Behavioral Help

Companies are employing new strategies and combining efforts with vendors in new ways to better manage mental-illness risk control.

Saturday, September 1, 2007
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Look inside two of America's leading companies to see how employers can today help their employees cope with personal problems.

The New York-based American International Group -- AIG -- is the country's wealthiest insurer, and Redmond, Wash.-based Microsoft the nation's leading information technology company. Within their global reach, both have tens of thousands of employees working domestically -- roughly 50,000 each.

They have crafted complex solutions to helping their employees cope when trouble hits. Their goal is to reduce down time and staff turnover, and increase quality of life.

In contrast to employee-assistance programs of a conventional model, AIG and Microsoft have vastly expanded the scope of services and intertwined internal and vendor resources.

AIG's EAP continues to successfully handle a stark challenge brought on by the 9/11 World Trade Center attacks. Post-traumatic stress disorder from the event afflicts a number of its New York City staff.

At the same time, Microsoft's highly advanced integrative approach and its investment in metrics point to where employee behavioral risk management is heading.

Indeed, the direction of employee behavioral risk management among the Fortune 500 today is aggressively headed toward combining resources, integrating programs and seeking out performance data where none existed before. This data dimension requires both employers and vendors to collaborate -- for the first time.

Employee problems can be isolated events, such as needing emergency child care, or episodes of chronic conditions, such as months of depression. They can be career-shattering threats, such as a descent into drug abuse.

Researchers and practitioners are measuring these risks and their toll better today than as recently as five years ago.

And they're finding a persistence of serious behavioral conditions, such as depression, bipolar disease and substance abuse within the American adult population.

American employers are encountering in their workforces just as many, if not more, very serious personal problems. At some point in their lifetimes, half of Americans will meet the clinical criteria for behavioral disorders, which factor into at least half of doctor visits by adults.

Then there are greater overall feelings of being pressured at work and home. As Linda Bern, who runs AIG's EAP, says, "How we address employee problems reflects how every living person is under a lot more stress than before."

"We have to stay ahead of the curve to develop resources to meet their needs," she adds, referring to work/life demands on workers such as elder and child care.

The Hybrid Solution

Bern, 58, works out of the Wall Street area office of AIG. She was brought up in the New York City area and earned her undergraduate degree at the University of Buffalo in psychology and French. With a master's in social work from Fordham University in New York, Bern has kept up her clinical license while managing EAPs for over two decades. After a stint at Philip Morris, she has been with AIG for 22 years. "I very much want to make a difference, here," she says.

Shortly before she started at AIG, the insurance conglomerate had made a decision to bring its EAP partly in-house and, thus, to adopt what EAP professionals call a hybrid model. Two years after she arrived, AIG promoted her to director of the health-assistance program. She now reports to both the head of the medical department, in which the program is lodged, and to the head of human resources. (The hybrid model has not changed since her promotion.)

With just one assistant, "I run the program and am responsible for quality assurance, and I see some people for assessment and referral and oversee the entire program through ComPsych," the company's EAP provider. Employees call a dedicated 800 number. Chicago-based ComPsych arranges for them to see a counselor within 24 hours. "We feel very strongly in the value of a face-to-face meeting with a counselor."

Having kept her clinical license intact, Bern also counsels employees. "I can get involved in matters of employee and employer conflict. One of the huge advantages of the hybrid program we have is that I am an AIG employee and know the culture, and managers feel comfortable with me. When someone calls me, I may refer them on to the HR people."

The most significant event in her career at AIG was, unquestionably, the World Trade Center terrorist attacks in 2001 -- three blocks away.

"We have seen and continue to see people who are still struggling with post-traumatic-stress disorder," she says. "We are still working with people who have had some time for symptoms to arise."

How It Worked on 9/11

AIG's response to the attack validated the hybrid model of pairing internal and external resources.

"I tend to come in early and was already in the office before the first plane hit. I very clearly recall hearing a noise and seeing paper fly. I put the TV on and saw the second plane hit. Our building shook at that time. Once the buildings collapsed, you could not look out because the air was black with dust. It was late afternoon when I left, around 2 or 2:30 p.m., and was able to get back to New Jersey where I lived."

The company moved its operations temporarily to an uptown Park Avenue address. But "we did not return to Lower Manhattan until the following Tuesday. I was working a lot from home. I was working to get ComPsych into the place. I got counselors ready to roll when we came back on Tuesday."

She arranged for employee meetings in special locations throughout the building. At each meeting, there were two counselors, and one might take an employee out of the group for more private counseling. The groups went on for a month.

As far as restoring employee productivity after 9/11, Bern says she doesn't have any numbers. But her sense was that people really wanted to get back to normalcy. People really wanted to work.

Employees with post-traumatic-stress disorder had access to help from several sources. "I personally know of at least a dozen cases," Bern says. Some could have gone out on disability with Bern knowing about them. Some people never came back.

She is sure there are people who accessed mental-health services through their health plans, and through ComPsych. An important byproduct of AIG's strict regime of confidentiality, which impedes data collection, is that the company does not have a unified database on PTSD cases.

Over time, the scope of services to employees through the EAP has expanded into the work/life domain. AIG has an elder-care program to help those caring for elderly relatives. For that, it relies on Partnership for Elder Care, which was founded in 1988 and works under the umbrella of a nonprofit sponsored by the New York City Department for the Aging.

