Successful Strategies for Reducing the Impact of Behavioral Health

Successful Strategies for Reducing the
Impact of Behavioral Health Claims
Presented by:
Blessy John – Discover, Project Manager, Health & Welfare Plans
Deborah LaBonar, PhD – Aon Hewitt, North American Absence Analytics Leader
March 17, 2015
Confidential and Proprietary ©2015 Discover Financial Services
Agenda
• Setting the Context
• Three Strategies
• Outcomes
• Advice for Employers
• Next Steps
2
Discover at a Glance
• A leading credit card issuer/payments processor
• One of the most highly recognizable brands in U.S
− 1 in 4 U.S. households
• Two main categories of Products and Services:
Payment Services
Direct Banking


Discover Card
Discover Bank



Discover Network
PULSE Debit Network
Diners Club International
Becoming a leading direct bank and payments company
3
Discover Locations and Functions: North America
U.S.A
Arizona: Phoenix
Call center, Customer Service & Banking and Cardmember Assistance,
Discover Network, Marketing Services
California: Irvine
Discover Home Loans
Colorado: Denver
DCI Americas Regional Office – Relationship Management
Canada
Delaware: New Castle
Call center, Customer Service & Banking and New Accounts, Delaware
Finance
Delaware: Greenwood
Discover Bank (Retail), Cardmember Services & Consumer Banking
Illinois: Riverwoods
Headquarters
U.S.A.
Kentucky: Louisville
Discover Home Loans
New York: Pittsford
Discover Student Loans
Mexico
Caribbean
Ohio: New Albany
Call center, Customer Service & Banking, Discover Network,
Loss Prevention & National Recovery
Texas: Houston
PULSE Administration & Operations
Utah: Salt Lake City
Utah Processing Center (UPC): Administration & Processing Services
Utah: Lake Park
Call center, Customer Service & Banking, Marketing Services,
New Accounts, Discover and Personal Loans
4
Discover’s Livewell Approach
 Living a healthy lifestyle in a way that fits you
 Making smart choices when you elect and use your Discover benefits
 Taking charge and being personally responsible for your health
 Striking a balance at work, home and play
 Planning for tomorrow as well as for today
5
Global Benefits Team
• The Global Benefits Team supports Discover’s 13,000+ employees and
is responsible for managing global benefits as well as 30+ benefit
vendors
• Overall goals as it relates to leave of absence:
− Manage cost associated with leaves and disability, including
preventable wellness initiatives and work life balance programs
− Manage the vendor relationship as it relates to leave of absence
policies and procedures and ensures Discover is compliant with all
applicable laws
6
Discover Partnership
• In 2011, Discover transitioned the
administration of their leave and
disability program from a previous
vendor to Aon Hewitt
• From the beginning, Discover
stressed the importance of analytics
and using the data to drive the
absence strategy and focus
7
The Business Problem
Disability Incidence Benchmarks
7.0
11.3
14.6
6.4
5.6
10
5
0
Prior Year
IBI Finance and Insurance
Year 1
AH Book of Business
Short Term Disability
Incidence Rate
10
11.3
15
5
0
Year 1
AH Book of Business
Discover Call Centers
9
Discover
14.9
Discover
7.0
• Fifty-nine percent of Discovers’
population is within one of the Call
Center locations
Claim Incidence per 100
• Further analysis demonstrated that
the Call Center populations were a
primary driver of Discover’s high
incidence rate
15
Claim Incidence per 100
• After Year 1, data demonstrated
that Discover’s overall short-term
disability incidence rates were
higher than external benchmarks
Short Term Disability
Incidence Rate
Identifying the Primary Clinical Driver of STD
25%
19%
15%
10%
8%
20%
11%
• Behavioral Health is identified as
the most prevalent clinical
category, accounting for almost
20% of closed claims, and over
27% of the total claim cost
Behavioral Health as
Percentage of Claims
5%
0%
Year 1
AH Book of Business
Discover
Behavioral Health as
Percentage of Claims
25%
15%
10%
10%
20%
8%
• Within the Call Center populations,
Behavioral Health claims
accounted for 23% of the claims as
compared to 10% within the
remainder of Discover
IBI
23%
• Discover’s rate was trending well
above the external benchmarks
5%
0%
AH Book of Business
Discover Call Center
10
Year 1
Discover Non-Call Center
Strategic Intervention
Implementing Change
• The high prevalence and high cost of
Behavioral Health claims led
Discover to set an annual target of
reducing the overall cost of
Behavioral Health claims by 10%
• Discover took an integrated approach
to addressing this area of concern, by
focusing on three different strategies
to achieve this goal:
− Behavioral Health Specialist
− Access to Care
− Onsite EAP Counselors
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Strategy 1: Behavioral Health Specialist
