This document summarizes findings from a 5-year research project on pathways to substance use disorder treatment. Key findings include: - Integrated EAP/MBHC products had higher rates of any behavioral health service use compared to MBHC-only products, driven by higher EAP use. - More generous EAP benefits within integrated products were associated with lower subsequent non-EAP outpatient utilization and costs. - Employer choices in EAP design include session limits, delivery modes, and worksite services offered. Industry and organizational type influenced choices. - Higher employer EAP promotion and worksite activities were associated with higher EAP utilization, while higher workplace stress was associated with lower utilization. - Employee EAP

1. Findings from a 5-year Research Project on
Pathways to Treatment for Substance Use
Disorders: Implications for EAPs
Presenters:
Elizabeth L. Merrick, Ph.D., MSW
Bernie McCann, M.S., CEAP
Brandeis University
Vanessa Azzone, Ph.D.
Harvard Medical School
MA/RI Chapter of EAPA Symposium 2011
Waltham, MA
May 13, 2011
Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment
(Funded by the National Institute on Drug Abuse P50 DA010233) 1

2. Brandeis/Harvard Center on Managed Care
and Drug Abuse Treatment
Substance Abuse Treatment Pathways in
Employer-Sponsored Programs: Research Team
Brandeis University:
Elizabeth L. Merrick, Ph.D., M.S.W. (Project PI)
Constance M. Horgan, Sc.D. (Center PI)
Dominic Hodgkin, Ph.D.
Sharon Reif, Ph.D.
Bernard McCann, M.S., CEAP
Harvard University:
Thomas G. McGuire, Ph.D.
Vanessa Azzone, Ph.D.
MHN:
Deirdre Hiatt, Ph.D.
Arlene Darick, LCSW, CEAP
Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment
(Funded by the National Institute on Drug Abuse P50 DA010233)
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3. Context
 Much unmet need for behavioral health
assistance, including substance abuse
 Workplace = opportunity to intervene
 Need to understand facilitators, barriers,
patterns and experience of care in
contemporary EAP model
 EAPs now frequently provided by managed
behavioral health care organizations,
sometimes in conjunction with managed
behavioral health care benefits
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4.  Subsidiary of HealthNet, Inc. (NYSE: HNT)
 Affiliates: 1100 associates; 45,000 network providers; 1400
hospitals and care facilities
 850 clients (Employers, Unions, Insurers, etc.)
 Provides services to apx. 5.4M individuals in 50 states
 Products include:
 EAP
 Managed behavioral health care (MBHC)
 Integrated EAP/MBHC (Both EAP and MBHC benefits;
goal is seamless transition if both are accessed)
4

5. EAP-Related Research Questions
1. How are EAP benefit features related to access,
utilization, and costs?
1a. MBHC versus integrated EAP/MBHC products
1b. EAP benefit generosity within integrated product
2. What purchasing choices in EAP design and
workplace services do employers make?
3. How are workplace characteristics and program
promotion activities related to utilization?
4. How do EAP users learn about EAP services and
what do they use EAP for?
5

6. Q1a – How Does Utilization of Any BH
Services Vary Within Integrated Versus
MHBC Only Products?
 Study focused on: Comparisons of service use
patterns between MBHC and integrated EAP/MBHC
products
 Sample: 286,750 enrollees, weighted sample,
integrated and MBHC only, 2004
 Data source: Administrative benefits and enrollee
claims data files
 Design/analysis: Cross-sectional; logistic
regression, weighted for eligibility and
demographics
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7. Q1a: Integrated vs. MBHC Products:
Any Claim
5.7%
* 4.8%
Percent of Enrollees
Any behavioral
health claim
Any substance
abuse claim
0.21%* 0.17%
Integrated MBHC Only
Integrated includes clinical EAP claims.
* Differences between products are significant at p < .01
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8. Q1a: Integrated vs. MBHC Products:
Any MBHC Claim
4.6%** 4.8%
Percent of Enrollees
Any behavioral
MBHC health
claim
Any MBHC
substance
abuse claim
0.19% 0.17%
Integrated MBHC Only
*Differences between products are significant at p < .01
** p<.05
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9. Q1a: Integrated vs. MBHC Products:
Outpatient Visits
5.5%*
4.6% 4.6%
Percent of Enrollees
4.4%*
2.4%
0.0%
Integrated MBHC
Any outpatient
Any clinical EAP
Any outpatient MBHC
*p<.01, significant difference between products
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10. Q1a - Implications
 Greater proportion of enrollees use any services in
integrated product – consistent with increasing
access via EAP benefit
 The greater proportion of service users in
integrated stems from EAP use; proportion using
MBHC is slightly lower in integrated – consistent
with concept that EAP may help with earlier
intervention
 Caveats: Some MBHC enrollees may have EAP
outside of MHN. We observed and discuss only
plan services
10

