View
1
Download
0
Category
Preview:
Citation preview
Evaluating quality in mental health careThe shortcomings of traditional EAPs and health plan networks and how to overcome them
A LY R A W H I T E PA P E R | M A R C H 2 0 1 9
Executive Summary
Employers are increasingly making mental health one of their top priorities. With anxiety and depression on the rise, 61 percent of employers say they will implement a company-wide behavioral health action plan by 2021, according to Willis Watson’s annual Best Practices in Health Care Employer Survey1.
It’s a sound business decision. A report2 issued by the National Alliance of
Healthcare Purchaser Coalitions (NAHPC) claims that every dollar spent on more
effective and easily accessible mental health coverage, potentially returns four.
Unfortunately, many traditional health plans, Employee Assistance Programs
(EAPs), and app-based solutions still aren’t addressing the fundamental issues
of accessibility and quality care. Meanwhile, employees are receiving care that
may be ineffective or even harmful, while employers foot the bill for inadequate
solutions.
With the cost of healthcare already so high, no one has an appetite for additional
wasted investments. The good news is that there are steps you can take to
evaluate the quality of your existing mental health benefits.
This report covers two important facets of the quality conversation:
The limitations of traditional networks and EAPs
The five key criteria to evaluate mental health solutions
Use this guide to help you consider alternatives that may more fully address the
challenges of quality and accessibility.
Poor mental health care has a high price for companies and employees.
1.
2.
Evaluating Quality in Mental Health Care | March 2019 PAGE 3
The challenges of traditional networks and EAPs
In traditional networks, only 5 percent of providers are both offering therapies that have been proven effective and available to see new patients. It’s no wonder employees find these traditional programs difficult to use and employers have difficulty measuring their effectiveness.
Challenge #1: poor network adequacy — bigger isn’t necessarily better
Many traditional networks and EAPs create the illusion of access with their
large networks, but fail to vet providers for quality or availability. While many
employers consider a large network an indicator of guaranteed access, most
provider directories include clinicians who are not taking new patients, retired,
or even deceased. The reality is, 75 percent of in-network providers aren’t
accepting new patients. Of the remaining 25% who are available, even fewer
practice effective therapies proven to work.
Employers may review geo-access reports, which look at provider density across
urban, suburban, and rural geographies. However, this method for evaluating
access does little to assess the actual availability of those providers or whether
their expertise is a good fit for employees’ needs. Without rigorous and ongoing
management of provider availability, networks are more limited than they
appear, and on average, patients have to wait 21 days for their first appointment.
Looking for a metric to evaluate just how small these “big” networks actually
are? More than 50 percent of mental health and substance abuse claims come
from out-of-network providers. The issue is specific to mental health — more
than half of mental health providers practice outside of employee health
networks, compared to only three percent of primary care physicians.3 This
75% of in-network providers aren’t accepting new patients.
Evaluating Quality in Mental Health Care | March 2019 PAGE 4
broken system creates a barrier for those seeking care and increases costs, as
many patients are forced to pay-out-of pocket and deal with the hassle of health
plan reimbursements. With the rising prevalence of mental health issues across all
ages and costs increasing, the matter is only getting worse.
Challenge #2: Treatments that are ineffective or harmful
When an individual seeking care finally gets an appointment, it may be with a
provider who is a poor match for their specific issues, or practicing treatments
that aren’t proven to reduce symptoms. Only 20 percent of therapies practiced
today have evidence that proves they help patients improve or recover. The
80% of therapies have never been proven to work
Proven methods
˚ Cognitive Behavioral Therapy
˚ Acceptance & Commitment Therapy
˚ Dialectical Behavioral Therapy
˚ Prolonged Exposure Therapy for Trauma
˚ Interpersonal Therapy for Depression
˚ Emotionally-Focused Therapy
˚ Exposure & Response Prevention
˚ And more…
Unproven methods
˚ Family Constellations Therapy
˚ Coherence Therapy
˚ Past Life Regression Therapy
˚ Focused-Orientation Therapy
˚ Imago Relationship Therapy
˚ Jungian Depth Analysis
˚ Regression Therapy
˚ Dream Work
˚ Shamanism
˚ Brainspotting
˚ Biogenetic Analysis
˚ Possibility Therapy
˚ Redecision Therapy
˚ Postmodern Therapy
˚ PsychoDrama
˚ Body Talk System
˚ Play Therapy
˚ Somatic Therapy
˚ Lifespan Integration Therapy
˚ Emotional Freedom Techniques
˚ Depth-Oriented Brief Therapy
˚ And more...
