Challenge

An extensive hospital system reported increasing dissatisfaction and underutilization of its employee assistance program (EAP) at a time when workers said they needed more access to behavioral health services.

The existing EAP program allowed employees unlimited virtual visits but only three free face-to-face visits with a counselor. If additional care was needed, employees had to find an in-network behavioral health provider, establish another new patient relationship and re-initiate care for the same concern. The providers accepting new patients were limited, and time-sensitive care was delayed.

The health system had worked hard to successfully increase its heath savings account (HSA) plan participation, but employees on this plan complained about having to pay for additional behavioral health services. At the same time, those without HSAs were charged only a co-pay, generating ill will for the employer’s HSA program. Further, as employees waited for additional counseling, many turned to their primary care providers for prescription medications that may have been unnecessary had help not been delayed. Data analytics indicated an increase in the employer’s health plan expenses.

Solution

Hylant’s team worked with the client to identify solutions to the challenges, generated a list of qualified program managers, released an RFP, evaluated RFP responses, ensured that demand for services could be met and that the plan would meet IRS HSA compliance requirements, and made final recommendations.

The solution: An integrated EAP and behavioral health benefits program with a single, expanded pool of in-network providers. The new EAP plan allows for free, unlimited virtual visits. Evidence-based medicine shows that, on average, many behavioral health concerns can be managed with 7.5 visits. For this reason, the number of free face-to-face visits was increased to eight and expanded to “per incident/per year” for all employees and dependents.

When EAP visits are exhausted, patients can transition to using their behavioral health benefits and continue working with their existing counselor or clinician, avoiding critical delays in care. All providers bill the medical plan and receive a pre-negotiated reimbursement for services, which helps reduce out-of-pocket exposure for employees electing the HSA plan.

The new plan manager promotes the program effectively to employees. While cost savings was not an initial goal and the program had a higher fixed cost, the team calculates that the overall plan cost will result in a seven-figure cost reduction over time. Six months into the program, leadership, employees and behavioral health providers agree that the program is a success.

Partner with an employee benefits broker who will strategize and ensure that your health programs and benefits work for your entire team.