11. Q1b: Does EAP Benefit Limit Affect the
Use and Cost of Outpatient BH Care?
 Study focused on: Whether the EAP session
limit affects utilization and cost of outpatient
mental health treatment; i.e., number of sessions
and total annual spending
 Sample: EAP/outpatient service users, in an
EAP/MBHC integrated product during 2005
(n = 26,464)
 Data source: Administrative and claims data
 Design/analysis: Cross-sectional, generalized
linear models with log link
11

12. Q1b: Study Sample
Gender: Female - 58% Male - 42%
Status: Employee - 49% Spouse/dependent - 51%
EAP session benefit:
3 sessions/year - 31%
4-5 sessions/year - 7%
3 sessions/incident - 15%
4-5 sessions/incident - 46%
Mean # of OP visits: 5.83 (7.86 SD)
Mean OP session payments: $467 ($699 SD)
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13. Q1b: Findings – Use of OP Sessions
Effect of EAP benefit on regular OP sessions*
3 EAP sessions/year
4 EAP sessions/year 7%
3 EAP
sessions/incident 12%
4-5 EAP
sessions/incident 17%
0% 50% 100%
*Controlled for: gender, region, age, status, diagnosis & enrollment duration
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14. Q1b: Findings – Cost
Effect of EAP benefit on regular OP payments*
3 EAP sessions/year
4 EAP sessions/year 3%
3 EAP
sessions/incident 17%
4-5 EAP
sessions/incident 15%
0% 50% 100%
*Controlled for: gender, region, age, status, diagnosis & enrollment duration
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15. Q1b - Implications
 Within an integrated product, increasing a minimal
EAP benefit to a more generous level is associated
with lower utilization and costs for subsequent non-
EAP outpatient sessions
 Thus, when an EAP feature is included within an
integrated EAP/MBHC benefit, it is not simply an
added expense to employers
 Users do seem to perceive some differences between
EAP sessions and non-EAP outpatient sessions. This
suggests that EAP sessions are not merely duplicating
outpatient sessions, but are used differently
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16. Discussion/Q & A
16

17. Q2 – What Choices in EAP Design and
Worksite Services Do Employers Make?
 Study focused on: Employer size, industry,
organizational type, workplace substance abuse
policies, and level of health insurance benefits.
 Sample: 103 purchasers each with 1,000+ covered
employees, EAP-only product.
 Data sources: EAP administrative data, EAP workplace
activity data and results from Account Manager
questionnaires.
 Design/analysis: Cross-sectional; bivariate tests of
association
17

18. Data Sources
Account Manager Questionnaire – Distributed to
MHN Account Managers, this 25 item questionnaire
addressed purchasers’ workplace substance abuse
policies, drug testing practices, level of unionization,
nature/ extent of health coverage, EAP program
features, benefits eligibility of workforce, workplace
focus on health promotion, level of worksite stress.
Account Activities Database - Number and type of
EAP worksite activities; i.e., employee orientations,
mental health and wellness presentations, substance
abuse prevention and policy presentations,
supervisory training, and management consultations.
18

19. Q2: Employer Choices in EAP Limits
Percent of Employers
34%
45%
3-4 sessions 5-7 sessions
8+ sessions
21%
N = 103 employers 19

