Targeting Depression: An Employer's Approach

May 15, 2003

Depression is widespread and debilitating. This screening program's successful utilization has a projected return on investment.

 

Targeting Depression:
An Employer's Approach

Jump to:Choose article section...Educating about depressionProviding screening and referral toolsProviding case management servicesUtilization and estimated savingsFuture Direction

By Chelle Dainas, PhD and Laura Beien, LCSW

Depression is widespread and debilitating. This screening program's successful utilization has a projected return on investment.

More than 19 million Americans suffer from depression, generating medical and disability costs that are at least as high as those of hypertension, diabetes, back problems and heart disease.1,2 Depression ranks among the top three behavioral health problems reported by employees. Twenty percent of workers experience mild to major depression in any given year, but nearly two-thirds of those affected go undiagnosed and untreated3 — even though more than 80 percent of them can be successfully treated and return to normal activities, including work, according to the National Mental Health Association. 4

In 2001, Abbott Laboratories realized that it was no exception to these statistical rules. Examining health care and disability data for its 42,000 U.S. based employees, the company found that depression had the second highest incidence after cardiovascular disease. It was also the third highest in total treatment dollars spent and the fourth highest average cost per case. Mental health disorders ranked fourth in short-term medical leave and second in long-term disability case frequency, and 36 percent of Employee Assistance Program (EAP) cases had depressive disorders.

Working with its EAP provided by APS Healthcare (formerly Innovative Resource Group), Abbott implemented a comprehensive Depression Disease Management (DDM) program to decrease the number of employees suffering from depression. The objectives were to provide an enhanced benefit, increase the health and productivity of employees and their families, and reduce overall health care costs. Core components include depression education, screen and referral tools, and case management services.

Educating about depression

A comprehensive toolkit was distributed worldwide to Abbott EAP and wellness champions, typically human resources representatives, who are responsible for onsite health promotion, awareness and education. The toolkit provides a range of information about depression, treatment options, resources and websites, as well as promotional and presentation materials for conducting onsite programs and events. These include handouts on depression, EAP and Work/Life Resources Program, plus Depression Screening Day Promotional Campaign materials such as a sample newsletter, site-specific e-mail , and/or voicemail script, and various website updates.

Providing screening and referral tools

In May 2002, Abbott launched a confidential phone and web-based screening tool that provides immediate feedback and directs at-risk members to the EAP for appropriate treatment. The telephone screening has an automatic feature that allows members in crisis to be transferred directly to the EAP. The tool also offers screening for bipolar, anxiety and eating disorders and alcohol abuse.

Providing case management services

Abbott's program offers biweekly follow-up calls from a care manager to answer questions, assess symptoms, functioning and medication compliance, and to discuss treatment. Care managers, who are licensed masters-level clinicians or psychiatric nurses, do not provide treatment but act as facilitators, advocates and educators. If a member is not currently in psychotherapy, the care manager may assist in finding a therapist. Or if a member is getting medication management from a primary care physician, the care manager may suggest a psychiatrist. Contact may continue for up to six months, or until the care manager determines the member is ready to be discharged from the program. In addition, patients can receive monthly educational newsletters with topics such as recovery, medication, successful treatment, self-care and the role of the primary care physician.

Utilization and estimated savings

In the first 10 months of the DDM program, nearly 2,400 employees and adult dependents have used either the web-based or telephone depression screening. Forty-six percent of those screened had indications of being likely or very likely to have a depressive disorder, but nearly 90 percent were not in treatment at the time, which is consistent with national averages. Women participants outnumbered men by a 3-to-2 ratio and were slightly more likely to screen positive for depression.

Because an extensive promotional campaign boosted response during the first two months, Abbott examined screening results from July 2002 through February 2003 for a clearer picture of characteristic patterns. Sixty-four percent of those screened had indications of depression. Among these, 42 percent have since accessed behavioral health treatment, with three out of four treatment seekers accessing EAP services. In addition, of those responding to a follow-up survey, 67 percent of those having indications of depression plan to seek further evaluation or treatment, and 85 percent found the screening tool helpful.

