Implementation of Modern EAP Can Bring Value, Efficacy

Employee assistance programs (EAPs) might well be relics. Yet replacing them with something better is not easy. A transition might be described in simple terms, but change is simple only in concept. People cling to tradition. More difficult yet is when social institutions have people clinging to interconnected traditions. Systems prefer homeostasis, much as people prefer the familiar.

A strong argument can be made for replacing EAP counseling visits with the use of digital self-care tools. Less than 5% of a population utilizes in-person visits. An average episode entails roughly one in-person visit. The case strengthens with research. Several digital behavioral healthcare companies have published digital results that are comparable with in-person clinical outcomes.

EAPs were designed for prevention and health promotion rather than the treatment of diagnosable conditions, and they are best understood as a health and wellbeing benefit. They should be rooted in the primary care setting. Employers have funded EAPs. Would they endorse changing the services as suggested? Will everyone support a role for the PCP? Can we leverage existing digital providers?

Employers control the dollars and the relationships

EAPs will remain moribund arrangements if employers do not want any changes. Inertia is a powerful force. Yet so too is the prospect of saving money. Digital services should be cheaper than funding a network of professionals. Still, substantial investment must be made in the promotion of these new digital services, and most account maintenance activities remain. PCPs would be complex new partners.

The key arguments for change are reaching more people and maintaining strong clinical outcomes through any transition. Employers understand that many brick-and-mortar operations have moved to digital formats. They also know that promotion is a constant demand and not a one-time event. Digital is appealing because it is confidential, always available, potentially quite engaging, and successful.

It costs money to make major changes. Employers must be convinced the new arrangement is worth the cost and the trouble. Some clinicians will be upset at losing referrals. All PCPs will not be equally accommodating. Existing digital behavioral health companies must embrace this opportunity to provide a new product. Leadership expertise in change management will be needed for a smooth implementation.

Primary care physicians are enduring waves of change

PCP practices were challenged before the pandemic, but in 2020 they are experimenting with digital modalities in ways they never contemplated. It has become a necessity for many to survive. They are witnessing the strengths and weaknesses of the digital experience. Digital is a term covering many capabilities beyond video sessions. Interactive digital self-care tools are viable standalone solutions.

This transition to digital resources for behavioral healthcare can use PCP endorsement. However, the benefit could thrive on its own without PCP support. PCPs will not host the platform, develop the content, or launch the marketing campaigns to build adoption. They will be asked to recommend these resources and encourage clinical team members to incorporate digital lessons into patient care.

It can be argued that behavioral health needs have long outstripped the clinical capacity of primary care offices. PCPs and their staff largely accept that behavioral disorders and essential health behaviors underlie much of what they encounter each day. Yet PCPs are facing existential threats to their practices and have little to spare on this issue. This model asks little of them. Most will see the value.

Digital vendors own this healthcare benefit

The change contemplated here would not be possible if several startup companies had not created an effective solution over the past 10 years. Leveraging the principles of cognitive behavioral therapy and other proven interventions, they have assembled services that address the cost and access problems of traditional therapies. The flaw is that these services have been sold to supplement existing solutions.

Digital vendors have provided health plans, behavioral health and EAP companies with digital solutions to supplement care under various insurance benefits. They are sold as auxiliary services in part to reduce conflict with existing solutions. The behavioral health clinician, the disease management nurse, or other professional offers the primary intervention for each insurance product.

A change to standalone digital resources would mean the former EAP benefit is now owned by the digital company. The employer would establish new contracts for this digital wellbeing product. The PCP and the digital company would work out their business relationship in the process. Digital wellbeing services would not be supplemental. Digital vendors would not be subcontractors to an EAP company.

Accessing your health and wellbeing benefit

Many employers prefer to brand products they offer to employees, and so this benefit for health and wellbeing may go by many names. Access to the benefit will be gained by securing an employer code from either the employer or the PCP office. Marketing campaigns will highlight features and benefits of the digital product. One implicit feature of this product, endorsed by PCPs, is that it is stigma-free.

Each employer implementing this new digital product must account for what happens to aspects of the old EAP product. Some may retain a small network of professionals for mandatory assessments of fitness-for-duty. There will be decisions about subcontractors to the current EAP vendor. For example, the work-life balance subcontractor might be retained or have its services digitally converted.

Employees are accustomed to digital services for a wide range of needs. They will adjust to a new health benefit easily if they are comfortable with its value and credibility. There will be varying levels of contentment with replacement of the old EAP benefit, driven partly by experience with that benefit. Employers and vendors have deep experience implementing new benefits.

Primary care rising to the occasion

While this plan for replacing the EAP counseling benefit with a digital wellbeing benefit may be promising, it cannot reach full potential without the enthusiastic participation of PCPs. This is an opportunity for PCPs to embrace behavioral health as a core dimension of primary care. The ideal scenario has the digital vendor enhancing the benefit annually in consultation with PCPs.

The integration of behavioral healthcare into primary care has been under discussion for decades. It has already occurred in various ways, and yet behavioral care is still not integral to most primary care practices. Adding this digital benefit pushes the discussion forward. It should be easier to absorb than the onsite services of a psychotherapist. All in good time.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.