JEA Q1 2020

Cover Story

A Next-Gen EAP for Today’s Workforce

By Susan Skinner, MS, CEAP

Organizations are made up of people – executives who make the big decisions and staff at all levels who come to their worksite or work remotely to get the job done. One day, many of these same jobs may be replaced by machines that don’t break down – emotionally, at least – but until then, effectively managing people is what makes all organizations tick.
The Employee Assistance Program (EAP) industry grew out of a central idea: When an employee at any level of the organization comes to work compromised or impaired (e.g., addiction, anxiety, depression), personal and organizational performance suffers. Over the years, EAPs have expanded their reach and range of services to address the increasing complexity of modern life. People can’t conveniently compartmentalize their lives. The emotional drain of experiencing childcare and eldercare issues, problems with family and relationships, legal or financial worries impact employees at home and at work.

Blurred Lines between Work and Life
Today, the business landscape is shifting, with blurred lines between work and life, global competition, rapid market and technology changes, rise of the gig economy, and increased workforce mobility. Just as news comes in ever-shorter cycles, employers and employees alike operate in a state of constant flux. These broad environmental dynamics are occurring alongside a parallel set of personal challenges and major life events (e.g., having a baby, getting a promotion, relocating), all with their associated daily demands.
One of the most essential functions of an EAP is to provide confidential support services – on demand, when and where employees need them – as well as tools to help keep employees present-minded, focused, prepared, and resilient.
While the challenges have never been greater, the reality is that a widespread but little recognized problem exists in the EAP industry: the emphasis on driving fees lower and lower has led many of the nation’s EAPs to purposefully limit meaningful interaction with the same “at-risk” employees with the same employees they are contracted to help.

Components of a Next-Gen EAP
How does a next-gen EAP differ from a typical employee assistance program?

* Focuses on proactive and continuous engagement versus only at “point of need”;
* Leverages technology to extend EAP expertise and support to a global workforce;
* Utilizes that same technology to reduce employee hesitancy to connect with trained professionals to resolve personal challenges;
* Offers a comprehensive set of user-driver programs and tools for a range of conditions, behaviors, and life events; and
* Consistently delivers superior outcomes to more employees at all levels of the organization.

Structural Problems
While healthcare costs continue to rise, market rates for full-service EAPs have dramatically fallen more than 40% since 1990, forcing many vendors to cut corners and deliver less (Sharar, 2019). Many purchasers have grown content to pay as little for the service as possible in order to have it, and many EAP vendors have been willing to do so.
In order to make their business models work, these EAP vendors have managed to convince purchasers that nebulously defined “utilization” ought to be the overriding metric of success. The emphasis on utilization rather than on outcomes is easy to “game.” Since there is no industry-standard definition, EAP vendors are free to define utilization to their advantage – where a website visit, administrative telephone inquiry or downloaded help-sheet counts toward “utilization.” Many EAP vendors define utilization using this inflated approach that is silent on the most important metric, certainly from a clinical and financial standpoint: outcomes.
Indeed, isolated from view and lacking true valid comparative measures of effectiveness, most EAPs operate without measuring – let alone improving – their outcomes. Instead of results, many EAP vendors have focused on low price and low-cost features, leading to an environment where marginal vendors are able to “compete” with optimal ones. While companies continue to engage these low-cost, low-impact EAPs, they ultimately do so at great expense, as “at risk” and underperforming employees are not adequately engaged, assessed, or treated.
As a result, employers get less for their shrinking benefit dollar, often in areas where their needs and the potential returns are the highest. Benefit consultants are missing strategic opportunities to improve workforce well-being and contain medical plan claims. Everyone loses over what are essentially pennies on the benefit dollar.
A bare-bones EAP that discourages and limits interaction with credentialed counselors results in employers spending money on services that do not adequately address the needs of their employees and their families who are grappling with major issues (e.g., depression, loneliness, anxiety, substance abuse) and life circumstances (e.g., marital conflict, financial woes, stress).

A Changing Landscape
When job candidates are screened, employers look at their work histories, educational attainment, skill sets, and culture fit. They typically know nothing about their candidates’ mental health issues, family history of suicide, recent losses or personal difficulties – all common risk factors that can impair job performance, productivity and morale.
The scope and severity of personal problems that employees bring to the workplace are the manifestation of several alarming societal trends, in particular the increasing prevalence of suicidal behavior and widespread cross-generational loneliness and isolation.
According to a report by the Centers for Disease Control and Prevention, 47,000 Americans died by suicide in 2017, up 33% from 1999 (Heldegaard, Curtin, Warner, 2018). Researchers have found that the majority of suicides are related to problems with relationships, substance abuse, health, jobs, or finances.
We have also seen a rise in drug overdoses. There were more than 70,000 drug overdose deaths in 2017, the highest number of drug overdose deaths for any single year in US history (CDC). What are termed “deaths of despair”, suicides and drug overdoses (including those from prescribed opioid painkillers) – are an ever-escalating problem contributing to the declining trend in life expectancy in the U.S. over the past several years.
Alienation – feeling despondent, lonely, and without purpose – affects millions, and is so widespread that social isolation may be as great a public health hazard as obesity or tobacco use. According to a study conducted by AARP, approximately 42.6 million U.S. adults age 45 and older were suffering from loneliness (AARP Foundation, 2018). Moreover, a Cigna survey suggests that Generation Z, adults between ages 18 and 22, may be the loneliest segment of the population, which doesn’t bode well as this generation enters the workforce en masse (Cigna, 2018).
Carla Perissinoto, a geriatrician at the University of California-San Francisco states that social isolation hasn’t received sufficient attention. “Policy in this country doesn’t address this kind of concern, because many health care workers believe that social factors have nothing to do with medicine.” No age group is exempt from feelings of isolation and loneliness. These trends are not expected to be reversed or arrested, in part due to social, cultural, and even business drivers (such as increased mobility and flux, which make it harder to form and maintain relationships). It is also driven by ubiquity of social media, which blur the lines between appearing, and actually feeling, connected.
Suffice it to say that EAPs that emerged several decades ago to address such issues as alcoholism and drug dependency, face far greater challenges today. We have tools and body of evidence to do a much better job of identifying and treating current-day problems, but the prevalent EAP service delivery models described in the previous section ill-equip – indeed ill-serve – employers and employees who desperately need solutions.

