Linking Workplace Polices & Programs with Treatment Utilization: Preliminary Findings

Linking Workplace Polices & Programs with Treatment Utilization: Preliminary Findings

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  Linking Workplace Policesand Programs with Treatment Utilization: Preliminary Findings Presenters: Brandeis University: Bernie McCann, M.S., CEAP MHN: Deirdre Hiatt, Ph.D. Addiction Health Services Research Conference Boston, 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 AbuseTreatment 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 BackgroundEmployee 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 onPathways 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 O bservable 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 SourcesAdministrative 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 Focusof 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 Percentof enrollees (N = 697,389 enrollees ) For EAP enrollees, n = 129,639 For Integrated enrollees, n = 567,750 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%
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  Environmental Factors (N= 697,389 enrollees ) *Data gathered for benefit year 2005 Percent of Enrollees b y 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%
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  Employer Policies (N= 697,389 enrollees ) *Data gathered for benefit year 2005 Percent of Enrollees b y 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%
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  Predictors of AnyClaim: Covariates Enrollee type [ref = Dependent] Gender [ref = Male] Female Employee < 18 Age group [ref = 36-55] 18-35 > 55 EAP product 1 Integrated product *Values significant P <.01; **P<.05 Logistic regression odds ratios; N = 697,389 enrollees
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  Predictors of AnyClaim: 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 1 2.56* EAP product Integrated product
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  Predictors of AnyClaim: Employer Policies/Workplace Activity Zero tolerance for policy violation 1 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.