Wellness plans evolve from treatment to prevention for post-pandemic workforce

Treatment programs fail to address root cause of substance misuse

Specific to employee wellbeing and behavioral health, employers, insurers, brokers, and service providers are collectively tracking and analyzing program costs, utilization, and behavioral health claims at the enterprise level. It is important to note that these metrics are macro-level lagging indicators, which reflect the effectiveness of prior period program offerings, initiatives, and activities.

While these industry best practices are unquestionably valuable, a detailed analysis of these trends fails to accurately reveal real-life events and circumstances impacting the daily lives of the beneficiaries of these programs and services. It is often those nameless, faceless individuals, represented by the numbers on a spreadsheet, who are in most desperate need of wellness programs, mental and behavioral health care services.

Unintentionally and involuntarily, millions have been caught up in the storms of day-to-day life in our VUCA permacrisis world. While some may be mildly impacted by the continuing waves of disruption, an encounter with trauma or crisis can cause others to fall somewhere on the mental or behavioral health spectrum, which includes anxiety, depression, and substance use disorder (SUD).

As well-intentioned as the wellness, mental and behavioral health care industries may be, their efforts sometimes fall short of meeting the needs of today's post-pandemic workforce. A recent study published by Kaiser Family Foundation and CNN reports 9 out of 10 U.S. adults believe there is a mental health crisis in the country. SAMHSA, the Substance Abuse and Mental Health Services Administration reported in 2021 that 46.3 million people met the clinical criteria for SUD. That same report stated 94% of people with a SUD received no treatment.

At the same time there is an overwhelming need for mental and behavioral health services, there is a critical shortage of services and service providers, as documented in a December 2022 letter from the American Hospital Association (AHA) to Congress. This letter reports "the nation is ill-prepared to respond to the mental health crisis due to severe shortages in the behavioral health workforce."

In other words, when considering the continuum of care, the industry that provides treatment services for millions is rapidly approaching a critical crossroad because it lacks the capacity to provide needed treatment services now, and for the foreseeable future. The AHA letter serves as a clarion call to the benefits industry. The time to act is now.

Prevention and awareness is critical to avert behavioral health care crisis

Fortunately, the continuum of care is broader than the focus on treatment alone. The continuum also includes prevention, which is supported in the workplace primarily through workforce wellness programs. Healthcare.gov states that workplace wellness programs are "intended to improve and promote health and fitness… including programs to help you stop smoking, diabetes management programs, weight loss programs, and preventative health screenings."

According to SHRM, The Society for Human Resource Management, "Wellness programs are provided to employees as a preventive measure to help avoid illness while improving and maintaining the general health of the employees."

With a current U.S. market estimated at more than $450 billion in 2022 and growing at more than 5% annually, wellness is BIG business; a significant amount of that future increase will be directed at the wellness-related employee benefits needed to help employees struggling to navigate the post pandemic, VUCA permacrisis world.

Workplace prevention demands innovative wellness benefits

A major gap exists in current wellness programs that place little to no emphasis on mental and behavioral health issues, including SUDs. But, as noted in the 2016 U.S. Surgeon General's report, now is "A Time for Change." And benefits brokers are well positioned to be the primary drivers of the change that is needed.

Sommer Sherod, Vice President, Health Care Strategy and People Strategy Consulting for Insurance Office of America (I.O.A.) put it this way. "I think it's important that we begin to treat the wellness strategy as diligently as we treat cost containment of health care strategies. Typical and tactical conversations include: how should we spend wellness dollars? What kind of wellness technology is offered by our carrier? But now, we (brokers) need to take it a step further and drive beyond the vanilla conversations. Creating change involves encouraging employers to take risks and try new things." Sommer went on to say that "As consultants, we can't keep the conversations around wellness at surface level. We need to dive in, understand demographics and interest, and push clients to commit to one or two new ideas."

So exactly what type of new ideas might employers, brokers and other industry professionals explore? Where should they begin to focus on workplace prevention for mental and behavioral health and SUD?

Tech-driven data prescribes preventive solutions

Howard Gerver, President of HR Best Practices, and a self-described health care benefits data geek and mental health champion, offered a few suggestions, beginning with a quote by the late Peter Drucker. "If you want something new, you have to stop doing something old." Howard continued, "A natural place to start is to better understand the prevalence of mental health by condition among the employee (and family member) population. That understanding is comprised of two elements:

1. An analysis of how health services and medications are being consumed by diagnosis and treatment, and
2. An independent review of all programs that touch mental/behavioral health (e.g., EAP, digital behavioral health, addiction recovery)

It's only when an employer has this objective and baseline understanding, can they start to target prevention training programs. Among technology-savvy professionals this approach is known as data segmentation-driven, personalized communications. This is a great starting point for helping employees and their family members learn of risky behaviors."

Howard presents a very persuasive argument supporting the old adage that "an ounce of prevention is worth a pound of cure. When implemented correctly, prevention training/awareness programs can save thousands of dollars and precious lives."

This fact is supported by evidence-based prevention research that indicates a return on investment from prevention programs can range between $2-$20 for every dollar spent. Despite this well-documented fact, effective prevention programs are sorely underused in the workplace.

With the existence of such data that clearly supports the business case for change, one might ask, why does the benefits industry resist shifting their focus from treatment to prevention?

One reason was highlighted by the AHA letter. There are severe shortages of clinical professionals available to provide preventative mental and behavioral health awareness education and training.

Health and wellness coaches and practitioners are working in the prevention space, unlike mental and behavioral health clinicians; however, they are not trained to provide training or guide safe conversations in the workplace on mental and behavioral health topics, which include substance misuse, addiction, and recovery.

In addition to health, wellness and HR professionals, many facilitators are individuals with personal lived experience with mental and/or behavioral health issues including substance misuse, addiction and recovery. These non-clinical individuals are ideally suited to extend the continuum of care beyond traditional treatment into the prevention space. They are available to complement and supplement the existing under-resourced system of care. And because there is still significant stigma and fear in the workplace regarding mental and behavioral health issues, these facilitators, peers, allies and champions are taking the lead to create the psychological safety in the workplace that is needed to initiate and sustain long-term change around these topics.

Related: High cost of substance use disorder can be offset by employer sponsored insurance

Employers, insurance carriers, brokers and other wellness, mental and behavioral service providers will benefit by partnering with prevention-focused organizations to meet the growing needs of today's highly challenged, post-pandemic workforce.

Cheryl Brown Merriwether is the cofounder, vice president, and executive director for International Center for Addiction & Recovery Education™ (ICARE)