FIGURE 1: UNPROVEN TREATMENTS ARE COMMONLY PRACTICED WITHIN TRADITIONAL NETWORKS
Evaluating Quality in Mental Health Care | March 2019 PAGE 5
remaining 80 percent of therapies may be ineffective, or even iatrogenic,
meaning that they can actually cause psychological harm. Harmful therapies
include Conversion Therapy and Recovered-Memory Techniques.4
Challenge #3: High friction in the member experience
Attempting to get support from an EAP can be an exercise in futility for many
members. Sixty-seven percent of people never get care due to the many
barriers,5 highlighted in figure two on the following page. After being routed
through an 800-number, they are left to sort through a cumbersome directory of
providers with little support to understand what is the right care for their issues,
or help finding a therapist or coach who offers it. EAPs offer minimal online
content for self-care support, while what is offered is typically unengaging. This
friction, plus the high cost of care and stigma around mental health, results in
as few as one in seven receiving effective care. Sadly, people with anxiety or
depression wait an average of eight or more years before they get help.6
Challenge #4: Lack of insight into quality and results
Unfortunately, most EAPs don’t take a data-driven approach to evaluating
patient progress to ensure that people are actually getting better. Best practices
for quality care include capturing a baseline assessment for each patient and
gauging progress throughout treatment using standard clinical measures. It is
advisable not to rely on proprietary measures defined by an EAP, but instead to
look for standardized measures that have been validated for patient outcomes,
like the PHQ-9 (used for evaluating symptoms and severity of depression) and
GAD-7 (used for evaluating symptoms and severity of anxiety).
EAPs may track some form of engagement and use this as a measure of the
value of their service, but even then, how they calculate this metric may be more
noise than signal. An average of two percent engagement nationally is hardly
an impressive result, especially when you consider that almost 20 percent of
Americans suffer from a mental health issue in any given year. Some EAPs report
higher engagement rates, but often count non-meaningful touchpoints in their
Sadly, people with anxiety or depression wait an average of eight or more years before they get help.
Evaluating Quality in Mental Health Care | March 2019 PAGE 6
numbers, such as calls into their call center or visits to an EAP-hosted booth at a
wellness event. Misleading numbers conceal how few people are, in fact, able to
access care.
Challenge #5: Limited coverage and types of care
Research shows that most people need between eight and 16 sessions to reliably
improve or recover from anxiety and depression. However, most EAPs only cover
three to five sessions before referring members back to their health plan. While
the health plan may offer more coverage, individuals face a myriad of challenges
that may prevent them from receiving effective care. Without adequate coverage
to help individuals improve, outcomes and quality suffer.
In addition, most EAPs don’t offer different types of care, such as self-care apps,
coaching, and therapy, suited to address the diverse needs of a workforce. They
typically offer a one-size-fits-all approach that doesn’t account for the variety of
issues and varying degrees of severity, requiring different treatments. Without the
appropriate type and level of care for each individual, it is difficult to demonstrate
reliable improvement and high rates of recovery.
EAPs engage an average of 2% of employees.
