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Ancillary Behavioral Benefits Should Be Cannibalized and Reconstituted in Primary Care
Executives are always scanning business trends to identify potential opportunities. Sometimes the most promising trends are recurrent or persistent. This often reflects a problem being neglected. A good example is the chronic underutilization of behavioral benefits that are ancillary to primary insurance coverage. These benefits are often designed for prevention, early intervention, or special populations.
These insufficiently used benefit packages are usually employer-funded, and one of the main reasons employees do not use them is inconvenience. The crux of the problem is that the benefit is for a separate, standalone service. Separate programs generally have distinct access procedures, networks, and financial arrangements, and these can become access barriers.
Why not restructure the benefits to overcome these barriers? Employers know from experience that benefits and services often need modifications to improve their use. Radical change is needed at times. Consider the analogy of car designers who cannibalize old models to produce new ones. It may be time to cannibalize several benefits that have lost their luster and rebuild them to increase their appeal.
Consider the following 3 benefits ripe for cannibalizing:
- Employee Assistance Programs. EAPs are preventive or early intervention services to be used for all types of distress. Many bells and whistles (from work/life balance to legal and financial counseling) have been added to increase benefit use. EAP visits have no copay, but they are underutilized. The added benefits get even less use. People find access complicated—even virtual models have this problem.
- Wellness Benefits & Workplace “Culture of Health.” Employers have funded behavior change programs for smoking cessation and weight loss. Also, they have worked with experts to establish a culture of health in the workplace. This ranges from onsite wellness programs to cafeterias with healthy choice architecture. These perennial problems persist, and culture change is mainly a focus for big worksites.
- Disease Management. DM is designed to help people change unhealthy behaviors contributing to chronic conditions like diabetes and congestive heart disease. However, low utilization has long been a problem. People fail to enroll or to answer nursing calls targeting individualized health goals. Many people feel like they’re being nagged, and they reject separate programs redundant with medical care.
Reconstituting Ancillary Behavioral Benefits
These distinct benefit programs are alike in focusing on behavior. They also share a common limitation. They are independent programs, separate from the medical or behavioral insurance plan. Funded by knowledgeable employers, their Achilles heel is that they are disconnected from the services people use routinely in primary care. This is a limitation of separate behavioral healthcare insurance as well.
As designed currently, these benefits cannot simply be shifted to primary care. Yet they could be dissolved in their current state, then rewritten as health promotion and disease prevention programs for primary care. This is doable now because therapists are steadily moving into primary care. This trend will intensify as our staff and programs are steadily consolidated into health systems.
Healthcare experts want to move upstream from sick care to health care, from treating illnesses to preventing or stopping disorders early in development. Behavior change is a critical part of this. If the intent is to facilitate access and meet patients where they are, these services belong within primary care.
New products often start on a standalone basis. For example, consider today’s digital therapeutics platforms. They ultimately must be situated inside systems of care to get the level of use warranted. Yet until then, they will be sold independently and get more limited use.
Many innovative healthcare ideas are abandoned because they lack funding. This proposal starts with funding. It starts with realizing that employer funds have flowed inefficiently for years. We need these benefits shifted to primary care for easier access, with provider reimbursement structured accordingly.
The Mission for Behavioral Executives
Employers know well that their ancillary behavioral programs have low utilization. While their intended goals may be more fully realized in primary care, this will be a disruptive process—right in concept, but difficult in execution. Most practical problems can be solved, but the biggest hurdle may be anxiety over upending established programs and traditions.
Some consolation can be found by revisiting our history. Behavioral healthcare would probably already be a primary care service had our field been more advanced when primary care was created. Our field is now clinically advanced. For better or worse, we are riding the tide of consolidation into medical settings. Let us go back to the beginning. We are now ready to play a key role in population health.
Behavioral executives must reach out to employers and health systems to promote this new prevention model centered on behavior change. Separate programs are expedient, but disconnecting them from healthcare has been an error. They should live in the healthcare setting most people visit: primary care, where therapists will be multiplying. This is a major business opportunity for our field.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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