Employer action

Employer call to action

What businesses and policy leaders can do to better address economic, emotional burden of depression in the workplace

Have a clear idea of how your investment in health care, including that for depression, is being used. Identify the prevalence of behavioral health conditions in your covered populations, the percentage treated and where treatment occurs. Quantify spending on prescription medications used to treat mental illnesses, and identify if and where there is waste due to treatment adherence problems, under-dosing, overuse of brands, and other misuse. Identify barriers precluding patients from seeking treatment by a mental health specialist, such as higher co-pays, benefit limits or network inadequacy. Visit depressioncalculator.com from SHRM and PhRMA to better gauge cost of depression within your highly valuable employee population.

Experts say a reason health costs are skyrocketing is that payers aren’t paying enough attention to outcomes, so they end up financing care that can be unnecessary, expensive, or does little to improve health. Businesses, health plans, public agencies, professional training programs and funding groups need to support development of evidence-based protocols that demonstrate superior outcomes. Moreover, they need to communicate these to purchasers and providers for adoption and leverage, and educate their constituencies on the advantages of seeking this care. In the end, this may do more to control costs than short-term cost-cutting measures, say experts.

Proactive employers are actively managing the supply side by using comparative measures to assess provider performance and pushing providers to report their performance publicly; they also offer financial rewards to providers and create incentives for consumers to reinforce quality and efficiency. Participants in Leapfrog Group and Bridges to Excellence purchase health care according to its actual value. See statehealthfacts.kff.org for how your state’s health care compares with other states; and the Massachusetts model that mandates public release of performance and payment data.

When considering vendor programs in depression, employers can look for endorsements from the National Committee for Quality Assurance or URAC, both offering disease management vendor accreditation. Three with NCQA accreditation for depression programs are CorSolutions, Health Integrated and Kaiser Permanente Care Management Institute. Looking for a universal health plan evaluation tool? Visit eValue8, a disease management module from the National Business Coalition on Health. Depression is one of four conditions covered, and eValue8 queries health plans on identifying members with depression, treatment guidelines, member/physician support and more.

Mandating better coordination between general medical and specialty behavioral health services is key to improving health care service delivery, as significant quality and accountability problems arise from lack of coordination and integration among managed care vendors of employers. By rethinking their benefits design and requiring health vendors and managers to coordinate with one another, employers can minimize fragmented and ineffective care. Employers should also urge their health plans to reimburse physicians for collaboration and care management, so if primary care and mental health clinicians consult on a patient’s care, this would be covered by health plans; MercyCare Health Plans in southern Wis. reimburses for care management.

Often, depressed employees will avoid treatment over fears that it will adversely affect their career. So the key to containing costs from workplace depression is to ensure that employee confidentiality is upheld, that barriers to treatment are minimal, and that workplace repercussions are absent. Forward-thinking employers are working their EAPs to remove the stigma of depression, and to offset the significant cost differential between encouraging depressed employees to seek treatment and not doing so. For more on building a healthy and highly functioning workplace read “Mental Health: It’s part of our workplace” from SAMHSA, the Substance Abuse and Mental Health Services Administration.

Research shows that more than three-quarters of benefit managers believe the cost to their companies in lost productivity because of depression is greater than the cost of treating this condition. Yet only 11 percent facilitate employee screenings. Evidence-based anonymous screening tools for behavioral and substance-use disorders are offered through Screening WorkplaceResponse by Screening for Mental Health, Inc.



One of the most important, practical and easiest steps employers can take to minimize the effects of depression in the workplace is to ensure primary care physicians are being paid for screening for depression. Often physicians do not screen for depression because they believe they will not be paid for their time. Employers can ask insurers to educate physician office managers on how to code a visit so that a screening test would be covered. Communication is key and often a policy change is not needed—just communication between employer, insurer and provider.

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