FIGURE 2:
Traditional EAPs - High friction and only 2% engagement
Lose motivation and give up
Lose motivation and give up
Lose motivation and give up
Lose motivation and give up
Call 800-number, sift through a directory
Wait 1+ months for an appointment
Receive poor
quality or wrong care
Quit or make little progress
Call a dozen providers, wait for
call-backs
Evaluating Quality in Mental Health Care | March 2019 PAGE 7
How to evaluate the quality of your mental health solution
Understanding the intricacies of mental health treatments, provider networks, and benefit coverage is enough to overwhelm even the most seasoned benefits professionals, not to mention the members who are looking for support. Here we will break down the most important components to consider when evaluating the quality of your current solution or considering a new solution.
Do your networks do the following?
1. Include only treatments that are evidence-based
There are hundreds of therapies out there, but only a handful of them have
been proven to work. Known as evidence-based treatments, as defined by the
Society of Clinical Psychology,7 these proven methods have been researched
and tested in randomized controlled trials and repeatedly demonstrate results in
terms of helping people actually feel better. Common evidence-based therapies
(EBTs) include Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and
Exposure and Response Prevention (ERP).
Ask your EAP if they exclusively offer providers who practice EBTs.
When your network offers only providers who practice evidence-based
treatments, your employees receive the most effective care to improve
functioning and recovery, as quickly as possible. The result is a healthier, more
productive workforce and, over time, lower health care costs overall.
If your EAP only offers a lengthy directory without personalized recommendations, it will be a frustrating experience that doesn’t result in effective care.
Evaluating Quality in Mental Health Care | March 2019 PAGE 8
Check to see if your EAP supports individuals in finding providers
suited to their needs.
Therapies are evidence-based only for a specific problem area, so individuals
seeking care need further support to find and choose a provider who has
expertise suited to their needs. For example, Exposure and Response Prevention
is the gold standard treatment for someone with Obsessive Compulsive
Disorder (OCD), but is not recommended for someone with a primary psychotic
disorder. If your EAP only offers a lengthy directory without personalized
recommendations, it will be a frustrating experience that doesn’t result in
effective care.
2. Verify your network adequacy and quality
While many EAPs and health plans tout a large network, it’s worth exploring how
they recruit, qualify, and train providers to maintain quality and availability on an
ongoing basis.
EBTs for…
Depression
˚ Behavioral Activation
˚ Cognitive Behavioral Therapy
˚ Problem-Solving Therapy
˚ Self-Management Therapy
PTSD
˚ Prolonged Exposure
˚ Cognitive Processing Therapy
˚ Seeking Safety
˚ Present Centered Therapy
FIGURE 3: EXAMPLES OF EVIDENCE-BASED TREATMENTS
Evaluating Quality in Mental Health Care | March 2019 PAGE 9
FIGURE 4: WHAT IS AN EVIDENCE-BASED TREATMENT?
1. Fewer than 25 sessions - Evidence-based treatments are often
short-term, and research shows that the results are long-lasting.
2. Goal-setting - Providers focus treatment sessions on specific
patient goals and continually track progress towards those
goals.
3. Progress measurement - Tracking patients’ progress via
thoroughly researched clinical measures allows providers
to tailor their approach to ensure efficacy. Standardized
measurement tools include PHQ-9 and GAD-7.
4. Skill development - When people are stuck, they sometimes
need new strategies rather than insight or catharsis. Effective
treatments teach practical skills to better manage thoughts,
emotions, and behaviors.
5. Skill practice between sessions - Treatment usually involves
assignments to help patients practice new skills. The more they
practice, the faster they progress.
The most effective methods share some common characteristics8
Key questions to ask:
How does your EAP ensure that providers are accepting new patients?
Look for an EAP that has processes in place to assess provider availability
on an ongoing basis. Also, verify that your network includes providers who
are located near where your employees live and work and have expertise
that matches their needs. To ensure the best member experience, the
EAP should offer bi-weekly verification or real-time updates synced with
providers’ calendars and the option to book appointments online.
Modern solutions will use smart data-driven tools to rapidly identify, qualify, and onboard high-quality providers who are right for your workforce.
