Wednesday, January 20, 2010

EAPs Can Do Managed Care and Increase Their Value

1. If you work for an internal EAP with a company that is self-insured, consider approaching your human resources and benefits management team to discuss the possibility of getting the mental health component of your EAP "carved out" so you can provide limited managed care services. If you are a very well trusted tenured pro, they just might consider it. Listen up. I am not recommending to you anything that I have not done myself, including this task.

2. If you can achieve this goal, it will increase utilization rates dramatically. Here is the selling angle: 1) The EAP can pre-screen and refer employees to appropriate mental health professionals based upon their clinical evaluations and guidance. This will save money by getting employees to the right provider the first time.

As an incentive, permit 80% coverage for mental health benefits versus 50% for those that don't go through the EAP. Self-insured companies can do this sort of thing. This will also allow the EAP to identify behavioral/medical problems that may underlie existing disorders contributing to the symptoms brought to the EAP session by the client.

3. Even a phone interview with an employee to discuss a referral -- in the event the employee does not perceive the need for a face-to-face interview, or refuses -- can go along way toward identifying primary health problems that can be more effectively treated by the referral source the EAP might suggest.

4. If you succeed in getting a carve-out, the primary services you will provide include: 1) approving therapists; 2) notifying the insurance company who they should approve payment for; 3) re-certifying regularly; 4) selecting providers when a specialist on the managed care panel doesn't exist; and, 5) deciding to pay higher fees than the managed care company is willing to do themselves. This is a good deal for employees and can increase confidentiality. Yes, it will save money for the company, too. That's right, many managed care companies will not require "outpatient treatment reports" and they will accept the EAP's approval of out-of-panel therapists. You decide. You have to be diligent, but remember, "its your money not managed care's money."

5. All of this can limit the amount of clinical information, other than a CPT code, that will go to the massive computer memory at the managed care company. This improves actual and perceived confidentiality. Survey other internal programs nationwide to identify strategies capable of adding this dimension to your EAP services.

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