National Behavioral Consortium

1. National Behavioral Consortium PRICING STRATEGIES AND VALUE Discussion Leader: Tom Bjornson Founder & CEO, Claremont Behavioral Services January 23 , 2008

2. What’s an EAP? Objectives? Place at Table? • Counseling Benefit? • Productivity Tool? • Focus on Outcome Metrics vs. Process

3. Versions of EAP: • Disability Plan Sponsored • Ceridian • Health Plan Sponsored • Blue Cross of California • Aetna • Cigna • Large MBHO • Magellan • Value Options • Regional MBHO • NBC Founders • Agency-based • Family Services • Regional EAP • Chestnut • Claremont • Internal Staff Models • Medical • Human Resources

4. EAP Best Practices Employees & Family Members Managers, HR, Labor Leaders Promotion, Awareness, and Perceived Value Self Referral Problem Identification and Referral Triggers Disease Management Case Consultations Health Promotion & Wellness Initial Response & Case Handling Coordination EAP Case Management and Advocacy EAP Counseling Life Management Critical Incident As Needed, Behavioral Health Benefits and On-Going Care Case Closure

5. Best Practices, AA& Legal Compliance Ameliorating employee complaints regarding employment practices like harassment and supervisory methods Benefit Admin. & Disease Management Employee Retention & Turnover Organizational ChangeSupport Minimizing negative employee impacts of mergers, downsizing, acquisitions, major policy changes Identifying depression, stress, anxiety, physical conditions (high blood pressure, back conditions); then managing improvement Focusing on retaining the top 20% of the workforce and managing improvement in the bottom 20% Work Performance Management Absence Management Internal Security & Threat Management Critical Incidents & Trauma Response Execution of progressive discipline programs to address work performance problems; and facilitating a skillful management response DFW & Drug Testing Proactively and routinely identifying and handling employee threats of violence or other disruptive behaviors Responding to traumatic events, co-worker accidents, robberies, natural disasters Addressing causes of time away from work, including issues of co-morbidity; and engaging conditions requiring commitment to change Identifying, treating & managing substance abuse cases to clear outcomes Workers’ Comp & Safety Prevention, early intervention, case-finding & return-to-work support Summary of Internal Referral Triggers Administrative Financial Events Responding to wage garnishments, early access to retirement accounts, tax liens and other financial crises Labor-Management Collaboration Labor contract administration, handling grievances and finding ways to collaboratively resolve work issues and discipline situations

6. Goals for EAP Relationship • Cost Transparency & Alignment of Motives for Increasing Utilization • Embedding Stakeholder Use of Referral Triggers • Interface – Disease Management, Health Promotion & Behavioral Benefits

7. Capitation Conflicts with EAP Role • Capitation = Taking risk against program use • Misaligned Motives & Commodity Services • Declining Utilization by At Risk Individuals • Management Services – “Lost in Translation” • Low Expectations & Cynicism = Lack of Internal Support • Cost of Treating vs. Cost of Not Treating

8. Performance Based Pricing Models • Case Rate: Variability Based on Utilization • e.g. $500 per clinical case and $125 per work life case • Claremont’s Model: Capitated Retainer, plus Fee for Service Counseling Visits • e.g. $1.75 PEPM for all program services, plus $85 per visit actually used - Performance Guarantee: Management Referrals Risk Sharing: Based on Employer Metrics & Outcomes

9. Claremont’s Performance Rate Rate Comparison with Current EAP Vendor * Claremont’s Utilization Goal Current Vendor’s Rate & Results

10. Performance Guarantee Performance Guarantee for Management Referrals: Apre-determined number employees will be referred to EAP by management each year. A refund of $400 for each “case” below this guaranteed level will be made, if required: • Number of guaranteed management referrals is generally 1% of the employee population; • Performance Guarantee only available if the group selects Performance Pricing.

11. Pricing Implications • Basis for Role Change and Market Perception of Value • Market Need & Cost Impacts Well Documented • Different Value Story for Benefits’-Overcome Cynicism & Practices EAP Clinical Outcomes • For what? • How many? • To what outcomes? EAP & Employer Metrics Need for Internal Ownership, Planning & Stakeholder Engagement