20. Q2 - Employer Choices - Findings
 84% of employers set limits per issue/incident;
15% per benefit year; 2% no limits.
 72% selected a flexible service delivery mode with
the option for enrollees of either in-person EAP
sessions or telephone counseling.
 Employers in the mining, manufacturing,
transportation and utilities industries were more
likely to provide enrollees with a more generous
EAP benefit (higher number of sessions, per
concern/incident rather than annual limit).
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21. Q2 - Employer Choices - Findings
EAP Worksite Activities & Services:
 53% hosted onsite mental health and wellness
educational presentations (Average annual hrs per
worksite = 8.2)
 48% scheduled workplace substance abuse
prevention or policy training (Average annual hrs per
worksite = 6.9)
 37% received advanced training or organizational
consultation for management or supervisors (Average
annual hrs per worksite = 8)
 Non-commercial & not-for-profit employers (i.e., health
care, government agencies, public education) had the
highest user rate of any worksite activities/services
21

22. Q2: Implications
 Employers do have a number of similarities in
preferences when purchasing EAP products; such
as number and allotment of “free” sessions, and
for modes of delivery, but variations in demand for
worksite services do occur – e.g. by industry,
organizational type.
 Understanding what each particular purchaser’s
preferences and its unique workforce needs are
valuable in selecting the right menu of program
features and services, and thus to maximize its
benefit to the organization.
22

23. Q3 – How do Organizational and
Workplace Factors affect EAP Utilization?
 Study focused on: Four factors - level of
workplace stress; overall level of employer focus on
wellness/health; extent of employer EAP/MBHC
promotion; level of workplace EAP activities
 Sample = 742,937 enrollee (weighted) in EAP-only
or integrated product (26 employers), 2005
 Data sources: EAP administrative data including
claims and eligibility files, results from Account
Manager questionnaires, and EAP workplace
activity data.
 Design/analysis: Cross-sectional; generalized
estimating equations
23

24. Q3 - Organizational Factors and
EAP Utilization - Findings
When EAP Utilization is linked to Workplace Factors…
Higher Employer 1.14*
EAP Promotion
EAP Worksite 1.09*
Activities
Higher 0.96**
Workplace Stress
Higher Employer
Focus on Wellness 0.86**
0 1
Odds Ratio (98% CI) *p<.01; **p<.05
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25. Q3: Implications
 Raising program visibility through employer
promotion and conducting EAP worksite
may be key to increasing utilization.
 However, when experiencing major
stresses or critical incidents, our finding of
an association with lower rates of utilization
suggests it may be necessary to increase
or better target these outreach efforts and
worksite activities to encourage those in
need.
25

26. Discussion/Q & A
26

27. Q4: What Are Employee User
Perspectives on EAPs?
 Study Focus: Facilitators, barriers and experiences with
EAP services.
 Sample: 361 employee users of EAP-only product who had
EAP claim past year and self-reported as an EAP user.
 Data Source: Telephone survey of a stratified random
sample of employees covered by MHN’s stand-alone EAP,
conducted in 2009-10. EAP users were queried regarding
beliefs, knowledge and experience with services in past
year. Among potential respondents with current available
phone numbers, 57% participated in survey.
 Design/Analysis: Cross-sectional; descriptive statistics
27

28. Q4: EAP users
Black
6% Asian
Gender 5%
Race
Other
6%
Male Female
56%
44% White
82%
55+ 18-34
15% 14%
Age
45-54 35-44
39% 32%
N = 361 employee users
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29. Q4: EAP users
Employment Supervisory
status* role?**
Salaried Yes
45%
30%
Not No
Hourly
employed
47%
70%
7%
*N = 361 employee users **N= 335 employee users
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30. Q4: EAP users
Fair/Poor
Health 8% Past year
status risky drinking? 10+ days
11%
Good Excellent
22% 27%
None 1‐5 days
58% 25%
Very good
42%
6‐10 days
6%
Yes
12%
Current
smoker?
No
88%
N = 361 employee users
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31. Q4: EAP Users’ Information Sources About the EAP
From posters/Flyers/HR
communications 77%
From employer website 71%
From employee orientation/ 58%
Training session/workshop
From supervisor 38%
From coworker 33%
From Union 13%
N = 361 employee users
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32. Q4: EAP Users’ Beliefs About the EAP
Believes EAP can help with:
Family & relationship issues 100%
Mental health issues 98%
Alcohol or drug use 95%
Work stress & job performance 95%
Child/elder care & work/life* 82%
Believes EAP is confidential: 96%
N = 361 Employee users *N = 357 Employee users with W/L benefits
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33. Q4: Reasons for Accessing EAP
Family issues/
82%
Personal concerns
Mental health/ 48%
Emotional issues
Job stress/ 34%
Workplace issues
Alcohol or drug 3%
use issues
None of above 2%
N = 361 Employee users
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34. Q4: Who Influenced Decision to Use EAP?
Employer/
Supervisor
Healthcare 14%
provider
5%
56%
None of
25% these
Family or
Friends
N = 229 users with initial scheduled EAP session
34

