Successful Strategies for Reducing the Impact of Behavioral Health
Transcription
Successful Strategies for Reducing the Impact of Behavioral Health
Successful Strategies for Reducing the Impact of Behavioral Health Claims Presented by: Blessy John – Discover, Project Manager, Health & Welfare Plans Deborah LaBonar, PhD – Aon Hewitt, North American Absence Analytics Leader March 17, 2015 Confidential and Proprietary ©2015 Discover Financial Services Agenda • Setting the Context • Three Strategies • Outcomes • Advice for Employers • Next Steps 2 Discover at a Glance • A leading credit card issuer/payments processor • One of the most highly recognizable brands in U.S − 1 in 4 U.S. households • Two main categories of Products and Services: Payment Services Direct Banking Discover Card Discover Bank Discover Network PULSE Debit Network Diners Club International Becoming a leading direct bank and payments company 3 Discover Locations and Functions: North America U.S.A Arizona: Phoenix Call center, Customer Service & Banking and Cardmember Assistance, Discover Network, Marketing Services California: Irvine Discover Home Loans Colorado: Denver DCI Americas Regional Office – Relationship Management Canada Delaware: New Castle Call center, Customer Service & Banking and New Accounts, Delaware Finance Delaware: Greenwood Discover Bank (Retail), Cardmember Services & Consumer Banking Illinois: Riverwoods Headquarters U.S.A. Kentucky: Louisville Discover Home Loans New York: Pittsford Discover Student Loans Mexico Caribbean Ohio: New Albany Call center, Customer Service & Banking, Discover Network, Loss Prevention & National Recovery Texas: Houston PULSE Administration & Operations Utah: Salt Lake City Utah Processing Center (UPC): Administration & Processing Services Utah: Lake Park Call center, Customer Service & Banking, Marketing Services, New Accounts, Discover and Personal Loans 4 Discover’s Livewell Approach Living a healthy lifestyle in a way that fits you Making smart choices when you elect and use your Discover benefits Taking charge and being personally responsible for your health Striking a balance at work, home and play Planning for tomorrow as well as for today 5 Global Benefits Team • The Global Benefits Team supports Discover’s 13,000+ employees and is responsible for managing global benefits as well as 30+ benefit vendors • Overall goals as it relates to leave of absence: − Manage cost associated with leaves and disability, including preventable wellness initiatives and work life balance programs − Manage the vendor relationship as it relates to leave of absence policies and procedures and ensures Discover is compliant with all applicable laws 6 Discover Partnership • In 2011, Discover transitioned the administration of their leave and disability program from a previous vendor to Aon Hewitt • From the beginning, Discover stressed the importance of analytics and using the data to drive the absence strategy and focus 7 The Business Problem Disability Incidence Benchmarks 7.0 11.3 14.6 6.4 5.6 10 5 0 Prior Year IBI Finance and Insurance Year 1 AH Book of Business Short Term Disability Incidence Rate 10 11.3 15 5 0 Year 1 AH Book of Business Discover Call Centers 9 Discover 14.9 Discover 7.0 • Fifty-nine percent of Discovers’ population is within one of the Call Center locations Claim Incidence per 100 • Further analysis demonstrated that the Call Center populations were a primary driver of Discover’s high incidence rate 15 Claim Incidence per 100 • After Year 1, data demonstrated that Discover’s overall short-term disability incidence rates were higher than external benchmarks Short Term Disability Incidence Rate Identifying the Primary Clinical Driver of STD 25% 19% 15% 10% 8% 20% 11% • Behavioral Health is identified as the most prevalent clinical category, accounting for almost 20% of closed claims, and over 27% of the total claim cost Behavioral Health as Percentage of Claims 5% 0% Year 1 AH Book of Business Discover Behavioral Health as Percentage of Claims 25% 15% 10% 10% 20% 8% • Within the Call Center populations, Behavioral Health claims accounted for 23% of the claims as compared to 10% within the remainder of Discover IBI 23% • Discover’s rate was trending well above the external benchmarks 5% 0% AH Book of Business Discover Call Center 10 Year 1 Discover Non-Call Center Strategic Intervention Implementing Change • The high prevalence and high cost of Behavioral Health claims led Discover to set an annual target of reducing the overall cost of Behavioral Health claims by 10% • Discover took an integrated approach to addressing this area of concern, by focusing on three different strategies to achieve this goal: − Behavioral Health