"We have also expanded in terms of offering assistance with children services," says Bern. "You can dial the 800 number and be referred to a program, run by Child Care Inc., to help parents with special-needs children." Child Care is a nonprofit early education and child-care resource and referral agency based in New York.

Bern also provides emergency child care through Bright Horizons, headquartered in Watertown, Mass. Publicly traded, Bright Horizons is a leading provider of employer-sponsored child care. One manager, the mother of twins, called Bern to say, "I am sitting in my office crying because I can now take a vacation." Since her now-toddler children were born, she'd been using up all her leave time attending to child illnesses or covering when child care was not available.

The Microsoft Approach

This hybrid, broad scope of services model of AIG has been taken to new heights by Microsoft, which is now massively integrating it with other diverse employee-centric services. Microsoft, like AIG, blends internal with external resources, relying on numerous specialty vendors.

The software giant differs from AIG in consolidating many operations besides the EAP under the direction of a single team. That way, Microsoft reflects a trend toward greater integration of employee risk-management programs. Also, it has a cutting-edge involvement in metrics.

Theresa Melcher is the senior manager of U.S. benefits, responsible for the strategy, design and end-to-end management of multiple plans and programs involving more than 15 vendor partners.

These programs include disability management, leave of absence, time-off programs, workers' compensation, safety compliance, parenting programs, employee assistance, severance and unemployment administration. She has an immediate staff of eight.

Melcher has been at Microsoft for 11 years. Coming to the company with a recruiting background, she started in HR as a recruiting coordinator and moved to U.S. benefits a few years later to manage leaves of absence.

She was hired, as she tells it, on the basis of on-the-job training and experience.

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Microsoft's scope of services in the work/life domain is broad. Parenting programs include day-care discounts, family backup care, summer camps and more. The EAP even runs marital-counseling classes.

Not surprisingly, the company's EAP is popular. A relatively large share -- 10 percent or more -- of Microsoft workers make use of at least one service in a given year.

Melcher reveals her integrative style when she talks about reducing disability days of employees. "Our No. 1 goal is to promote early return to work from a leave of absence. One way we accomplish this is by partnering with our employees' health-care providers early on to ensure they understand that Microsoft welcomes reasonable accommodation requests -- anything from offering the opportunity for a gradual return to work to providing assistive technology/ergonomic equipment," she says.

She communicates with treating physicians to make sure they're aware of the range of free services "that might also enable an employee to return to work sooner." Some of these benefits include the EAP, weight management, disease management and smoking cessation programs, just to name a few.

She also works closely with the health plans and providers to get better outcomes from leaves due to mental health. "We updated our leave policies to help ensure employees seek appropriate care and treatment for behavioral-health conditions," she says. "Our behavioral-health benefits offer a generous number of visits in addition to those offered through the EAP. The policy changes, in conjunction with the utilization of our benefit options, have helped reduce time away from work."

"We've also partnered closely with a vendor that specializes in behavioral absence-management services," Melcher says, "such as employee telephonic interviews and peer-to-peer consultations. We also utilize job-coach vendors in accommodation situations to help employees perform essential functions of their positions and remain at work."

Keeping Track

In addition to hybrid and broad-scope services, there is one more key development in managing employee behavioral risk: better data.

Microsoft is engaged in benchmarking the performance of its disability programs with hundreds of employers who participate in EMPAQ, or Employer Measures of Productivity, Absence and Quality. This benchmarking service is organized by the Washington-based National Business Group on Health.

EMPAQ's core suite of comparative reports has covered disability cost, claim incidence, lost-time duration, Family and Medical Leave, incidental absence, employee satisfaction and return-to-work.

EMPAQ's growth since its creation a few years ago speaks to a major development in managing employee behavioral risk: the availability of reliable comparative data for benchmarking purposes. EMPAQ looks at costs, frequencies and outcomes. It can do that over time for one employer or compare with other employers in the same industry group.

The San Francisco-based Integrated Benefits Institute also provides benchmarking data on a single-employer and comparative basis.

The next step in data management is to assess the results of specific programs by using massive amounts of data. Cigna Behavioral Health just did that.

A pilot project, completed in 2006, involved about 500 claimants with major mental conditions such as depression.

Many of them also had physical conditions including diabetes and cardiovascular problems. All were enrolled in Cigna plans.

Their medical and disability experience could be tracked, step-by-step, in an integrated database. No easy task even today.

Cigna assigned telephonic care advocates to the group. The claimants received, on average, 1.2 hours a week of coaching and encouragement.

As a result, the enrolled population had 48 percent fewer outpatient visits for all purposes compared to historic patterns. In contrast, a control group experienced a 33 percent increase. Enrollee health-care expenses averaged $3,000 less than historical patterns.

Advances such as Cigna's put pressure on vendors to collaborate, data-wise. David Campbell, senior vice president for customers and quality management at ComPsych, says there is "going to be a better system for sharing and merging data to predict potential programs. The only way we can do this is to share data among vendors."

Ten years ago, most Fortune 500 companies sequestered their help to employees with personal problems into narrowly defined, telephonically run quick assessment and referral EAPs, run by a vendor.

Today, employers can arrange a mix of diverse resources and programs and can arm themselves with far better data. The underlying behavioral risks remain pervasive and difficult.

Yet, because of these advances discussed above, they are much more manageable.

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