Best practices for developing & maintaining a high

Transcript Best practices for developing & maintaining a high

BEST PRACTICES FOR DEVELOPING & MAINTAINING A HIGH QUALITY EAP PROVIDER NETWORK

Objectives

• Provide the tools to effectively develop and maintain a vibrant EAP Network • Distinguish between an EAP Network and a Behavioral Healthcare Network • Build an external and hybrid (internal/external) model Provider Network • Engage quality providers • Employ effective communication strategies

Some of our LifeWorks Customers

LifeWorks EAP/US Model

EAP

Short-term problem resolution Employer selects session model

Behavioral Health Benefits

Medical model - diagnosis and treatment Assess personal issues impacting work Counseling, not treatment • Inpatient, Partial, IOP • Outpatient, Substance Abuse Treatment Generally low risk, routine cases Solution focused Pre-diagnostic Higher levels of care Longer term treatment model

Select Highly Qualified Network Providers

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Provider Screening Criteria

5 years of post master’s degree direct clinical experience 3 years of experience providing EAP counseling Independent license at the highest level of practice in the state of residence • • • • License in good standing with no sanctions Malpractice Insurance $1M per occurrence; $3M aggregate Assess provider’s knowledge of EAP practice through phone interview and “EAP 101” training module completion.

Assess provider’s understanding of workplace organizations, issues and cultures • Culturally diverse: Generational, gender, ethnic, racial, sexual orientation

Primary Source Verification

Obtain credentials directly from the original or primary sources • Licensure – state boards • Insurance – declaration page of insurance policy • Office of Inspector General – verify that individual is in good standing to work in the U.S.

http://exclusions.oig.hhs.gov/

“Right Sized Network”

• Minimum of 98% match of provider practice addresses with participant zip codes Urban (within 5 miles) Suburban (within 15 miles) • Providers regularly receive referrals and remain familiar with unique aspects of the EAP and services offered by the local client company.

Rural (within 20+ miles) Video counseling available • Providers matched to footprint of client employee population.

• Different from managed behavioral health and medical plan network • EAP networks do not include psychiatrists, inpatient facilities or other programs (i.e., partial hospital, IOPs or residential programs)

Network Landscape

• Monthly geographic reports: • Identify gap areas • Target recruitment opportunities • Work with Account Management team to constantly compare and match provider availability to client/employee footprint • Increase efficiency of Network Development specialists

PNS

Regional Map

Guam

Hawaii

OR WA ID CA NV UT AZ MT WY CO NM VT NH ND MI MN SD WI NY NE KS OK IA MO AR PA OH IL IN WV VA KY MS TN AL GA NC SC TX LA FL Black States = 98% Match Green States = 96% - 98% Match Yellow States = 93% - 95% Match Red States = ≤ 92% MA NJ DE MD RI CT

DC Virgin Islands

Staffing Recommendations

• Director – Masters level, CEAP/licensed • Clinical Manager – Masters level, CEAP/licensed • Affiliate Managers – Masters level, CEAP prepared/ license preferred • Network Development Specialist – Masters level • Credentialing Specialist – Masters level • PNS Systems Coordinator

Provider Portal

• Intake • Progress Notes • Case Closure • Linked to Case Management system and Client Dashboard reporting of outcome measurements and ROI • EAP Training

Network Quality Monitoring

• Credentialing Committee Director, VP Operations, Corporate Attorney, PNS Staff • Sanction monitoring/review Identified both through credentialing process and weekly sanction monitoring through Council on Affordable Healthcare (CAQH) • Appeals Committee Director, VP Operations, Cooperate Attorney, PNS Staff Review any written request from a provider • Process Provider placed on temporary inactive while reviewed and investigated

Network Communication

• Provider Advisory Committee • Survey Provider Network – to assess level of satisfaction with LifeWorks • Quarterly newsletter • Email blasts • Targeted Trainings/Ceridian LifeWorks Products Updates • Phone and one-on-one support/clinical case consultation

Affiliate Comments

“Thanks so much for your help with this, Carolyn! It is much appreciated. You have accomplished this so quickly, compared to other companies that I work with.” “Thank you and please let your supervisor know that you have been great to work with. So uncommon these days!!!” “Just wanted to say ‘Thank you so much!’ for your patience, assistance and hanging in with me to get his done. You must be a great asset to your company!” “You have made a very difficult situation for me almost a dream come true. I wish there were more customer service people like you that understand what real customer service is really about. Tell your boss that I said so, too!”

EAP SERVICE MODELS

EAP Service Models

Internal (Staff Model)

EA provider is employed by the company. Member Assistance programs. Services offered by trained union members/employees.

External

Comprehensive EAP/Work Life vendor supplied services offering all of the standard elements through a full service call center(s) and contracted provider affiliates.

Hybrid

Both vendor supplied services with regularly scheduled in person, onsite services. Onsite may be employed by vendor or contracted.

Session Models and Employer Oversight

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Determined by the client company:

Average 3 sessions to 8 sessions – with few exceptions Economics, workforce, behavioral health benefit, culture Possibly managed out of the employer’s: • Corporate/Regional Benefits Department • Health and Wellness Department • Occupational Health/Medical/Wellness Department

EAP SERVICES

EAP and Work-Life Services

SERVICES FOR PARTICIPANTS (client employee/caller) Counseling Legal / Financial Health Coaching and Wellness services Research Comprehensive website: Lifeworks.com

SERVICES FOR EMPLOYER (HR, all levels of management) Management Consultation, Referral Formal and Mandatory Case Management Substance Abuse Assessment and Case Management Consultation on employee issues and sensitive workplace situations Onsite Support – Routine EAP Counseling Onsite Support - Crisis Response Risk and Threat Assessment

Top 10 Presenting Issues

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Stress Management Couples Relationship Issues Depression Family Relationship Issues Divorce/Separation Grief and Loss Anxiety Custody, Visitation and Child Support Budgeting and Basic Money Management Work Related Stress

Supervisors and EAPs – Different Views

What the Supervisor sees: Observable workplace behaviors

• • • • • • Poor job performance Absenteeism / Tardiness Presenteeism Work accidents/injuries Poor workplace relations Workplace disruption • • • • • • • Interpersonal Marital/Family Substance use Vocational Emotional Financial Legal

What the EAP sees: Underlying personal concerns

Top 10 Issues Selected on Website

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Emotional Well-Being Legal Financial Work Parenting & Child Care Managing People Addiction & Recovery Older Adults Legal Issues Health Management