The opioid epidemic has been at the forefront of national news as the number of deaths continue to increase each year — rising threefold from 1999 to more than 63,000 in 2016. Benefit advisers and others in healthcare have taken notice. But it’s important to keep in mind that the addiction crisis is much broader than opioids. Tobacco and alcohol use remain a huge problem that cannot be understated —with alcohol impacting one in eight working adults and tobacco closer to one in five.
In addition to the medical expenses required to treat substance use disorders, a significant — and somewhat hidden — portion of the cost to employers comes in the form of absenteeism (days missed due to illness) and presenteeism (days at work with limited job productivity due to poor health). The CDC has estimated alcohol use to cost about $180 billion in lost workplace productivity and tobacco use disorders more than $156 billion annually. If individuals with substance use disorders received appropriate attention, employers could save billions of dollars and significantly improve employee well-being.
Advisers must focus on actions that can make a meaningful dent in these trends from both a provider and purchaser perspective to address substance use disorders more holistically. Here are four things employers can do to help address the crisis.
Use data to understand the true magnitude of the problem. To start, it helps to come to terms with how widespread the problem may be. Once employers understand the scope, they can begin to identify health needs. The National Safety Council, Shatterproof and NORC at the University of Chicago collaborated to design “The Real Cost of Substance Use to Employers” tool. This free resource estimates the number of employees and dependents affected and by which substances and provides specific information about the cost of substance use in the workplace, incorporating lost time, job turn-over and training, and healthcare.
To get an even clearer picture, employers should work with their health plans and data warehouses to identify patients in need of additional support and treatment. Beyond looking at medical claims, employers can use proxies, such as looking at the number of injuries filed on a Monday versus a Tuesday, to identify employees with substance use disorders.
Increase treatment rate by reducing stigma in the workplace. The National Institute of Drug Abuse defines addiction as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. By recognizing substance use disorders as a disease and starting a dialogue within the workplace, employers can reduce the stigma that may keep people from seeking help and encourage them to seek out treatment options.
Insist your population receive evidence-based treatments. As a purchaser of healthcare, employers can manipulate plan design to encourage the members of their populations to receive evidence-based treatments (for example, covering medication assisted treatments first dollar). Employers should start by asking their health plans what they are doing to direct members to providers with evidence-based practice patterns. If they are not doing so, employers should make this a priority with their health plans or pilot their own program.
Employers can ask their behavioral health partners what they are doing specifically to address substance use disorders. Do telehealth vendors offering mental health services offer dedicated substance use support? If they have a cognitive behavioral therapy solution, is it designed to treat substance use disorders, or just depression and anxiety broadly? Employers should understand whether partners are intending to invest in this area and, if not, should make it a priority.
Hold providers accountable. By exploring new ways of paying healthcare providers — with health plan partners or on their own — employers can tie payment to quality measures to encourage providers to prescribe appropriate treatments for patients with substance use disorders. For example, if provider payment is partly dependent on performing well on certain quality measures, such as screening for tobacco use and cessation intervention, providers may be more likely to screen their patients, hopefully, leading to more appropriate interventions and treatments for their tobacco use.
Employers working together
We urge employers to get involved because the problem is larger than most think. One way employers are working together and exploring their options for addressing substance use disorders is by participating in Catalyst for Payment Reform’s Substance Use Disorders Collaborative. Over the course of this year, large employers will convene to explore the strategies listed above, with the hope of tailoring initiatives to improve care for members of their populations with substance use disorders. CPR will turn the lessons learned during this effort into purchasing tools that other employers and healthcare purchasers can use to implement high value strategies that address substance use disorders.
By facing these issues head on, businesses can do their part to curb this epidemic while making a positive impact not only on the health and well-being of their employees and family members, but also on their financial bottom line.
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