National Behavioral Consortium
PRICING STRATEGIES AND VALUE
Discussion Leader: Tom BjornsonFounder & CEO, Claremont Behavioral Services
January 23 , 2008
What’s an EAP? Objectives? Place at Table?
• Counseling Benefit?
• Productivity Tool?
• Focus on Outcome Metrics vs. Process
Versions of EAP:
• Disability Plan Sponsored- Ceridian
• Health Plan Sponsored- Blue Cross of California- Aetna- Cigna
• Large MBHO- Magellan- Value Options
• Regional MBHO- NBC Founders
• Agency-based- Family Services
• Regional EAP- Chestnut- Claremont
• Internal Staff ModelsMedicalHuman Resources
Problem Identification and Referral Triggers
Case Consultations
Managers, HR, Labor Leaders
Self Referral
Promotion, Awareness, and Perceived Value
Employees & Family Members
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Initial Response & Case Handling Coordination
EAP Counseling
Life Management
Disease Management
Critical Incident
Health Promotion &
Wellness
As Needed, Behavioral Health Benefits and On-Going Care
Case Closure
EAP Best Practices
Summary of Internal Referral Triggers
Benefit Admin. & Disease Management
Identifying depression, stress, anxiety, physical conditions (high blood pressure, back conditions); then managing improvement
Best Practices, AA& Legal Compliance
Ameliorating employee complaints regarding employment practices like harassment and supervisory methods
Critical Incidents & Trauma Response
Responding to traumatic events, co-worker accidents, robberies, natural disasters
Work Performance Management
Execution of progressive discipline programs to address work performance problems; and facilitating a skillful management response
Labor-Management Collaboration
Labor contract administration, handling grievances and finding ways to collaboratively resolve work issues and discipline situations
Internal Security & Threat Management
Proactively and routinely identifying and handling employee threats of violence or other disruptive behaviors
Absence Management
Addressing causes of time away from work, including issues of co-morbidity; and engaging conditions requiring commitment to change
Administrative Financial Events
Responding to wage garnishments, early access to retirement accounts, tax liens and other financial crises
DFW & Drug Testing
Identifying, treating & managing substance abuse cases to clear outcomes
Employee Retention & Turnover
Focusing on retaining the top 20% of the workforce and managing improvement in the bottom 20%
Workers’ Comp & Safety
Prevention, early intervention, case-finding & return-to-work support
Organizational ChangeSupport
Minimizing negative employee impacts of mergers, downsizing, acquisitions, major policy changes
Goals for EAP Relationship
• Cost Transparency & Alignment of Motives for Increasing Utilization
• Embedding Stakeholder Use of Referral Triggers
• Interface – Disease Management, Health Promotion & Behavioral Benefits
Capitation Conflicts with EAP Role
• Capitation = Taking risk against program use• Misaligned Motives & Commodity Services• Declining Utilization by At Risk Individuals• Management Services – “Lost in Translation”• Low Expectations & Cynicism = Lack of Internal Support• Cost of Treating vs. Cost of Not Treating
Performance Based Pricing Models
• Case Rate: Variability Based on Utilization - e.g. $500 per clinical case and $125 per work life case
• Claremont’s Model: Capitated Retainer, plus Fee for Service Counseling Visits- e.g. $1.75 PEPM for all program services, plus $85 per
visit actually used- Performance Guarantee: Management Referrals
Risk Sharing: Based on Employer Metrics & Outcomes
Rate Comparison with Current EAP Vendor
* Claremont’s Utilization Goal
Current Rate $2.25 PEPM
Clinical Utilization 3%
Number of Visits Per Case 1.9
Current Vendor’s Rate & Results
Claremont’s Performance RateUtilization Level Performance Rate ($1.40 PEPM + $87/Visit)
3% $1.81 PEPM
6% $2.23 PEPM
9%* $2.64 PEPM
12% $3.05 PEPM
15% $3.47 PEPM
Performance Guarantee for Management Referrals: A pre-determined number employees will be referred to EAP by management each year. A refund of $400 for each “case” below this guaranteed level will be made, if required:
• Number of guaranteed management referrals is generally 1% of the employee population;
• Performance Guarantee only available if the group selects Performance Pricing.
Performance Guarantee
Pricing Implications• Basis for Role Change and Market Perception of Value
• Market Need & Cost Impacts Well Documented
• Different Value Story for Benefits’-Overcome Cynicism & Practices
EAP Clinical Outcomes• For what?• How many?• To what outcomes?
EAP & Employer Metrics
Need for Internal Ownership, Planning & Stakeholder Engagement
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