35. Q4: EAP Services Users Received
In-person sessions only 50%
Telephone only 24%
Telephone & in-person 24%
Had scheduled EAP
74%
session
EAP referred to mental
health services
78%
EAP was 1st behavioral
health service used 86%
*N = 361 Employee users
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36. Q4: How Much EAP Helped Users With Concerns
Not at all
4%
11%
A little
60%
25%
A lot
Some
N = 228 users with initial scheduled EAP session
36

37. Q4: Summary Findings
 EAP assistance with family/personal and mental
health issues is most common, but 1/3 of users
reported EAP helped with job stress/workplace
issues; indicates EAP provides a workplace-focused
benefit to a significant number of users.
 Obtaining EAP help for drug/alcohol issues was not
frequently reported by enrollees; may be masked.
 Employer communications, including via internal
website, were a key source of information on EAP
benefits.
 Most employees who used clinical EAP services
reported they helped a lot and were a valued benefit.
37

38. Q4: Implications
 Ensuring that EAP providers are well-versed in
addressing job stress and workplace issues
remains critical, even in today’s broad-brush,
network-based programs.
 Enhancing employer communications regarding
EAPs is important, since so many employees
learn about the EAP and its services in that way.
 Focusing on additional ways to identify risky
drinking and other substance use disorders is a
challenge and an opportunity for EAPs.
38

39. SA Treatment Non-Users’ Likely
Source of Assistance
100%
23% 24% 27%
80% 38%
50%
17%
60% 32% 33%
40%
35%
60% 36%
20% 44% 40%
27%
14%
0%
Family/Friends SA/MH General med EAP Self-help
professional provider support group
Not likely Somewhat likely Very likely
N = 133 non-users of SA treatment
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40. Limitations of Our Findings
 We cannot determine causality from the
collected data -- given the various studies’
observational, cross-sectional and non-
experimental design.
 We cannot generalize our findings to all
EAP or behavioral healthcare service users,
given that our sample and data came from
only one large EAP/MBHO provider.
40

41. Next Steps
 Linking employee survey findings to
actual claims data; e.g., how responses
of service users relate to service
utilization patterns.
 Investigating the full range of behavioral
health-related services used by clients,
both in and out of covered health plan
benefits.
41

42. For more on methods & findings cited:
Q1a: Merrick EL, Hodgkin D, Horgan CM, Hiatt D, McCann B, Azzone V, Zolotusky G, Ritter G, Reif S,
and McGuire TG. (2009) Integrated employee assistance program/managed behavioral
healthcare benefits: Relationship with access and client characteristics. Administration and
Policy in Mental Health 36(6):416-423.
Q1b: Hodgkin D, Merrick EL, Hiatt D, Horgan CM, McGuire T. (2010) The effect of employee
assistance plan benefits on the use of outpatient behavioral health care. Journal of Mental
Health Policy and Economics. 13(4):167-174.
Q2: McCann B, Azzone V, Merrick EL, Hiatt D, Hodgkin D, Horgan CM. (2010) Employer choices in
EAP design and worksite services. Journal of Workplace Behavioral Health. 25(2):89-106.
Q3: Azzone V, McCann B, Merrick EL, Hiatt D, Hodgkin D, Horgan CM. Workplace stress,
organizational factors and EAP utilization. Journal of Workplace Behavioral Health 2009;
24(3):344-356. PMC Journal – In Process
Q4: Merrick EL, Hodgkin D, Hiatt D, McCann B, Horgan CM. (2011) EAP service use in a managed
behavioral health care organization: From the employee perspective. Journal of Workplace
Behavioral Health. [Forthcoming]
MORE INFO: merrick@brandeis.edu
mccannbag@gmail.com
azzone@hcp.med.harvard.edu
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