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Following the pathways to substance use treatment

January 1, 2008
by Bernard McCann, MS, CEAP, Deirdre Hiatt, PhD, and Elizabeth L. Merrick, PhD, MSW
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A five-year project will examine how consumers use managed behavioral health and EAP services

Substance abuse negatively impacts public safety, reduces workers’ productivity, and contributes to higher healthcare costs, premature death, and disability for millions of Americans.1 In fact, substance use disorders are among the most common medical conditions.2 Although clinical advances in recent decades have increased the availability of effective treatments for substance use disorders, these treatments persistently are underutilized.3

Reducing the impact of substance abuse on rising healthcare costs and worker productivity is particularly relevant to employers, as most substance users and most of those with substance use disorders are employed.4 Furthermore, a majority of the nonelderly population (60%) is enrolled in employer-paid insurance plans.5 Employees and their dependents in such plans often have multiple pathways to specialty substance abuse and other behavioral health treatments, including managed behavioral healthcare (MBHC) carve-out plans, employee assistance programs (EAPs) and, in some cases, “integrated” products that combine features of both product types. To facilitate treatment access and engagement for those with substance use disorders, understanding the treatment pathways individuals utilize is critical.

Funded by the National Institute on Drug Abuse, Substance Abuse Treatment Pathways in Employee Groups is a five-year research collaboration between MHN of Point Richmond, California, and the Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment.* The goal is to study aspects of treatment access. MHN is a MBHC organization that provides stand-alone EAP, MBHC carve-out, and integrated products. The Brandeis/Harvard Center is a partnership between Brandeis University's Institute for Behavioral Health and Harvard Medical School's Department of Health Care Policy.

Relatively few large-scale research efforts have investigated mental health and substance abuse services utilization within the variety of contemporary MBHC product types. Stand-alone EAPs, behavioral health carve-outs, and integrated programs continue to evolve, and research is crucial to understand current approaches to address workplace substance abuse.6

Specific goals of the Pathways study include describing access to specialty treatment for substance use disorders, profiles of service utilization, treatment costs, and performance indicators. The various contributions of employer workplace policies, EAP/MBHC product types, and client preferences will be investigated along with other utilization factors. Researchers are interested in the differences in substance abuse treatment access, engagement, and costs between integrated and stand-alone versions of EAP and MBHC products. Research questions the collaboration hopes to answer include:

  • Is EAP availability associated with increased access to substance abuse treatment?

  • What effect, if any, does integrating EAP and MBHC products have on barriers to substance abuse treatment?

  • Is earlier intervention via EAPs reflected in case severity, level of care, and/or utilization measures?

  • How do workplace substance abuse policies and program promotion affect utilization?

  • Are enrollees’ beliefs regarding confidentiality and treatment effectiveness related to their decisions to use services?

Study data to examine these aspects will come from three distinct and complementary data sources: MHN's administrative records from the years 1999 to 2008, information collected regarding employer/purchaser organizations, and a survey of plan enrollees’ perceptions and experiences. The enrollee survey will examine help-seeking behavior, resource use, experience of care, and perception of benefits for both users and nonusers of substance abuse treatment services. The researchers will analyze claims, eligibility, authorization, and initial assessment data, and link these to data collected from account managers and plan enrollees.

Research collaborations between private-sector behavioral healthcare companies and academic institutions can be mutually beneficial if their respective goals and missions are acknowledged and addressed. Advantages to behavioral healthcare companies such as MHN include gaining new and more sophisticated insights about their covered population, which can assist them in better targeting services and allocating appropriate resources. Affiliating with academic researchers can provide a long-term, resource-intensive capacity, increasing a company's ability to examine clinical processes, thereby affording new levels of data quality and analysis. Other advantages include the ability to provide employer clients with aggregated feedback regarding their workforce and dependent populations to support earlier and more precise forecasting of trends. Access to more accurate information on employee and plan enrollees’ behavioral healthcare utilization might allow a MBHC company to confidently recommend more customized benefits packages.

For academic researchers, the wealth of unique information in private-sector databases and enhanced access to survey participants are especially valuable, affording a more comprehensive understanding of client behavior and organizational factors related to treatment access and utilization in employer-paid behavioral healthcare.