Evaluating Quality in Mental Health Care | March 2019 PAGE 10
Does your EAP curate and expand their network based on your needs?
Consider a mental health solution that uses technology and data to build and
maintain their network. Modern solutions will use smart data-driven tools to
rapidly identify, qualify, and onboard high-quality providers who are a good
fit for your workforce. This curated network should account for where your
employees live and work, who they are, and the types of issues they’re dealing
with. To effectively address their needs, your network should have the right
mix of providers, including therapists and coaches specializing in children,
couples, parents, Millennials, diverse and sensitive populations, substance abuse,
suicidality, and self-harm. In the age of personalization, your employees expect
and deserve care that is tailored to them; technology enables this at scale.
What incentives does your EAP offer to attract the highest quality clinicians?
With so few providers participating in traditional networks, find out how your EAP
is attracting the best evidence-based providers. Look for EAPs that simplify the
business of having a private practice. This might include steady client referrals
whose needs match their expertise; APA-accredited continuing education
training; and tools for managing invoicing, scheduling, and more.
Does your EAP include providers who only practice
evidence-based therapies?
Evidence-based treatments are an important foundational component to
ensuring high quality care. Consider how deeply your EAP adopts an evidence-
based approach to care. How do they recruit providers and assess their practice
approach on an ongoing basis?
3. Use technology to improve the member experience
Look for smart technology that overcomes stigma and barriers
Does your EAP or mental health solution offer the convenience and simplicity of
modern web and mobile applications as a core part of the member experience?
You can order groceries, delivered to your home, from an app and get music
recommendations perfectly suited to your taste. You should expect the same
modern approach to mental health care.
Data-driven technology can intelligently match employees to the right type of care for their needs.
Evaluating Quality in Mental Health Care | March 2019 PAGE 11
Online tools that streamline the member experience help to overcome stigma
and other barriers to care. Online platforms can collect data from individuals
— symptoms, severity, and preferences — and intelligently match them to the
right care — from self-care apps and digital lessons to one-on-one work with a
mental health coach or therapist. Tools can also offer convenient instant online
booking to make the process more approachable and private.
Include care navigation and guidance tools for personalized care
Are personalized care recommendations a key component of your mental
health solution? Data-driven technology can help employees navigate the
complexities of mental health care and intelligently match them with the right
type of care. Having an elite network of available providers is an important
foundation, but it is still not enough to ensure optimal outcomes. Different
evidence-based treatments are designed for different problem areas. For
example, Cognitive Behavioral Therapy (CBT)is a good fit for relieving
symptoms of anxiety and depression and Motivational Interviewing (MI) is
designed to help people suffering from substance use disorders. A one-size-
fits-all approach or leaving employees to navigate the complexity alone will
result in subpar care or no care at all.
Include app-based messaging, digital exercises, and self-care resources
Does your EAP offer self-guided tools, resources, and one-to-one messaging
with providers between sessions? Some EAPs have online content, but most
is not evidence-based or particularly engaging. Quality self-care options are
important for enhancing skill development between sessions with a provider
and those who prefer to tap into support anytime, anywhere.
4. Measure quality using data
How does your EAP demonstrate value? If it’s more of a black box than a
beacon of clarity, explore whether it is tracking and measuring the right criteria
to help you understand quality of care. Defining the right metrics is important to
shed light on engagement, satisfaction, and outcomes. Assess these measures
for your EAP on a quarterly basis to ensure it's living up to its promise.
To effectively address their needs, your network should have the right mix of providers, including therapists and coaches specializing in children, couples, parents, Millennials, diverse and sensitive populations, etc.
Evaluating Quality in Mental Health Care | March 2019 PAGE 12
Theme Metrics
Engagement ˚ % employees engaged (sign-ups)
˚ % engaged who get into care
˚ Average time to first appointment
Satisfaction ˚ % satisfaction with member experience
˚ % satisfaction with provider
Outcomes ˚ % improved or recovered (clinical)
˚ % stress reduction (subclinical)
Population Insights
˚ % engaged in different care programs (therapy, coaching, self-care apps)
˚ % by primary need (stress, anxiety, depression, etc.)
