The impact of substance use and mental illness on the workplace has been well documented. But how well do employers grasp what’s at stake when faced with employees whose adult dependents are grappling with a mental health or substance use issue?
These employers are confronted with two significant challenges:
- Hidden Costs: Employees’ dependent children ages 18 to 25 with mental health conditions or substance use disorder (SUD) contribute to higher benefits costs through increased claims. But what employers may not realize is that these costs may spiral out of control when young adults seek treatment at out-of-network facilities in states far from home.
- Ripple Effect: Beyond the costs, the ripple effect of mental illness and SUDs also takes a toll on employers in the form of lost productivity and absenteeism. Employees whose children experience mental illness and/or SUDs are often preoccupied with managing their children’s conditions.
These young adults may be unable to stay in school or keep a job. They may be in and out of hospital emergency rooms and rehabilitation treatment centers, or arrested for criminal activity.
Family strains caused by these difficulties frequently spill over into the workplace. The resulting stress, anxiety and distractions may hinder parents from being fully engaged at work.
By understanding these conditions and their impact, employers can begin to take steps to contain costs and help their employees improve productivity.
Treatable Condition
SUD encompasses the abuse of alcohol and other drugs, including the use of legal substances such as prescription medications in ways not prescribed or recommended.
It is important for the general public and for those impacted by substance use disorders to understand that a SUD is not an indication of moral or personal weakness. Rather, it is a chronic, complex brain illness – commonly associated with genetic and biological factors – that interferes with a person’s day-to-day ability to function. Unfortunately, the stigma associated with having a SUD often deters people from seeking treatment.
It’s important to recognize that SUDs are treatable. Indeed, treatment can help individuals recover their ability to live a full life. Success rates for treatment are roughly on par with recovery rates for other chronic diseases including asthma, diabetes and hypertension, according to the Office of National Drug Control Policy. Recovery is possible and is a reality for over 23 million Americans across the country.
Impact on Young Adults
Many mental health and substance use disorders begin when people are in their teens and 20’s. The numbers paint a stark picture.
- SUD rates among people age 18 to 25 are twice that of adults 26 and older (18.9% versus 7.0%, respectively, in 2012; Source: Substance Abuse and Mental Health Services Administration. [2013]. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings [HHS Publication No. SMA 13-4795, NSDUH Series H-46].)
- Among 18- to 25-year-olds, 32 percent of those with any mental illness and 40 percent with a severe mental illness also have a substance use disorder (Source: Ibid.)
- Rates of chronic nonmedical use of opioids are highest among 18- to 25-year-olds. (Source: Behavioral Health Coordinating Committee, Prescription Drug Abuse Subcommittee, U.S. Department of Health and Human Services, Addressing Prescription Drug Abuse in the United States: Current Activities and Future Opportunities, 2013.)
Why Costs are Soaring
Optum has seen a substantial spike in treatment costs among 18- to 25-year-olds in recent years. Our behavioral health claim costs for 18- to 25-year-olds soared 41 percent (per member/per month) between 2011 and 2013. SUD monthly costs jumped 80 percent. (Findings from an Optum May 2014 analysis of behavioral care costs for dependents ages 18-25 among national, ASO and fully insured, HMO/PPO/POS membership.)
A significant portion of these costs is attributable to young adults receiving medical care at out-of-network residential treatment centers with high per-diem charges.
Substandard quality at some of these facilities is another cost driver. In our experience, patients typically have higher relapse and readmission rates than those using in-network facilities closer to home. Recovery from SUDs is an ongoing process and individuals treated in their local communities are better able to connect with recovery support services to assist them in the process.
Inappropriate Treatment Settings
In our estimation, members may not receive the most appropriate or cost-effective treatment in out-of-network treatment settings for three reasons:
- Some out-of-network facilities may not abide by an insurance plan’s treatment guidelines. As a result, patients may not be covered for certain services and would have to pay out of pocket.
- Close analysis of claims from some treatment centers indicates questionable practices in treatment protocols and in billing patients, families and their insurance companies. A prime area of concern is drug screenings through laboratory tests. These tests are often administered inappropriately and far more frequently than necessary, and are billed at rates well beyond the usual and customary charges.
- Typically, after release from an out-of-network facility, patients return home without a support system. This may trigger a return to previous self-destructive behavior and relapse, followed by readmission to another treatment center. Receiving treatment at a facility close to home, however, helps reduce the potential for a future readmission. Patients return home with an established local support network of family, friends and providers that is vital to recovery. If, in fact, relapse does happen, early intervention is available because the support system is in place to re-engage the individual in their recovery process.
Case Study: Florida
Optum’s analysis of recent claims for substance use treatment in Florida found:
- The costs of treatment in out-of-network facilities were, on average, three times higher than the costs of treatment at in-network facilities.
- Nearly 75 percent of the cases of young adults treated in Florida involved individuals who were not Florida residents.
- Individuals from outside the state treated at out-of-network facilities were readmitted at higher rates — between 11 percent and 40 percent higher, depending on the level of care — than Florida residents who used in-network facilities.
(Findings from an Optum May 2014 analysis of behavioral care costs and readmission rates among 18- to 25-year-old members using at least one facility-based service for non-alcohol substance abuse treatment that discharged in 2013.)
What Employers Can Do
Educate: Young adults and/or their families typically select treatment centers in the heat of a crisis. They may not be equipped to ask probing questions about the treatment practices or outcomes before deciding. They also may not know what treatment and support systems are available to them in their home communities. During the recovery process, access to advocates and peer support is essential. Employers can provide educational resources to help employees with young adult dependents understand the many options available for SUD treatment which may include medication assisted treatment.
Promote: Use of Employee Assistance Programs should be encouraged. EAPs are a valuable resource for employees and their young adult dependents to seek counsel and assistance with confidential screenings, treatment referrals and follow-up care to support individuals in or seeking recovery.
Monitor: To help uncover potential fraud and abuse, employers ― in partnership with their health plans ― should implement drug screening and reimbursement codes that follow the recommended guidelines of the Centers for Medicare and Medicaid Services
Advocate: Two-thirds of young adults with mental illness and/or substance use disorder did not receive any services in the past year. When they do seek treatment, it sometimes falls well short of evidence-based practices. Employers should advocate for more evidence-based practices within community-based programs and the availability of peer support networks which support long-term recovery.
Of course, it will take action from everyone with a stake in this issue ― employers, patients and their family members, health plans and providers ― to create better systems for supporting young adults trying to recover from mental illness and/or SUD.
Optum does not recommend or endorse any treatment or medications, specific or otherwise. The information provided is for educational purposes only and is not meant to provide medical advice or otherwise replace professional advice. Consult with your clinician, physician or mental health care provider for specific health care needs, treatment or medications. Certain treatments may not be included in your insurance benefits. Check your health plan regarding your coverage of services.
