A Next -Gen EAP for Today’s Workforce · A Next -Gen EAP for Today’s Workforce How a Next-Gen...

A Next-Gen EAP for Today’s Workforce

How a Next-Gen EAP can impact engagement, resilience and performance across today’s workforce.

https://www.paseap.com

| A Next-Gen EAP for Today’s Workforce 2 Copyright ©2019 Personal Assistance Services.

A Next-Gen EAP for Today’s Workforce Introduction Organizations are made up of people – executives who make the big decisions and staff at all levels who come to their worksite or work remotely to get the job done. One day, many of these same jobs may be replaced by machines that don’t break down – emotionally, at least – but until then, effectively managing people is what makes all organizations tick.

The Employee Assistance Program (EAP) industry grew out of a central idea: When an employee at any level of the organization comes to work compromised or impaired (e.g., addiction, anxiety, depression), personal and organizational performance suffers. Over the years, EAPs have expanded their reach and range of services to address the increasing complexity of modern life. People can’t conveniently compartmentalize their lives. The emotional drain of experiencing childcare and eldercare issues, problems with family and relationships, legal or financial worries impact employees at home and at work. Today, the business landscape is shifting, with blurred lines between work and life, global competition, rapid market and technology changes, rise of the gig economy, and increased workforce mobility. Just as news comes in ever-shorter cycles, employers and employees alike operate in a state of constant flux. These broad environmental dynamics are occurring alongside a parallel set of personal challenges and major life events (e.g., having a baby, getting a promotion, relocating), all with their associated daily demands.

One of the most essential functions of an EAP is to provide confidential support services – on demand, when and where employees need them – as well as tools to help keep employees be present-minded, focused, prepared, and resilient.

While the challenges have never been greater, the reality is that a widespread but little-recognized problem exists in the EAP industry: The emphasis on driving fees lower and lower has led many of the nation’s EAPs to purposefully limit meaningful interaction with the same "at risk" employees (those with life and mental health concerns) that they are contracted to help. This paper offers a “rethink” of EAP, examines the structural limitations of many of today’s EAPs, and illustrates the positive impact a Next-Gen EAP can have on employee engagement, well-being and performance across the organization.


Components of a Next-Gen EAP: • Focuses on proactive and continuous engagement, vs. only “at point of need” • Leverages technology to extend EAP expertise and support to a global workforce • Utilizes that same technology to reduce employee hesitancy to connect with trained

professionals to resolve personal challenges • Offers a comprehensive set of user-driven programs and tools for a range of conditions,

behaviors, and life events • Consistently delivers superior outcomes to more employees at all levels of the

organization.

The Structural Problems While healthcare costs continue to rise, market rates for full-service EAPs have dramatically fallen more than 40% since 19901 forcing many vendors to cut corners and deliver less. Many purchasers have grown content to pay as little for the service as possible in order to have it and many EAP vendors have been willing to acquiesce. In order to make their business models work, these EAP vendors have managed to convince purchasers that nebulously defined “utilization” ought to be the overriding metric of success.

The emphasis on utilization rather than on outcomes is easy to "game." Since there is no industry-standard definition, EAP vendors are free to define utilization to their advantage – where a website visit, administrative telephone inquiry or downloaded help-sheet counts toward "utilization." Many EAP vendors define utilization using this inflated approach that is silent on the most important metric, certainly from a clinical and financial standpoint: outcomes.

Indeed, isolated from view and lacking true valid comparative measures of effectiveness, most EAPs operate without measuring – let alone improving – their outcomes. Instead of results, many EAP vendors have focused on low price and low-cost features, leading to an environment where marginal vendors are able to "compete" with optimal ones. While companies continue to engage these low cost, low impact EAPs, they ultimately do so at great expense, as "at risk" and underperforming employees are not adequately engaged, assessed or treated.

As a result, employers get less for their shrinking benefit dollar, often in areas where their needs and the potential returns are the highest. Benefit consultants are missing strategic opportunities to improve workforce wellbeing and contain medical plan claims. Everyone loses over what are essentially pennies of the benefit dollar. A bare-bones EAP that discourages and limits interaction with credentialed counselors results in employers spending money on services that do not adequately address the needs of employees and


their families who are grappling with major issues (e.g., depression, loneliness, anxiety, substance abuse) and life circumstances (e.g., marital conflict, financial woes, stress).

