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Mental Help For Workers Pays Off
Prevention costs less in long run.
By Victoria E. Knight (The Wall Street Journal)
The Courier Journal – Business Section, Monday March 3, 2008

About 2½ years ago, network-equipment provider Cisco Systems Inc. asked its U.S. workers to fill out a health survey to gauge their well-being. The results were a shock to the system.

Despite low turnover among its employees, 9% of respondents reported feeling anxious or depressed. Many also had problems sleeping. Lending urgency to the discovery, Cisco found that affected employees accounted for 40% of lost productivity that could be identified. Cisco decided to reach out to the employees -- anonymously, through health-care providers -- offering intensive treatment.

"Our employees are going to be with us for the long haul, so we want to get in front of chronic conditions; the focus is on prevention," said Pamela Hymel, Cisco's global medical director.

Millions of American workers struggle with stress, anxiety and depression at a huge social and economic cost. Around 222.7 million work days are lost annually due to absences and impairment related to depression alone, costing employers $51.5 billion, according to the National Institute of Mental Health.

But it is an issue that has largely flown under the corporate radar as the health benefits offered by employers focus on treating physical ailments. Social stigma and privacy concerns present other barriers. Plus, it can be hard to make a business case.

“Employers that take this on can get spooked by the short-term increase in medical costs due to higher prescription-drug usage,” said Shelly Wolff, North America practice leader for health and productivity at consultant Watson Wyatt Worldwide.

Evidence is emerging that may change that perception. A study published in the Journal of the American Medical Association in September said that after 12 months, employees suffering from depression who received support over the telephone from a clinical-care manager and exercised their choice of psychotherapy or antidepressants were 40 percent more likely to have recovered and 70 percent more likely to stay employed than those in a control group who received standard care, according to the 604-employee study funded by the National Institute of Mental Health.

Employees in the intervention program worked an average of two more hours a week than those in the control group. That is a $1,800 annual gain per employee in productivity, far more than the $100 to $400 cost per employee of the program.

Faced with escalating medical costs, employers are focusing more on prevention, and that is shedding light on the mental health challenges workers face. Large employers are increasingly using health-risk assessments, or HRAs, and are offering financial incentives, such as contributions to insurance premiums, to encourage employees to fill them out.

The answers can inspire outreach efforts by health plans, such as employee-assistance programs, which provide confidential counseling.

In fall 2006, Cisco offered $100 incentives to employees who filled out an HRA that contained more detailed questions about work absences, productivity, chronic and mental health conditions. The company offered another $100 to workers who participated in a wellness program, one of which is the pilot intervention program. Harvard Medical School and United Behavioral Health identified 210 employees as having some risk of depression and/or bipolar disorder. United Behavioral Health invited these employees to participate in a two-year study.

Help Offered
Half of the participants received feedback from United Behavioral Health about their assessments through the mail and were advised to seek care through the health plan. Employees in the intervention group were assigned coaches – therapists with master’s degrees – who provided confidential advice and support over the phone and through the mail and triaged care.

Participants also used WebNeuro, a software program developed by Brain Resource Co. that tests a person’s memory, reaction speeds, concentration, emotional recognition and other brain functions. Therapists can use the results to tailor treatment programs to employee’s needs and measure their effectiveness.
It is too early to say whether intervention makes a difference, as researchers at Harvard Medical School are just starting to gather data from the health plan, said Hymel, Cisco’s medical director. A major challenge is getting workers to complete the initial HRA, so last fall Cisco increased the incentives to $200 per employee.

Studies show social stigma surrounding mental health issues and concerns about confidentiality can deter workers from seeking treatment.

Hymel noted, however, that only 12 people declined to participate or left the study. Only the health plan, United Behavioral Health and one of its partners who conduct the HRAs, Matria Healthcare, have information about the employees.

“Cisco never knows which employees are in these programs,” she said. Cisco has access to blind, aggregate data, which is allowed under privacy laws because individuals can’t be identified from it.

“Federal law generally prohibits health plans from disclosing medical information about specific employees, and many states apply even stricter rules to mental health records,” said Sharon Cohen Watson, Wyatt’s counsel for group and health-care benefits.

Still, the notion of human-resources departments administering benefits and making hiring decisions can raise concerns about discrimination. Because of potential conflicts, most employers hire independent companies to administer their health plans.

Exercise Caution
Tom Bixby, a partner in Neal Gerber Eisenberg’s Health Law Practice Group, said employees should exercise some caution when filling out HRAs. Federal privacy protections only apply if the HRA is conducted by a health plan or company contracted by it, such as a wellness vendor, so employees should check.

“Employers also usually pledge not to look at or disseminate HRA data, in part because they don’t want the labor-law issues related with having this information in their personnel files and making the data an issue in a wrongful termination lawsuit,” said Andy Anderson, a lawyer who is an expert in health benefits. The Americans with Disabilities Act prohibits employers from requiring employees to take medical exams, including HRAs