Friday, February 8, 2013

The Future of Employee Assistance Program (EAP) Networks

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.
Related Posts Plugin for WordPress, Blogger...