Mental illness and problems with mental health cost employers $20 billion annually, and it’s the cause of one in every three claims for short- and long-term disability, according to a study by the Mental Health Commission of Canada. It’s no wonder mental health remains an area of focus for Canadian employers.
While they grapple with how to tackle the issue, we’ve seen a number of employers making changes to their benefits plans. These include: increasing the scope of services provided through employee assistance programs; raising the paramedical limit for psychological treatment or increasing the mental-health providers covered by their plan; or adding mindfulness or resiliency programs to wellness offerings.
While these changes are all positive, are we being purposeful about what we’re trying to achieve?
As is true with any decision around plan design, it’s valuable to take a step back and consider what exactly the change is responding to and set measurable goals and objectives. To achieve this, employers can ask three key questions:
- Why are we looking to make a change?
- What does success look like?
- How will we measure success?
There are many reasons an organization may consider changing the design of its benefits offering in response to concerns about mental health. While this isn’t an exhaustive list, they can include:
- Removing financial barriers to receiving good care;
- Improving timely access to care;
- Offering a variety of treatment options to address the diverse needs of the employee population;
- Better integrating existing elements of the program for a more fulsome solution;
- Reducing the incidence of disability claims due to mental health;
- Reducing the number of mental-health-related short-term disability claims that become long-term disability claims;
- Responding to bargaining;
- Feeling it’s the right thing to do and aligns with the culture;
- Proactively connecting the mental-health strategy to the overall business risk management strategy;
- Responding to employee feedback or pressure to match changes made by competitors; and
- A combination of the above.
The way an organization responds to the “why” question really drives the strategy and tactics around design change. For example, if an employer wishes to remove financial barriers to care, they may increase their annual limit for psychology and social work under their suite of paramedical providers. Or if they have a bundled approach to the annual paramedical benefit, they can choose to unbundle the psychological piece and let that sit outside the bundle of other providers.
An employer could look to change the coinsurance for the psychology/social work benefit to 100 per cent and remove session limits from the EAP offering. Reviewing the structure of the drug plan to reduce out-of-pocket expenses is another consideration. Conversely, if they’re looking to improve timely access to care, they could add coverage for private addiction treatment facilities or increase the number of practitioners included under a paramedical psychology benefit to also include psychotherapists, family and marriage therapists, clinical counsellors and web-based cognitive behavioural therapy.
Another option is adding telemedicine to the offering and/or looking at human resources policies regarding time away from the office to attend appointments. A number of different approaches are available to help employers achieve the same goal.
What success means for each organization and how it’s measured will also have a wide range of possible answers. One possibility is to base it on overall cost: the investment in an increase to the psychology benefit results in a reduction in overall STD claims costs and casual absenteeism. Or, the addition of pharmacogenetics as an eligible expense has resulted in a reduction in the cost of drugs treating depression and wastage charged to the plan. Productivity has increased, or turnover has decreased.
It may centre on incidence. The number of STD claims for mental health has decreased. The number of plan members reaching their benefit maximum for psychology has decreased. The number of plan members accessing care through a psychologist or social worker has increased.
It could also include other metrics. The company’s people leaders are now better equipped to identify and support an employee struggling with their mental health because they completed mental-health first aid training. A wellness program now contains three elements that support good mental health. The relative value of the benefits program is, as a result, in the top quartile compared to the competition. Plan design changes have had a measurable lift in employee engagement.
A data-driven approach to measurement will be a key component of determining how effective plan changes have been in relation to an employer’s original goals. These changes will likely need time to show their impact, so measuring repeatedly over a longer time is important.
Organizations can also use predictive modelling to illustrate the likely costs and incidences without a plan design change, and build out projections for both budgeting and analysis about the effectiveness of the impact. This analysis will provide an organization with a good picture of whether they’ve achieved what they set out to do, and will allow it to evolve its approach as needed.
Taking a step back, it’s important for an organization to be thoughtful about what they’re trying to achieve and why. As well, adding measurable goals and metrics and data analysis can help an organization move the right levers in their plan, and help identify interconnected elements in their approach to an overall mental-health strategy and a psychologically healthy workplace.