A Fresh Perspective
The Positive Impact of Employee Assistance Programs on Workplace Productivity
by Carol Harnett, Chair, Health and Performance Innovation Institute
Employee benefits brokers and consultants are uniquely positioned to counsel employers on how to address, according to the World Health Organization, the leading cause of "years lost to disability" – depression.
How can you accomplish this challenge? Two ways. First, you can assist your clients by starting – and finishing – the uncomfortable conversation around mental, emotional and behavioral health and how it impacts their employees and the workplace. Second, you can encourage employers to establish or maintain a service that effectively addresses emotional health issues – an employee assistance program (EAP).
How do you begin what, for some, is an emotional conversation about mental health and depression? Start with a business approach.
The World Health Organization (WHO) uses the Global Burden of Disease initiative to help countries sort out the productivity costs of diseases. WHO also ranks these diseases by their impact on mortality and disability as well as the cost-effectiveness of available interventions.The Global Burden of Disease message is three-fold:
- Treating illness costs money (direct costs);
- Not treating illness also costs money (indirect costs); and
- When indirect costs are greater than direct costs, treatment becomes an investment opportunity.
This approach begs a question. Can increased health care expenditure be an investment opportunity? According to Ron Kessler, a sociologist and professor of health care policy at Harvard Medical School, the answer is yes. "Flu shots and addressing seasonal allergies and safety-sensitive jobs have delivered return on investment for employers."
"There are also a number of major disease categories which present corporate investment opportunities," according to Dr. Kessler. "You find them by looking for commonly-occurring illnesses that are associated with substantial work impairment, are undertreated and for which effective treatments exist and produce a short-term ROI."
Dr. Kessler, the most widely cited researcher in psychiatry in the world for the last nine years, finds five of the most common conditions that represent the greatest opportunity for employers are depression, GERD (gastroesophageal reflux disease), sleep problems, back and neck pain, and anxiety.
At first blush, the almost 25 percent prevalence of back and neck pain seems like the greatest opportunity. When you combine prevalence, however, with the percentage of employees treated and excess lost workdays every year, tackling depression presents almost twice as much opportunity for employers (113 excess lost workdays for every 100 employees with depression versus 60 for workers with back/neck pain).
Depression is only the tip of the behavioral health iceberg. When you include the full array of mental health disorders, an estimated 26.2 percent of Americans over 18 years old struggle with emotional issues in any given year, according to Dr. Kessler’s research. And that figure doesn’t include the things that weigh on all of us like the economy, aging parents, growing children, job security and new-century problems such as online privacy, identity theft and over-mortgaged homes.
So, given all this mood-lowering news, is there something tangible that employers can do to help both their workplaces and their employees? The answer, again, is yes. And you can find the strategy within EAP’s – along with an array of work/life benefits such as child and elder care referral services, legal and financial consultations and even identity theft protection.
Dr. Kessler and I were, coincidentally, leading separate research projects several years ago around the effectiveness of employee assistance programs and the workplace, including disability claim incidence and duration. You can find details about Dr. Kessler’s research in the Journal of the American Medical Association (JAMA. 2007; 298(12):1401-1411) under the title, "Telephone Screening, Outreach, and Care Management for Depressed Workers and Impact on Clinical and Work Productivity Outcomes. A Randomized Controlled Trial." I will highlight my major findings here.
Let me start at the finish line and work backward. Employers who promoted their EAP’s and had good employee participation experienced a four to one return within six months to one year. Dr. Kessler’s team and mine found the same ROI even though our design was different.
In my case, the ROI was associated with decreased short-term disability claim incidence. The companies who experienced decreased incidence also showed employee assistance program utilization of at least 10 percent. Average EAP utilization for the employers who did not show decreased STD claim incidence was five percent.
The bottom line: simply having an EAP in place isn’t enough to keep employees happy, functioning and at work. People actually have to use it.
The other major finding from our research was the number of short-term disability claimants who were paid the maximum STD benefit:
- Nine (9) percent of employees whose employers did not offer EAP were paid the maximum benefit and effectively transitioned to long-term disability.
- Two (2) percent of workers who had access to an employee assistance program and used it were paid through the end of the STD benefit.
- In comparison, 6 percent of employees who were receiving STD benefits but didn’t use their EAP were paid the maximum STD benefit.
Another key point: most employees who go out of work and use their EAP go back to work before the short-term disability period ends.
How many visits did it take to achieve these results? That’s where the conversation gets interesting. Two EAP interactions, on average, drove these results.
The overall lesson for me was that when you get employees help early on, they stay at work and, if they leave work on a STD claim but use EAP, they will return to work before their benefits end.
Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, disability and value-based health. Follow her on Twitter via @carolharnett and on YouTube via The Work.Love.Play.Daily video blog.