˚ % by modality (in-person, video, onsite, self-care)
˚ % breakdown by demographics (age, gender)
FIGURE 5: RECOMMENDED MEASURES OF QUALITY
5. Offer comprehensive care for every need
Lastly, make sure your EAP or mental health solution is addressing the diverse
spectrum of needs across your entire employee population by offering different
types of care with an integrated approach. There are three different facets to
consider:
Modalities
Give employees different ways to receive care — in person at a provider’s office,
via a live video call from a convenient location of their choice, or through a self-
guided app. Also consider the option of bringing a mental health provider onsite
at your office for added convenience.
Give employees different ways to receive care — in-person at a provider’s office, via a live video call from a convenient location of their choice, or through a self-guided app.
Evaluating Quality in Mental Health Care | March 2019 PAGE 13
Types of care
Offer care options that are tailored to different levels of severity. For those
with mild symptoms of stress or relationship issues, mental health coaching
is a great option. For those with moderate symptoms, a blended care
approach that offers sessions with a provider plus online exercises and digital
content may be a good fit. For those with more severe symptoms, in-person
therapy will be most effective. Also, ensure that these different care options
are integrated for seamless transitions in the event that an individual starts
down one care path and needs to be transitioned to more intensive care. It’s
important to meet people where they are, help them find and access the right
care, quickly and easily, and make the entire experience seamless.
Care coverage
Most EAPs only offer a few sessions, which often isn’t enough to make any
significant improvement. Consider an EAP that offers enough coverage, at least
16 sessions, so that your employees have the care and support they need to
improve and recover. Research indicates that 16 sessions of evidence-based
treatment is often enough to help individuals develop new coping skills that
have lasting results.
Summary — five dimensions of quality
As you look for solutions to support your employees' mental health, manage
costs, and increase productivity, there are five key dimensions to evaluate:
1. Evidence-Based Treatments
2. Curated, Data-Driven Network
3. Clinically Valid and Standardized Measures
4. Tech-Enabled Member Experience
5. In-Person and Virtual Care Options
Consider an EAP that offers enough coverage, at least 16 sessions, so that your employees have the care and support they need to improve and recover.
Evaluating Quality in Mental Health Care | March 2019 PAGE 14
Each dimension is equally important to delivering measurable clinical outcomes
for employees in need. Quality solutions will offer proven methods through a
variety of channels suited to each individual. It will measure the effectiveness of
care at every stage of the care journey. It will use modern technology to enable
convenience and smarter, more data-driven care. And lastly, technology will
not ever completely replace the need for face-to-face work with an in-person
provider.
Your employees deserve the best care and with these five quality dimensions
in mind, you can take a quality-driven approach to evaluating mental health
solutions on the market today.
