP is a low-profile program and

low-budget priority. The most common complaint was not receiving any utiliza-

tion reports and not having an assigned account manager to call with requests

or questions.

HR managers with a free EAP said they would likely not return to a fee-based

program despite those serious shortcomings. Particularly among smaller and mid-

size employers, the message seems to be that vendor decisions are primarily about

cost, especially when the components of the fee-based and free programs are so

similar on paper that differences are not readily apparent or appreciated.

THEMES AMONG EAP PROVIDERS

Representatives of providers that deliver fee-based EAPs expressed concerns about

poor quality and a lack of workplace emphasis in free EAPs and voiced frustration

in trying to persuade consultants and employers that quality problems exist with

free EAPs. They also emphasized the need to broaden the scope of EAP services

to maintain or enhance revenue generation. Some even talked about developing

third-party distribution relationships with insurance plans through which the EAP

provider would deliver “backend” services for a free EAP offering. In other words,

they contemplate getting into the business of embedding EAP with an insurance

product rather than continue to lose market share to the free EAP trend.

These representatives believe free EAPs are eroding the integrity of the EAP

field and contributing significantly to the continuing deflation of EAP rates and

reduction in vendor margins and business volume. This segment of EAP providers

feels that free EAPs typically have the following characteristics:

Little or no regular promotion, which leads to utilization ceasingz

Few or no utilization reports, leaving HR staff unable to decipher employee needs z

and actual EAP activity

Critical incident response unavailable except as a “buy-up” servicez

No management consultations or referralsz

Intervention limited to telephone or online assessment and referral with those z

referrals not usually customized or specific to select providers

Face-to-face counseling offered but rarely providedz

Infrequent follow-up with cases, meaning there is no way to know whether z

employees have improved or received additional help.

A common theme among these representatives was that the underpinnings of

the EAP field’s emphasis on workplace intervention are tangential at best in free


programs. Formal management referrals and training on how to conduct manage-

ment referrals, which are the bedrock of employee assistance, are thought to be

completely missing in the free program.

These representatives all lamented the lack of a coherent strategy to educate

purchasers about the shortcomings of free EAPs and to better define what employee

assistance entails and what it doesn’t. They are frustrated by their inability to

convince employers that quality problems that can have serious consequences

exist in free EAPs.

Representatives of providers that provide free EAPs on behalf of insurance

plans characterized their business as a “money maker.” They are able to make

money because the EAP is buried in the insurance plan and is poorly promoted

by the insurance company, so utilization is low or nonexistent. Based on our

interviews, the insurance plan pays providers anywhere from 10 cents to $1.20

per employee per month (PEPM), compared with the typical fee-based EAP

that costs about $1.50 to $2.50 PEPM. Because their revenues are fixed under

the capitated model, providers rely on their ability to predict utilization and

service activity.

Every provider we interviewed has lost business to free EAPs, some more than

others. Providers of free EAPs also have lost fee-based accounts to other free EAP

plans. In the majority of cases, the losses have been small to mid-sized employers

wanting to embed services and reduce costs. The providers all seem to view the

introduction of free EAPs as a sign of a maturing industry and have considered or

undertaken different strategies to define and demonstrate value.

Like consultants and HR managers, providers recognize that demonstrating value

and quantifying outcomes are necessary if they are to successfully compete against

free EAPs. Despite this recognition, there is little evidence of any investment in

approaches to empirically measure outcomes. Many providers seem to continue

to rely upon subjective impressions and practitioner observations as the most

common form of measuring outcomes. In lieu of more systematic or objective

outcome measures, most EAP providers emphasize value propositions centered

upon building loyal relationships with key employer stakeholders and providing a

greater depth and scope of service, attributes rarely seen in a free EAP.

Providers also recognize the need to educate employers and benefits consultants

that EAPs have the potential to improve workplace performance or intervene

with vexing employee problems and are not just a set number of counseling

sessions. Many providers remain concerned that the workplace emphasis in EAP,

as distinctly different from the traditional psychotherapeutic perspective applied in

general practice counseling, is marginalized in the contemporary EAP and missing

altogether in the free EAP.

Because many purchasers have a limited definition of an EAP, some providers

are broadening their range of services, rebranding the term EAP and attempting

to create new value propositions.