A Changing Landscape When job candidates are screened, employers look at their work histories, educational attainment, skill sets, and culture fit. Employers typically know nothing about their candidates’ mental health issues, family history of suicide, recent losses or personal difficulties – all common risk factors that can impair job performance, productivity (absenteeism and presenteeism), and morale.

Often, problems at the workplace are lagging indicators of problems outside of work. Anxiety or depression don’t end when one walks into the workplace. They may be evident to close colleagues or confidantes and may be extrapolated from other more observable factors: absenteeism and/or a decline in performance or productivity. The scope and severity of personal problems that employees bring to the workplace are the manifestation of several alarming societal trends, in particular the increasing prevalence of suicidal behavior and widespread cross-generational loneliness and isolation. According to a report by the Centers for Disease Control and Prevention (CDC), 47,000 Americans died by suicide in 2017, up 33% from 1999. Researchers have found that the majority of suicides are related to problems with relationships, substance abuse, health, jobs, or finances.

We have also seen a rise in drug overdoses. There were more than 70,000 drug overdose deaths in 2017, the highest number of drug overdose deaths for any single year in US history (CDC). What are termed “deaths of despair” – suicides, and drug overdoses (including from prescribed opioid painkillers) – are an ever-escalating problem contributing to the declining trend in life-expectancy in the U.S. over the past several years.

Alienation – feeling despondent, lonely, and without purpose – afflicts millions, and is so widespread that social isolation may be as great a public health hazard as obesity or tobacco use. According to a 2010 AARP loneliness study, approximately 42.6 million U.S. adults ages 45 and older were suffering from loneliness. A 2018 Cigna survey suggests that Generation Z, adults between ages 18 and 22, may be the loneliest segment of the population, which doesn’t bode well as this generation enters the workforce en masse.

According to Carla Perissinotto, a geriatrician at the University of California-San Francisco, social isolation hasn’t received sufficient attention. “Policy in this country doesn't address this kind of concern, because many health care workers believe that social factors have nothing to do with medicine."


No age group is exempt from feelings of isolation and loneliness. These trends are not expected to be reversed or arrested, in part due to social, cultural, and even business drivers (such as increased mobility and flux, which make it harder to form and maintain relationships). It’s also driven by the ubiquity of social media, which blur the lines between appearing, and actually feeling, connected.

We could devote an entire white paper to these trends and their impact on the workforce. But suffice it to say that EAPs that emerged several decades ago to address such issues as alcoholism and drug dependency, face far greater challenges today. We have the tools and body of evidence to do a much better job of identifying and treating current-day problems, but the prevalent EAP service delivery models described in the previous section ill-equip – indeed, ill-serve – employers and employees who desperately need solutions.

The so called “EAP service” platforms provided by the least expensive or “free” (embedded) products only perpetuate the alienation, loneliness, and isolation that contribute to the emotional and social distress of today’s workforce.

Toward a Next-Gen EAP Next-Gen EAP is based on the following core principles:

• Success measured by outcomes shifts the focus to value, quality, and prevention that help keep employees from needing more costly medical plan services down the line.

• A greater range of access options lowers barriers to effective utilization – from digitally delivered screening, education and progress tracking to on-demand access to a licensed counselor via voice, text or chat.

• Systematic, targeted outreach “normalizes” the EAP: Educating employees about the range of available life event support services helps to eliminate the perceived stigma often associated with seeking traditional EAP services.

• Participant-centered care models are transformational and contribute to higher quality service delivery and better participant outcomes. EAP participants who play an active role in the management of their mental and physical health are more likely to follow their clinician’s treatment recommendations. They also have higher expectations of their provider in terms of advocacy, clinical customer service, and customized care.

“Human survival,” says Dolores Malaspina, professor of psychiatry, neuroscience and genetics at the

Icahn School of Medicine at Mount Sinai in New York, “depends on connectedness, with feelings of

loneliness serving as a biological signal to socialize.”


• The implicit function of an EAP is an organizational tool to retain talent and manage performance. All employees, including senior management, may eventually have personal issues that spill over into the workplace. Next-Gen EAP addresses not only the well-being issues that compromise employee productivity and performance but also impact other KPIs such as retention, engagement and healthcare costs.