Two previous EAP cost-benefit studies found that average total health care costs for EAP clients were significantly lower than non-EAP clients.5 Average annual outpatient costs were $590 lower per EAP case. Given the EAP cases generated during the first 10 months of Abbott's Depression Screening program and assuming that the previous outpatient cost reduction applies, the outpatient cost reduction would be $61,950 (i.e., 105 annualized cases X $590). Annual program costs, including first year start-up costs, were $23,000; thus, the expected outpatient cost savings is estimated at $38,950, yielding a 1.7:1 return-on-investment.

Future Direction

Going forward, promotional activities will continue throughout 2003, including company newsletter articles, educational materials and seminars offered by Abbott's EAP and wellness champions across all locations. The National Depression Screening campaign in October will promote additional participation. Promotion is essential for educating employees, their families and management about depression and assisting those who have it to use available resources.

On the administrative front, Abbott will be establishing system and process interfaces across its health plans, pharmacy, disability and disease management programs. Such coordination will facilitate early identification, align program objectives and minimize confusion between multiple case managers.

Primary care physicians and behavioral health professionals will also be a target for education about Abbott's program and referral process. Depression disease management data for 2002 will be examined to determine what provider interventions should be targeted, especially with respect to primary care treatment. This strategy will be instrumental in influencing provider behavior with respect to the effective treatment of depression. Educating primary care physicians will inform them about the program — everything from how to access it, identify and refer depressed patients to , the entire care management process.

Finally, Abbott will continue to conduct cost-benefit analyses of both the depression screening and the case management components, using health care and disability data, as well as customer satisfaction measures. Determining which program components have the greatest impact is a high priority.

Abbott considers the DDM program launch successful and the early results promising. Identifying 2.6 percent of its U.S. based employees or their adult dependents as having depression and getting many of them into treatment exceeded the company's expectations for the first 10 months of the program. Still, this is only a beginning, and we continue to try to make further progress since we know nationally 20 percent of workers experience depression in any given year, and that most of them are not treated.

Chelle Dainas, PhD, (cdainasphd@aol.com), is an Abbott retiree, who served as the company's Director, Corporate Health Promotion and Wellness, and Laura Beien, LCSW, (laura.beien@abbott.com), is Manager, Corporate EAP at Abbott Laboratories.

Abbott Laboratories is a global, broad-based company devoted to the discovery, development, manufacture and marketing of pharmaceuticals, nutritionals and medical products, including devices and diagnostics. For more information, visit www.abbott.com .

References

1. Druss, Benjamin G., "Health and Disability Costs of Depressive Illness is a Major U.S. Concern;" American Journal of Psychiatry; 157: August 2000.

2. Goetzel, Ron A., Ozminkowski, Ronald J., Sederer, Lloyd I., & Mark, Tami L., "Working with Depression: The Business Case for Quality Mental Health Services;" Business & Health, August 1, 2002

3. Tanouye, Elyse, "Mental Illness: A Rising Workplace Cost;" Wall Street Journal, June 13, 2001, p. B1.

4. National Mental Health Association (NMHA): For further information about workplace depression, contact the NMHA at 800-969-NMHA.

5. Dainas, Chelle, & Marks, David, "Evidence of an EAP Cost Offset;" Behavioral Health Management; July/August 2000.

More Business & Health Articles About This Topic:

Working With Depression, Part I: The Business Case for Quality Mental Health Services (Aug. 1, 2002)

Working With Depression, Part II: Finding and Funding Effective Treatment (Aug. 1, 2002)

Depression, Stress and Anxiety Climb the Corporate Ladder (Oct. 3, 2002)

Resource Links:

National Health Mental Associationhttp://www.nmha.org/

Abbott Laboratorieshttp://www.abbott.com

 



Chelle Dainas, Laura Beien. Targeting Depression: An Employer's Approach.

Business and Health

May 15, 2003;21.