IMPLICATIONS

The free EAP is projected to be an

option for employers well into the

future. Although the cost of an EAP

is miniscule when compared to a

comprehensive benefit plan, it is

still a factor and will always affect

the final decision. The motivation

for providing services can range

from recognition of the impact an

EAP can have on health and perfor-

mance to simply wanting to make

a commonplace benefit available.

The specific motivation has a direct

relationship to the monetary value

placed on the service.

While most employers know that

nothing is truly free, many seem

intrigued by the opportunity to

receive a “free” benefit. It removes

one expense line from a budget and

enables the embedding of an EAP,

thus reducing the number of vendors

as well as the time and effort required

to monitor and manage the service. Employers who accept a free EAP seem smart

enough to know they were drawn into a kind of cost-shifting game but are under

immediate pressure to reduce costs. Value-based purchasers, on the other hand,

realize that few services, especially human services, are true commodities and

believe competition for such services should focus on demonstrating results. These

value-based purchasers are placing a greater emphasis on measuring workplace

outcomes (in EAP and related programs such as health promotion or work-life)

as opposed to selecting vendors based on administrative efficiency and a buried

low price packaged as free.

The future of the fee-based EAP will be challenged if purchasers do not have a

clear understanding of how it differs from the free offering. There is a pressing need

for empirical research to shed light on the relative risks, benefits and actual costs

of fee-based and free programs. Some type of comparative effectiveness research

is needed to inform purchasing decisions and substantiate the claim that most free

EAPs are, as one survey participant put it, “passive, empty and delusive.”

Although value was the predominant theme among the three sectors, it is mostly

subjective, anecdotal and intuitive at this point. In the current economic environ-

ment, the more that EAP services provide only subjective value, the lower the price

RESOURCES PLUSFor more information related to this paper:

www.worldatwork.org Type in any or all of the following keywords or phrases on the search line:

z Employee assistance programs

z Employee benefits

z Outsourcing.

www.worldatwork.org/bookstore

z Managing Employee Health Care Costs: A Collection of Articles from WorldatWork

z Developing a Strategic Benefits Program: How-to Series for the HR Professional

z Self-Insuring Benefits Programs: A How-to Guide for the HR Professional

z Strategic Outsourcing: How-to Series for the HR Professional.

www.worldatwork.org/education

z Health and Welfare Plans — Plan Types and Administration, Certification Course: B3

z Health and Welfare Plans — Strategic Planning and Design, Certification Course: B3A

z Benefits Outsourcing — Selecting, Contracting and Managing Service Partners Certification Course: B12.


points become, making a free EAP even more attractive. In the future, value needs

to be defined as the demonstration and quantification of impact and outcome, or

the results of EAP intervention.

Some providers are trying to articulate a different value proposition for their

services. These providers are taking the time to better understand the “anatomy”

of the purchaser and the purchasing decision. Purchaser education and proof of

impact will be two keys to vitality and success in a marketplace that is price-

sensitive and in which a free EAP is an attractive option. z

American Business Publishing. 2006. “EA Professionals Cite ‘Free EAP’ Competition and Defining Value as Top Challenges.” EAP Management Newsletter 20 (11): 1-3.

Balcan, Marina-Florina, Avrim Blum, T.H. Chan and Taghi, Hajiaghayi. 2007. “A Theory of Loss Leaders: Making Money by Pricing Below Cost.” Technical Report (Carnegie Mellon University) July.

Burke, John. 2008. “The Lessons of ‘Free’ EAPs.” Journal of Employee Assistance, Second Quarter: 17-18.

Harbeke, Mark. 2009. “Friday Nugget: Keep Value a Priority in Tough Times.” http://www.winningworksplaces.org. Viewed May 10, 2009.

Holman, Ron. 2003. “Free EAPs.” California Broker, October: 62-63.

Sharar, David. and Dale, Masi. 2006. “Crises Facing the EAP Field.” Journal of Employee Assistance, Fourth Quarter: 7-9.

REFERENCES

AUTHOR

Dave Sharar ([email protected]) the managing director of Chestnut Global Partners, a provider of international Employee Assistance Plans and related behavioral health services. He is also a research scientist with the Commercial Science division of Chestnut Health Systems.

John Burke ( [email protected]) is the presi-dent of Burke Consulting, an international consulting practice providing business development and stra-tegic positioning services for vendors of Employee Assistance Plans, work-life and related behavioral health services.

worldatwork journal 06 compensation guidelines in a...

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