• Support for senior leadership and human capital management: Next-Gen EAP offers expertise on the human side of business strategy, from crisis management to organizational resilience.

• Going digital: Next-Gen EAP increases engagement and leverages technology to deliver personalized care through people’s preferred means of communication. Science-based screening, self-paced education and mindfulness exercises are supplemented with options to text with a coach, request additional services or speak directly with a licensed EAP counselor for in the moment support. The technology uses analytics to help employers monitor and address the emotional health of their workforce and to help participants achieve their personal goals and improve their quality of life.

• AI and machine-learning drives pathways to personalized, human-delivered, compassionate care. Next-Gen EAP leverages technology to expedite human-to-human connection with the right experts to successfully resolve personal challenges and address the conditions of loneliness and alienation.

• EAP as a change management platform: Job hopping, gig workers, and the fluid nature of modern work and life have heightened employee anxiety and sense of dislocation. Next-Gen EAP is about managing all manner of change at the individual and organizational level.


Typical vs. Next-Gen Typical EAP Next-Gen EAP

Reactive. Utilized only when issues significantly surface (at the “point of personal need”) often after the problems have been long-festering. Performance management, drug-free workplace referrals and on-site support services may be excluded.

Proactive. Focuses on prevention/early intervention that improves job performance, physical health and personal wellbeing. EAP is well-utilized, provides expertise on the human side of business strategy from crisis management to organizational resilience.

Vendor-Centered Access. Automated or customer service representative direction to website resources or list of network counselors to contact for self-scheduling.

Participant-Centered Access. Multiple means of access to licensed counselors and coaches (voice, text, chat, tele-video), Personally arranged and confirmed in-person care achieves twice the rate of participant follow-through compared to participant self-serve options.

Uses Technology for website-based information and provider self-search, CBT and symptom-tracking apps are for self-use, not integrated with EAP.

Leverages Technology to reduce employee hesitancy to connect; supplements personal care with science-based, user-driven tools; global analytics help employers monitor workforce emotional health, personal dashboards help participants monitor and achieve their personal goals. EAP Apps are integrated with synchronous and asynchronous access to counselors.

EAP utilization metrics based on touchpoints (calls or emails to request services, web page visits, training participants, downloaded articles) and contacts with a licensed professional. Counseling is session-focused.

Outcomes metrics based on level of engagement, cases of service with licensed professionals, symptom improvement, quality of life improvement, increased job productivity, averted claims to medical plan. Counseling is solution-focused.

Initial roll-out campaign with annual EAP reminders, passive approach to communication and promotion of EAP. Low levels of meaningful engagement and utilization.

Continuous internal and external integration within human capital initiatives. High levels of engagement, life event-focused benefit communication, integration with other benefits and services offered by employer.


School District Case Study: Next-Gen EAP in Practice Erin Abraham-Murray is Benefits Manager for the Francis Howell School District (FHSD), based in St. Charles County, Missouri. The district is comprised of 17,000 students and 2,300 employees spread across 23 buildings. Part of Erin’s charge is keeping medical and pharmaceutical costs down: “We’re self-insured, so we have a lot of skin in the game. We need to get out ahead of any and all potential high cost claims. And I know from previous experience that one of the best ways to do that is through your EAP.”

But Erin sees EAP as more than just a “defensive” tool. She views it as a central component of a healthy, vibrant culture. “When staff is on top of their game, energized, feeling well, it creates an environment of wellness and positivity, which will rub off on students.”

Prior to joining FHSD, Erin was with another school district that had its EAP bundled with its medical plan. “It wasn't a robust benefit, as it limited everyone to five or six visits. If you break your arm you know it will take six-to-seven weeks to heal, but with mental health it varies. If you make the clinician work within a session-focused rather than a solution-focused model, you are not going to resolve the issue.”

Personal Assistance Services (PAS) has partnered with FHSD since 1998. When Erin came on board, her goal was to get even more employees engaged with the EAP to further benefit from its impact and value. In concert with the FHSD’s wellness committee, and with the support of PAS, the district implemented a series of innovative programs to reduce the stigma associated with mental health, build trust, and improve both communication and engagement. “Wellness Champions” were designated in most of the district’s buildings. “The Wellness Champions know the pulse of the building and how to roll out an effective program. What works in one building may not work with the rest,” said Erin.

