Benefit Coordination Resolves Inefficiencies
When a behavioral health provider and an EAP share responsibility for mental health services, there is potential for miscommunication, underutilization of benefits, and administrative confusion. The net result can be wasted professional resources, unmanaged problems and unsatisfied employees. Through Health Program Integration, Claremont Partners recently resolved these inherent conflicts so that both service providers -- equally committed to appropriate and quality client care -- were able to develop a blueprint that assured seamless coordination. The plan assures employees’ ability to take full advantage of their benefits without delay or confusion, and addresses the employer’s demand for maximum value from vendors. Claremont Partners’ staff provided expertise to facilitate a discussion, explore clinical priorities, mediate differences and assure that the final plan met both vendor and client goals.
Data Mining Drives Planning
Neglecting to analyze a groups’ health profile and risk status can render disease management, behavioral health, and other wellness programs ineffective no matter how well-intentioned. Motivating better health and personal involvement in wellness programs is difficult enough without the guesswork inherent in programs not based on data analysis. Claremont Partners analysis of claims, prescriptions and compliance, and utilization assures clients a baseline profile of employees’ true health risks and opportunities. In a recent project, a graphic picture of the employee populations’ health profile was used to focus, fine tune and coordinate program offerings of the disease management, EAP, and behavioral health vendors.
The client requested a legal referral after receiving a DUI. In addition to the legal referral, Claremont offered EAP counseling. During the counseling visits, we were able to motivate the client to enter a treatment program. We worked with the client and his health plan to facilitate admission to a 28-day residential program. We continued to provide monthly telephonic follow-up for a period of one year to confirm that the client was continuing in aftercare and maintaining sobriety.
Anger Management Referral
An HR director called and requested a risk assessment after an incident in which an employee threw a whiteboard eraser across the room. The employee was valuable, but had a history of angry outbursts that intimidated co-workers. With concerns over potential for violence, we held extensive conversations with the director and the employee’s manager and determined that there was not an imminent risk of danger and recommended that the employee be referred to the EAP. The employee signed a release of information form that authorized Claremont to confirm participation in EAP with the director. In addition to EAP counseling, Claremont recommended participation in an anger management group. The employee was initially resistant, but gradually became more engaged in treatment. He completed EAP sessions and anger management group therapy. One year after completion of treatment, the Director reported that there were no more angry outbursts.
Death of Co-Worker
Claremont received a call from an HR Director reporting that a 36-year-old employee was killed in a bicycle accident over the weekend. The individual was married, had two young children and was very well liked at work. Claremont dispatched a clinician on the same day to provide a group debriefing, as well as a number of individual, on-site counseling sessions. Claremont provided information on coping with grief and loss and other appropriate support literature.
An employee called requesting assistance for "depression." During telephone intake we screened the employee for risk of suicide and provided a next-day appointment with a clinician specializing in depression. The clinician recommended a medication evaluation with a psychiatrist and also noted that the employee was significantly overweight and appeared to have a number of health issues. The employee did not know of any wellness resources available through her employer. The clinician contacted Claremont and was informed that the employer had a Wellness Coaching program. The clinician provided the employee with information on the Wellness Program at their next session and continued working with the employee beyond the EAP visits, utilizing the employee’s health benefit. The clinician monitored the employee’s compliance with the prescribed anti-depressant and participation in wellness coaching.