Dimensions of Quality What to Avoid What to Look For
Evidence-Based Treatments ˚ Treatments that are ineffective or harmful ˚ Only evidence-based treatments and providers
who practice them
Curated, Data-Driven Network ˚ Large network of providers with unverified quality
or availability ˚ Highly-curated network of available providers based on members’ needs and location
Clinically Valid and Standardized Measures
˚ Engagement metrics that don’t include whether or how quickly people access care
˚ No outcomes measures or non-standardized clinical measures
˚ Engagement metrics such as % of sign-ups, % in care, and average time to first appointment
˚ Standardized outcomes measures, such as PHQ-9 or GAD-7, that quantify % improved and % recovered
Tech-Enabled Member Experience
˚ Cumbersome directory of providers
˚ Little personalization or guidance to the right care
˚ Online portal that intelligently matches individuals to the right care, based on patient data (symptoms, severity, preferences) and provider data (treatments, expertise, availability)
Comprehensive Solution
˚ Point solutions that address a narrow set of issues or a small population
˚ One or few modalities (i.e., only self-care, in-person care, or virtual care)
˚ Tightfisted session limits that may not provide enough care for improvement or recovery
˚ Personalized recommendations for available providers
˚ Care for a diverse spectrum of clinical needs: therapy, coaching, self-care options
˚ Many modalities: virtual and in-person care
˚ Session coverage driven by the amount of care needed for clinical improvement (16-25 sessions)
FIGURE 7: FIVE DIMENSIONS OF QUALITY AT A GLANCE
References1. Willis Towers Watson 23rd Annual Best Practice in Health Care Employer Survey. (2019, January 3). Re-
trieved January 9, 2019, from https://www.willistowerswatson.com/-/media/WTW/PDF/Insights/2018/10/wtw-23rd-annual-best-practices-in-health-care-employer-survey-executive-summary.pdf
2. Achieving Value In Mental Health Support: A Deep Dive Powered by eValue8. (2018, August). Retrieved January 9, 2019, from http://higherlogicdownload.s3.amazonaws.com/NAHPC/3d988744-80e1-414b-8881-aa2c98621788/UploadedImages/Achieving_Value_in_Mental_Health_Support_Report_Final_9_12_2018.pdf
3. Achieving Value In Mental Health Support: A Deep Dive Powered by eValue8. (2018, August). Retrieved January 9, 2019, from http://higherlogicdownload.s3.amazonaws.com/NAHPC/3d988744-80e1-414b-8881-aa2c98621788/UploadedImages/Achieving_Value_in_Mental_Health_Support_Report_Final_9_12_2018.pdf
4. Lilienfeld, S. (2007). Psychological Treatments That Cause Harm. Perspectives on Psychological Science, 1(2), 53-70. Retrieved January 8, 2019.
5. Layard, R., & Clark, D. M. (2015). Thrive: The Power of Psychological Therapy. Chapter 4, Page 54. London: Penguin Books.
6. Layard, R., & Clark, D. M. (2015). Thrive: The Power of Psychological Therapy. Chapter 4, Page 54. London: Penguin Books.
7. Tolin, D. (2010). Is Cognitive-Behavioral Therapy More Effective Than Other Therapies? A Meta-Analytic Review. Clinical Psychology Review, 30(6), 710-720. Retrieved January 9, 2019.
8. O’Donohue, W., Buchanan, J. A., & Jane, J. E. (2000). Characteristics of Empirically Supported Treatments. The Journal of Psychotherapy Practice and Research, 9(2), 69-74. Retrieved January 7, 2019.
About LyraLyra reimagines the EAP to provide companies and employees with personalized,
effective mental health care that works. Serving more than 500,000 members nationwide,
Lyra brings together technology and an elite provider network to improve access, quality,
and outcomes for your employees.
7x engagement | 3x faster access | 3x better outcomes
˚ Frictionless member experience
Our online platform helps members find care
in just a few clicks. They can sign up and book
appointments instantly, choose to meet virtually
or in-person, and tap into digital tools to build
new skills.
˚ Elite providers and proven treatments
Lyra only works with the most qualified and
effective providers. Our therapists and coaches
use only evidence-based methods proven to
help people feel better.
˚ Personalized care for every member
Lyra uses technology to intelligently match
individuals with the right providers and
treatments based on their symptoms, severity,
and preferences.
˚ Gain insight into effectiveness
Get visibility into member utilization, satisfaction,
recovery and improvement rates, and mental
health needs of your workforce.
Support for issues that are simple, complex, routine, or unexpected.
˚ Therapy
˚ Coaching
˚ Self-Care Apps
˚ Critical Incident Support
˚ Work-Life Services
˚ 24/7 Member Support
Ready to reimagine your EAP? Get in touch with us.
Featured Customers
Ready to reimagine your EAP? Get in touch with us.
partners@lyrahealth.com | www.lyrahealth.com
Recommended