Tuesday, August 13, 2013

Let's Try This Again: Where the Partners of "Real" Employee Assistance Programs Await

I would like to recommend as one EA professional to another that you read a very nice synopsis of risk management that you will find at Wikipedia.com. Like most, I am not one to recommend Wikipedia as true authority site, but if you want to know how an escalator works, you certainly will get an accurate understanding of it at Wikipedia. "Risk management" is something that EAPs almost never discuss, and there are those among us, having aligned themselves with managed care, would rather the topic not be broached. Why? It has implications for dumping health insurance aligned EAPs. Alas, I type... It appears, and is fairly obvious on closer inspection, that property casualty insurance markets represent untapped and healthier relationships for EAPs than the health insurance markets that keep co-opting the field in oblivion. These P-C markets and their constituencies are far removed from concerns of health insurance companies and their financial goals. Financial goals of health insurance companies have one concern...containing costs. Property casualty insurance and p-c customers something else, but it is not primarily containing costs. It is preventing losses, incidents, and events that "cost". Their goal is more precisely preventing losses that cost them and their customer money. This is a profound difference, and it has implications for EAPs, what they do, defining functional programs, maximizing utilization, expanding EAP reach and programmatic options, and devising ways to penetrate more potential risk areas within the human-behavioral continuum in order to prevent incidents. Typically losses of P-C insurers and their customers are are managed by risk management. Health insurance dollars are managed by denial of benefits and avoidance of payouts--sometimes sneakily. See the difference? Let's examine this further, and see if you get a little more excited. Risk mitigation measures have four tracks. Here they are: 1) Design processes or programs with adequate built-in risk control and containment measures from the start. 2) Periodically re-assess risks that aren't going away and see what can be done to reduce their impact or likelihood of occurrence, or create added intervention tactics. 3) Transfer financial risks to an external agency so if they happen, you survive financially. (e.g. Contract with re-insurers like Lloyds of London) 4) Avoid risks altogether (e.g. by closing down a particular high-risk business area altogether. (Hey, let's turn down all of the applicants who ever took statin drugs for high cholesterol.) Which of the risk management techniques above do EAPs fit into? (Excuse me, I mean to say real EAPs, fit into?) If you guessed #1 and #2, then you are correct. Health insurance works heavily with #4. It's called insurance denial or services denial. If you get the drift of this article, you can see two things: 1) Property casualty insurance companies don't know squat about real EAPs because we aren't exploring who and what they represent to the field. 2) As a result, they do not know who we are and how we can help them. and 3) health insurance is a lousy partner for EAPs because all they do is exploit a few elements of EAPs to prevent payouts. Here's a bonus observation: 3) Property casualty insurance and risk management need everything an EAP could possibly offer to intervene with human risk and exposures that could lead to losses. And then they need research to push the edge of that envelope....for example, an EAP starting a support group for the spouses of firefighters that could help prevent domestic conflict and subsequent losses of all sorts.) Health insurance companies need only one thing from EAPs -- assessment and deferral (AKA referral) to lower-costing services when exposures appear, otherwise no services proactive or preventative are really needed from the EAP. In fact, it could be argued that proactive and preventative services of EAPs in a managed care model should be avoided because it will lead to more referrals. Financially, this is in conflict. Hmmmmm.