Erika Shea never imagined she would personally be involved with EAPs, aside from setting one up for an employer and gathering all of the marketing information for their employees to use. Generally, the benefit consultant for Group Insurance Associates, a partner firm of United Benefit Advisors, had found them to be an underutilized resource. However, the tragedy in Newtown, Conn., changed her perspective.

On the afternoon of the Dec. 14, 2012, shooting, Shea learned that a client's employee's son was one of the victims. Her client asked her to be ready to have grief counselors available by the next week. That following Wednesday there was a large employee turnout when she brought a counselor to the client's office. "It was very well-received and appreciated," Shea says. "If nothing else, it shined a light on what's available to them, and I hope that perhaps some of the employees continued to take advantage of the EAP services on an individual level."

Employers often now must not only meet the everyday workplace or business issues, but also assume some level of responsibility for providing support to employees during critical and potentially overwhelming times.

But Sean Fogarty, president of Chicago-based CuraLinc Healthcare, believes in order to maximize the value of the EAP in these situations, it's important that every level of the organization knows the program can be an invaluable resource to help employees normalize their response to the event.

"Whether proactively by keeping up with local news, or reactively by responding to a client's request for help, a strong EAP provider will take ownership of the response immediately and leverage their experience to hasten an organizational return to productivity, mitigate long-term stress responses, and enhance the employees' overall adjustment at work and at home," he says.

EAPs now appear to be an accepted, if not a required, employer benefit that employees have learned to expect. A 2008 National Study of Employers, the most recent data following 10 years of trends related to U.S. workplace policies and benefits, found that the EAP industry continues to grow, with 65% of employers providing EAPs in 2008, up from 56% in 1998.

Even more, the Employee Assistance Professional Association offers the following as evidence of this acceptance:

* More than 97% of companies with more than 5,000 employees have EAPs

* 80% with 1,001 - 5,000 employees have EAPs

* 75% with 251 - 1,000 employees have EAPs

The confluence of several landscape-changing drivers is making employee assistance programs more valuable than ever. The passage of the Patient Protection and Affordable Care Act, a focus on utilization rather than outcome, and more customized programs are just a few of the latest trends in EAPs that focus on all aspects of a member's life: health, career and lifestyle priorities. These new EAP trends are designed to engage people in addressing lifestyle issues and workplace stresses. It also allows employers to more efficiently manage health care cost by helping their employees improve overall well-being.



PPACA's influence

In the next twelve months, health care reform will cause EAPs to consider alternative treatment models. PPACA is forcing unprecedented changes to our health care delivery system, Fogarty says. Starting in 2014, more Americans will be accessing health care benefits, and they'll be doing it through channels that are already near capacity.

"With the number of behavioral health practitioners in the U.S. already trending downward, access to care for EAP services (particularly in rural areas) will be compromised," Fogarty says. "In order to provide reasonable access, EAPs will be forced to consider technology-based treatment models - such as distance counseling - as a core program offering."

Not only will the provision of video, telephonic and chat-based therapy options provide members with more efficient access to care, EAPs that implement alternative treatment models in 2013 can position themselves as a catalyst to the paradigm shift that will change health care delivery in 2014 and beyond.

Katie Banks, product marketing vendor manager with The Standard, adds that a 2012 Towers Watson Global study indicated alternative treatment models to be a trend worldwide, and one with important repercussions. The study found that two-thirds of employees feel unsupported, detached or completely disengaged, yet rely on practices and programs designed for an era that's rapidly disappearing.

"EAP vendors are responding by addressing the changing work environment by enhancing product offerings that allow for a wider array of resources and access," Banks says. "The use of Web, intranet and Internet technology, changes in after-sale promotional material, further integration of the EAP into other employer benefit products, and self-care offerings are the main tactics emerging."



Outcomes first

EAP providers - and employers that offer EAPs - will focus more on outcomes than on utilization.

Maria Lund, president and COO of Columbia, S.C.-based First Sun EAP, says, historically, EAPs measured success by demonstrating overall utilization of and satisfaction with services. This allowed purchasers to see that services were valued by employees.