Toward a Next-Gen EAP
Next-Gen EAP is based on the following core principles:

* Success measured by outcomes shifts the focus to value, quality, and prevention that help keep employees from needing more costly medical plan services down the line.

* A greater range of access options lowers barriers to effective utilization – from digitally delivered screening, education and progress tracking to on-demand access to a licensed counselor via voice, text, or chat.

* Systemic, targeted outreach “normalizes the EAP”. Educating employees about the range of available life event support services helps to eliminate the perceived stigma often associated with seeking traditional EAP services.

* Participant-centered care models are transformational and contribute to higher quality service delivery and better participant outcomes. EAP participants who play an active role in the management of their mental and physical health are more likely to follow their clinician’s treatment recommendations. They also have higher expectations of their provider in terms of advocacy, clinical customer service, and customized care.

* The implicit function of an EAP is an organizational tool to retain talent and manage performance. All employees, including senior management, may eventually have personal issues that spill over into the workplace. Next-Gen EAP addresses not only the well-being issues that compromise employee productivity, and performance but also impact other key performance indicators such as retention, engagement, and healthcare costs.

* Support for senior leadership and human capital management: Next-Gen EAP offers expertise on the human side of business strategy, from crisis management to organizational resilience.

* Going digital: Next-Gen EAP increases engagement and leverages technology to deliver personalized care through people’s preferred means of communication. Science-based screening, self-paced education and mindfulness exercises are supplemented with options to text with a coach, request additional services or speak directly with a licensed EAP counselor for in-the-moment support. The technology uses analytics to help employers monitor and address the emotional health of their workforce and to help participants achieve their personal goals and improve their quality of life.

* AI and machine-learning drives pathways to personalized, human-delivered, compassionate care. Next-Gen EAP leverages technology to expedite human-to-human connection with the right experts to successfully resolve personal challenges and address the conditions of loneliness and isolation.

* EAP as a change management platform: Job-hopping, gig workers, and the fluid nature of modern work and life have heightened employee anxiety and sense of dislocation. Next-Gen EAP is about managing all manner of change at the individual and organizational level.

Summary
Due to a misplaced emphasis on “utilization” (for which there is no industry standard definition) rather than on outcomes, millions of employees and their families are insufficiently engaged and inadequately treated...while employers spend millions of dollars on programs that limit meaningful engagement and intervention by their very design.
Next-Gen EAP focuses on proactive and continuous engagement. It leverages technology to extend EAP expertise and support to workforces around the globe, while it also guides individuals to connect directly with a trained professional to resolve personal challenges. It also affirms new ways of thinking about mental health and wellness.
For instance, an increasing number of new health companies are encouraging people to think and talk about nutrition as a problem of personal technology, where losing weight isn’t about self-deprivation, but about optimization. Ultimately, all roads lead to one overarching idea: Your EAP is only as good as its results in in demonstrably improving performance and productivity at all levels of the organization.

Feedback on this article is welcome by emailing journal@eapassn.org.

Susan Skinner, MS, CEAP, is the founder, CEO, and president of Personal Assistance Services (PAS) in St. Louis, MO. She may be reached at spskinner@paseap.com.

Editor’s note: Copyright © Personal Assistance Services. Used with permission.

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References

AARP Foundation (2018). A national survey of adults 45 and older: Loneliness and social connections [pdf] doi.org/10.26419/res.00246.001

Cigna (2018, May 1). New Cigna study reveals loneliness at epidemic levels in America: Research puts spotlight on the impact of loneliness in the U.S. and potential root causes. Retrieved from http://cigna.newshq.businesswire.com/press-release/new-cigna-study-reveals-loneliness-epidemic-levels-america

Hedegaard, H., Curtin, S. & Warner, M. (2018, November), National Center for Health Statistics (NCHS) Data Brief, No. 330. Suicide mortality in the United States, 1999-2017. (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.)

Sharar, D.A. (2019). Journal of Employee Assistance: 49(2): 10-13, 33.