Specialist − Access to Care − Onsite EAP Counselors 12 Strategy 1: Behavioral Health Specialist − Interviewing employee at the beginning of the claim, calling employee to check up on treatment/return to work status − Collaborating with the provider on treatment progress; discussing other options when progress isn’t recognized − Coaching the provider on how to get the employee back to work; suggesting transitional options such as reduced schedule or breaks 13 Percentage TRTW Nine months into the program, implemented a dedicated specialist to focus on Behavioral Health claims whose responsibilities include: 40.0% 30.0% 20.0% 10.0% BH Specialist begins 0.0% Closed Claim Duration • % of BH Claims With Transitional RTW 100 80 60 40 Behavioral Health Duration Trending BH Specialist begins Strategy 2: Employee Assistance Program • In early Year 2, Discover shifted the focus of their Employee Assistance Program − Emphasis placed on receiving care from a Behavioral Health professional versus Primary Care Physician − Emphasis on face to face counseling versus the telephonic model • Behavioral Health Specialist supports this model through recommendations to use EAP counseling and via soft transfers to EAP 14 Penetration Rate − Program modified to include up to 5 free visits (up from 3) EAP Penetration Rate 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% EAP focus shifts Strategy 3: Onsite EAP Counselor Behavioral Health Location Incidence Rate One Call Center location made a business case for an onsite EAP counselor based on their claims experience: Program overview: 15 • Topics cover the spectrum of work/life and counseling issues. • Counselor is introduced in New Employee Orientation & Management meetings • Counselor provides work life consultations, management referrals, EAP orientations as well as Critical Incidence Response • Since inception, this location has increased the hours the counselor is available; an onsite EAP counselor has been introduced to a second location due to the success in the pilot location Claim Incidence per 100 • With Behavioral Health as top driver of STD claims, the savings of preventing 13 BH STD claims equals the cost of an onsite EAP 5.0 4.0 Onsite EAP Counselor adopted 3.0 2.0 1.0 0.0 HR Feedback: “Employees have been more likely to utilize the service, due to the high touch and onsite convenience, to have their true needs appropriately identified and addressed, and to follow-through and maintain any necessary actions to affect positive change.” The Overall Results Behavioral Health Incidence Trending • Likewise the percentage of disability claims that fall into the category of Behavioral Health has been declining since Year 2, and in Year 4 the new Behavioral Health claims only represented 16% of the new STD claims Claim Incidence Per 100 • The overall incidence rate of new Behavioral Health claims has been declining since a high in Year 2 Behavioral Health Incidence Rate 3.0 17 2.0 2.0 1.8 1.0 0.0 Year 1 Year 2 Year 3 Year 4 Behavioral Health as Percentage of Claims 22.7% 25% 20% • Although this is slightly higher than the IBI Benchmark of 11.2% for the Finance Industry, it is 6 percentage points lower than the 22.7% recognized in Year 2 2.5 2.3 18.9% 20.1% 16.2% 15% 11.2% 10% 5% 0% Year 1 Year 2 Year 3 Year 4 IBI 2013 Benchmark Behavioral Health Total Savings Metric 18 Year 1 – Year 3 Change Covered Lives + 20% Claim Volume + 4% Incidence Rate - 13% Closed Claim Duration - 24% Cost per Closed Claim - 32% Total Paid – Closed Claims - 29% Disability Incidence Benchmarks 11.3 11.5 10.6 10.1 Claim Incidence per 100 Year 1 Year 2 Year 3 Year 4 10 5 0 Discover 13.4 15 14.0 20 16.3 Short Term Disability Incidence Rate 14.9 • With Behavioral Health driving the majority of STD claims, the reduction in these claims has noticeably impacted the overall incidence rate for the business 15 Claim Incidence per 100 • Since an overall high in Year 2, both Discover overall and the Call Center specific STD incidence rate has been declining Short Term Disability Incidence Rate Year 3 Year 4 10 5 0 Year 1 Year 2 Discover Call Centers 19 Next Steps • In 2015, Discover plans to expand the onsite EAP counselor program to two additional Call Centers • From an Analytics perspective, Discover intends to partner with Aon Hewitt to further explore the drivers of absence within their Call Center populations, including such factors as: − Employee Engagement − Manager Training and Attendance Management practices − Local Understanding of Disability/FMLA 20 Questions • Blessy John: Discover, Project Manager, Health & Welfare Plans [email protected] • Deborah LaBonar: Aon Hewitt, North American Absence Analytics Leader [email protected] 21