A debate is taking place in the Employee Assistance Program (EAP)
industry over the effectiveness of specialized EAP/Wellnesscompanies
and national insurance companies with large integrated EAP/behavioral
health networks. The EAP industry has long made the assumption that the
Specialty EAP/Wellness companies provide higher quality services and
yield better Returns On Investment (ROI). However, insurance company
EAP's have gained significant market share of the EAP industry.
Specialized
EAP/Wellness companies provide small local networks of EAP counselors,
management consultants and highly experienced account managers that have
a deep understanding of specific company cultures, needs and
expectations. Many of the large national insurance companies have large
significantly discounted EAP and integrated behavioral health networks
with high levels of member geographic access and include most of the
same providers as the specialty EAP companies.
The ROI of both
network types are difficult to measure accurately. However, both
Specialty EAP companies and insurance company EAP's are mitigating their
weaknesses and leveraging their strengths to compete in the EAP and
Wellness market.
Specialized EAP Company Networks
Specialty
EAP/Wellness companies tend to have small highly specialized EAP
networks. Most Specialty EAP/Wellness companies require EAP providers to
meet minimal standards in addition to having specific documented
training and experience with Employee Assistance.
Typical Minimal Requirements:
· Master's or doctorate in behavioral health field
· State License to Practice Independently
· Professional Liability Insurance Coverage
Many specialty EAP/Wellness companies require the following additional training and experience to be documented:
· One or more years of documented EAP training and counseling experience
· Ability to provide screening, brief-intervention and referral to treatment (SBIRT) or solution-focused counseling
· Ability to provide collateral contact, follow-up, and case management services
· 15-24 hours of specific training in the area of substance abuse
Specialty EAP/Wellness companies also tend to have even more specialized sub-networks.
· Post-Traumatic Stress Debriefing Specialistsand Crisis Response Networks
· Topic Specific Training Networks (stress, obesity, diabetes, anger, management dynamics, etc)
The
Specialty EAP/Wellness companies usually have local account managers
for every company worksite. Local account managers are highly
experienced EAP counselors and consultants that have experience working
with specific companies and/or local workforces and understand the
company culture. Local account manager's work with both management and
employees.
All Specialty EAP/Wellness companies have expert
management consultants. EAP/Wellness management consultants are highly
experienced and credentialed professionals that consult with either
management or human resources on behavior related employee issues.
EAP/Wellness management consultants have broad multi-industry experience
working with high-risk employee behaviors and issues. EAP/Wellness
management consultants provide critical consultation to companies on
unanticipated consequences of individual employee situations and
situations that affect large groups of employees.
Specialty
EAP/Wellness companies historically have provided small highly
specialized EAP networks. In some areas, because of the more intense
provider requirements geographic member access/availability to qualified
providers may be limited. For national employers, Specialty
EAP/Wellness companies may not have qualified network providers near all
of their locations.
Issues of Mitigation for Specialized EAP/Wellness Companies
· Network Size and Access: Lease large EAP networks and offer telephonic or video options
· Lack of Network in Areas of New Business: Add contractual network expansion performance guarantees
· Integration: Match health plans behavioral health network
· Accreditation:
· NCQA Certification
· Credential to NCQA standards and seek delegation agreement with healthcare organization
· Cost: Develop clear differentiation of the value of smaller highly specialized EAP/Wellness networks.
Certified Employee Assistance Professional (CEAP) Issue
The
Employee Assistance Professionals Association (EAPA) has an excellent
EAP professional certification program. The program was launched in 1986
but has had a minimal impact on the EAP/Wellness Industry for two
profound reasons.
1. Limited Access: Internationally, there are
only 4000-5000 CEAP's. Possibly more than half of the CEAP's do not have
state licenses to practice independently because it is not a
requirement, consequently making them ineligible for network
participation. Another half of CEAP's are part of internal EAP's and are
not participating in external EAP networks.
2. Cost or
Incentives: Whereas the CEAP credential assuresa high level of
understanding of employee assistance; the credential is relatively
expensive for independent practitioners and is not a requirement to
participate in any external EAP network. The credential costs the same
or more than many state licenses and results in a very small fraction of
new referrals.
The CEAP is an excellent credential; unfortunately
hardly a factor in today's national EAP networks because of limited
access or incentives for providers to become CEAP's. Today the CEAP
credential cannot be used to measure the quality of any external
EAP/Wellness program because of the small percentage of CEAP's in the
provider universe.
EAP Leased Network Issue
There are
several national/international EAP networks available for lease. Leased
networks can provide advantages but come with limitations as well.
1.
Leased networks are expensive in a commoditized industry. Costs are
difficult to trend and usually involve market specific discounted rates
and per member, per month (PMPM) charges and/or administrative fees.
2.
Generally, the large leased EAP networks are not accredited and do not
bring the same value as the large integrated EAP/Behavioral Health
insurance company networks.
3. Many EAP networks do not have
assignable language in their provider contracts; meaning legally the
providers cannot be leased to a third party. While it is rare in EAP, in
retrospect providers could prohibit third parties from assuming the
contracted discounted rate and be entitled to a significantly greater
fees or their full charges consequently neutralizing any discounted
advantage of the leased network.
The Insurance Company Integrated EAP/Behavioral Health Networks
All
of the large insurance companies have large national behavioral health
networks. Their behavioral health networks meet the nationally accepted
network access standards wherever the health plan has members or plans
to sell new business. Most health plans have built EAP networks by
amending the contracts of their existing behavioral health providers. In
a short period of time, this has resulted in very large, highly
discounted, NCQA accredited, national EAP/Behavioral Health Integrated
networks. The health insurance company incurs no extra cost to build,
manage or maintain their EAP networks. EAP is one of many product
amendments made to existing provider contracts.
Some insurance companies require the provider to list "EAP" as a specialty or require EAP experience.
The minimum requirements for most insurance company EAP/behavioral health providers:
· Master's or doctorate in behavioral health field
· State License to Practice Independently
· Professional Liability Insurance Coverage
NCQA
requires health plans to source verify the information above. However,
does require source verification of any specific experience; such as EAP
experience.
Consequently, the insurance companies EAP/Behavioral
Health generally do not have as specialized EAP networks. However, many
insurance companies can easily identify the self-reported specialties of
their providers. In addition, it is possible that every EAP specialist
in a specified market may be contracted.
Issues of Mitigation for Large Insurance Companies with an Integrated EAP/Behavioral Health Network
· Identify and report EAP specialists within the network
· Develop separate sub-networks
· Offer telephonic or video options
· Develop or acquire a strong internal EAP department
· Identify local market experts and develop consulting partnerships
· Differentiate the value of integration and provider discounts in comparison with specialty services.