− Interviewing employee at the beginning
of the claim, calling employee to check
up on treatment/return to work status
− Collaborating with the provider on
treatment progress; discussing other
options when progress isn’t recognized
− Coaching the provider on how to get
the employee back to work; suggesting
transitional options such as reduced
schedule or breaks
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Percentage TRTW
Nine months into the program,
implemented a dedicated specialist to
focus on Behavioral Health claims whose
responsibilities include:
40.0%
30.0%
20.0%
10.0%
BH Specialist begins
0.0%
Closed Claim Duration
•
% of BH Claims
With Transitional RTW
100
80
60
40
Behavioral Health
Duration Trending
BH Specialist begins
Strategy 2: Employee Assistance Program
• In early Year 2, Discover shifted the
focus of their Employee Assistance
Program
− Emphasis placed on receiving care
from a Behavioral Health professional
versus Primary Care Physician
− Emphasis on face to face counseling
versus the telephonic model
• Behavioral Health Specialist supports
this model through recommendations to
use EAP counseling and via soft
transfers to EAP
14
Penetration Rate
− Program modified to include up to 5
free visits (up from 3)
EAP Penetration Rate
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
EAP focus shifts
Strategy 3: Onsite EAP Counselor
Behavioral Health Location
Incidence Rate
One Call Center location made a business case for an
onsite EAP counselor based on their claims experience:
Program overview:
15
•
Topics cover the spectrum of work/life and counseling
issues.
•
Counselor is introduced in New Employee Orientation
& Management meetings
•
Counselor provides work life consultations,
management referrals, EAP orientations as well as
Critical Incidence Response
•
Since inception, this location has increased the hours
the counselor is available; an onsite EAP counselor
has been introduced to a second location due to the
success in the pilot location
Claim Incidence per 100
• With Behavioral Health as top driver of STD claims,
the savings of preventing 13 BH STD claims equals
the cost of an onsite EAP
5.0
4.0
Onsite EAP
Counselor adopted
3.0
2.0
1.0
0.0
HR Feedback:
“Employees have been more likely
to utilize the service, due to the
high touch and onsite
convenience, to have their true
needs appropriately identified and
addressed, and to follow-through
and maintain any necessary
actions to affect positive change.”
The Overall Results
Behavioral Health Incidence Trending
• Likewise the percentage of disability
claims that fall into the category of
Behavioral Health has been declining
since Year 2, and in Year 4 the new
Behavioral Health claims only
represented 16% of the new STD
claims
Claim Incidence Per 100
• The overall incidence rate of new
Behavioral Health claims has been
declining since a high in Year 2
Behavioral Health
Incidence Rate
3.0
17
2.0
2.0
1.8
1.0
0.0
Year 1
Year 2
Year 3
Year 4
Behavioral Health as
Percentage of Claims
22.7%
25%
20%
• Although this is slightly higher than
the IBI Benchmark of 11.2% for the
Finance Industry, it is 6 percentage
points lower than the 22.7%
recognized in Year 2
2.5
2.3
18.9%
20.1%
16.2%
15%
11.2%
10%
5%
0%
Year 1
Year 2
Year 3
Year 4
IBI 2013
Benchmark
Behavioral Health Total Savings
Metric
18
Year 1 – Year 3
Change
Covered Lives
+ 20%
Claim Volume
+ 4%
Incidence Rate
- 13%
Closed Claim Duration
- 24%
Cost per Closed Claim
- 32%
Total Paid – Closed Claims
- 29%
Disability Incidence Benchmarks
11.3
11.5
10.6
10.1
Claim Incidence per 100
Year 1
Year 2
Year 3
Year 4
10
5
0
Discover
13.4
15
14.0
20
16.3
Short Term Disability
Incidence Rate
14.9
• With Behavioral Health driving the
majority of STD claims, the
reduction in these claims has
noticeably impacted the overall
incidence rate for the business
15
Claim Incidence per 100
• Since an overall high in Year 2,
both Discover overall and the Call
Center specific STD incidence rate
has been declining
Short Term Disability
Incidence Rate
Year 3
Year 4
10
5
0
Year 1
Year 2
Discover Call Centers
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Next Steps
• In 2015, Discover plans to expand the onsite EAP counselor program to
two additional Call Centers
• From an Analytics perspective, Discover intends to partner with Aon
Hewitt to further explore the drivers of absence within their Call Center
populations, including such factors as:
− Employee Engagement
− Manager Training and Attendance Management practices
− Local Understanding of Disability/FMLA
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Questions
• Blessy John: Discover, Project Manager, Health & Welfare Plans
BlessyJohn@discover.com
• Deborah LaBonar: Aon Hewitt, North American Absence Analytics Leader
Deborah.Labonar@aonhewitt.com
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