"Later generations of measures focused on patterns of use - i.e. did the employee have his/her needs taken care of within the EAP service or was there a referral to the health care plan?" she says. "This allowed purchasers to see if EAPs were helping contain health care expenses."

CuraLinc Healthcare's Fogarty adds that for as long as he could remember, utilization was the sole metric used to measure the success or failure of an employee assistance program. Unfortunately, using this flawed logic, providers and clients assumed that a participant got healthier simply by using the EAP.

"While utilization should be one metric used to evaluate the effectiveness and value of an EAP, I think we'll see more providers add data regarding treatment efficacy into their patient management protocol," he says. "Because many EAP providers already use standardized tools for measuring outcomes, the transfer of this data from a clinical database to a client report (and, eventually, to a stronger value proposition) is on the horizon."

Additionally, Lund believes newer generations of measures are targeted at measuring impact to productivity, which is where employers get the most bang for their buck relative to EAP services. These measures assess pre- and post-service functioning in areas such as absenteeism, presenteeism and work engagement. They also give specific feedback to purchasers and organizational leaders as to how services are affecting the corporate bottom line.



Another trend in EAPs is taking a more customized service approach that offers a full range of issues that touch quality of life and workplace effectiveness. Lund believes that economic pressures, more complexity in work processes and more stress and health challenges in the workforce mean that employers have to make benefit choices based on how the benefits fit with the company's needs.

"Generic, one-size-fits-all EAPs are no longer adequate to create meaningful impact," Lund says. "Effective EAPs offer executive-level consultation to set and monitor specific program goals related to the needs of the organization and the workforce, so services can zero in on the issues that most affect the employees' needs and the corporate bottom line."

Banks believes approaching EAPs as a more holistic benefit that includes a wider variety of services than those behavioral health and substance abuse resources that once defined them. The inclusion of child and eldercare consultation and resources, legal and financial consultation and resources, concierge services, wellness seminars and resources, as well as robust Web-based information, assessments and links altogether address a broader need for today's workers.

"Most EAPs now provide support services to the employee's household members who, if struggling with a financial, legal, or emotional problem, can adversely impact the employee's productivity," Banks says. "As we all know, everyday life can present us with both unforeseen challenges and crisis situations."

For example, Banks says several literature reviews have examined the dozens of research studies done on the clinical effectiveness and utility of providing crisis-related critical incident response (CIR) services. The conclusion from these reviews is that CIR services, when properly delivered, are helpful in reducing the symptoms of severe stress that affect individuals who have experienced a workplace trauma or other critical incidents. According to a review by the National Institute of Mental Health, early, brief and focused psychotherapeutic intervention can reduce distress in bereaved spouses, parents and children.

"The business value for employers from the proper use of these services from EAPs is most likely to be found in the outcomes of reduced worker health care costs, reduced disability claim costs, reduced workers' compensation claim costs, reduced worker absence days, and reduced worker turnover from increasing the number of employees who can successfully return to work from being on disability after experiencing a traumatic event," Banks says.

Overall, Aida Visakay, CEO of AxisPointe LLC, a partner firm of United Benefit Advisors, says that more than ever, employers are realizing that marketing the full scope of EAP benefits, from the traditional counseling and management consultation resources to the nontraditional services such as financial, legal, and work/life assistance and promoting the preventive nature of the program, reduces the stigma associated with the EAP.

Fogarty adds that an EAP, if positioned effectively, can have a positive effect on employee productivity, engagement and resiliency. And because the majority of employers already provide an EAP, the role of the adviser is typically less about making a business case for the program and more about helping the client select a provider that suits the goals and the culture of the organization.

"The program can also impact direct and indirect health care costs - and, with some models, it can function as an integrated component of a client's population health management strategy that addresses behavioral health as both a primary and a co-morbid health condition," he says. "It's important that benefit advisers understand the different types of EAP models - as well as the goals of their client and the core competencies of the provider - before making any introductions or recommendations."

Shelton Harris is an Alabama-based freelance writer.

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