FHSD also partnered with Right Direction, a depression awareness initiative developed by the Center for Workplace Mental Health and Employers Health Coalition, Inc. Right Direction’s program provides customizable resources and materials to increase awareness, reduce stigma, and motivate employees and their families to seek help when needed.


Working with Right Direction and PAS, FHSD implemented several district-wide initiatives:

• Dimensions of Wellness: The goal of this initiative was to underscore the many dimensions of wellness, including but not limited to mental health. At each building, Erin and her team set up a “living room” featuring an EAP game board, a TV monitor that played relevant TED talks, and a “life guide” (that looks like a TV Guide) containing narrative of popular TV show episodes with applicable PAS resources that could help the characters in their “seven dimensions of wellness.” The initiative was geared to eliminate the stigma associated with mental health, while making it a fun, interactive learning experience.


• Each building was visited by a life-sized cardboard cut-out of an opera-singing grizzly

bear offering reading materials and learning kits. The grizzly got people buzzing and interested in the accompanying materials. According to Erin, FHSD saw a significant increase in counseling services utilization: “The living room and opera-singing grizzly got people talking!”

Measuring Impact • Annualized true utilization for 2018 was 10.81% • 96.1% of cases resolved within parameters of EAP benefit • 40.3% improvement in mental health • ROI = For every $1 invested on the EAP, $7.88 was returned in costs related

to employee personal concerns (reported by FHSD)

FHSD’s forward-thinking program checks off many of the boxes that characterize a Next-Gen EAP:

ü FHSD is proactive in partnering with the EAP to get out ahead of potential high-cost claims and create a positive culture.

ü FHSD’s creative and playful outreach goes a long way in “normalizing” the EAP, and reducing the stigma often associated with mental health services.

ü The initiative received buy-in from FHSD leadership.

ü The program is participant-driven in that it encourages staff district-wide to play a more active role in managing their health and well-being. The EAP offers flexible, solution-focused care based on an individual’s particular needs, vs. one based on an across-the-board limitation on the number of allowable counseling sessions.


ü The initiative promotes change at the individual and organizational level, and creates an environment of wellness and positivity for staff that rubs off on students.

ü Success metrics are based on outcomes (per the above utilization, self-reported improvement in overall wellbeing, and ROI figures).

Conclusion Due to a misplaced emphasis on "utilization" (for which there is no industry-standard definition) rather than on outcomes, millions of employees and their families are insufficiently engaged and inadequately treated...while employers spend millions of dollars on programs that limit meaningful engagement/intervention by their very design.

Next-Gen EAP focuses on proactive and continuous engagement. It leverages technology to extend EAP expertise and support to workforces around the globe, while it also guides individuals to connect directly with a trained professional to resolve personal challenges. It also affirms new ways of thinking about mental health and wellness. For instance, an increasing number of new health companies are encouraging people to think and talk about nutrition as a problem of personal technology, where losing weight isn’t about self-deprivation, but about optimization. Ultimately, all roads lead to one overarching idea: your EAP is only as good as its results in demonstrably improving performance and productivity at all levels of the organization.

“EAP is a great cost savings, as it helps keep medical plan deductibles and copays as low as possible for employees,” said Erin. “But it’s also a strategic business tool as we look at it as an investment in our employees, keeping them focused and on their game. This enables all of us, from school administrators to support staff, to achieve our ultimate goal: creating a positive culture for our students to learn and grow.”


About PAS

Personal Assistance Services (PAS) is a Next-Gen Employee Assistance Program (EAP) that has been a leader in the field for more than three decades. Serving across the country and around the globe, we offer services for the entire spectrum of demographics, all at no cost to employees and their dependents. We also offer performance improvement tools for managers, on-site support following disruptive events at the workplace, and forensic and organizational consultation for management and human resources. All of these services help employees and managers solve problems, navigate challenges and strengthen their work and home life. For more information, visit www.paseap.com.

9735 Landmark Parkway St. Louis, MO 63127 (800) 356-0845 Email: [email protected]

1 Sharar, D.A. Journal of Employee Assistance Q2 2019 Vol.49 2 Goetzel, R.Z. et.al. Journal of Occupational and Environmental Medicine April 2018 3 Granberry et al, National Behavioral Consortium Industry Profile of External EAP Vendors, 2013

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