January 09, 2020

Global Employee Assistance Programs

As companies become increasingly global, employers are searching for ways to improve the health and productivity of their employees around the world by implementing employee assistance programs (EAPs) globally.

Full Series

Even organizations that are very invested in their EAPs find it difficult to determine whether employees are more productive, are less absent from work, and have decreased health care claims costs after using an EAP. This is for multiple reasons. For one, employees must be assured of their confidentiality when they use the program. And for vendors and employers, finding a way to link EAP usage with individual health benefits claims or health assessment results while ensuring employee data confidentiality is difficult. Also, the nature of emotional health makes tracking the ROI difficult. With diseases or other conditions, biometric results can provide an overview of an employee’s health status and whether it is improving or not. But when it comes to measuring an employee’s emotional health or stress levels, the process is more challenging. Self-report and clinician-report may be the best metrics employers currently have to show employee health improvement over time related to EAP utilization. There are also challenges related to attributing changes to one specific program since EAP is often just one part of a broader well-being initiative.

Despite these roadblocks, employers realize that showing some type of benefit is a crucial step in continuing their HR initiatives. Employers are exploring various options to see whether their investment in global EAPs is paying off. Some of these options include a) reviewing utilization reports, b) probing employee/client satisfaction with the EAP, c) analyzing the impact on employee health status and/or productivity and d) conducting a business review of the EAP vendor.

Utilization Review

At a minimum, EAP vendors provide some sort of utilization report to their clients on an annual and/or quarterly basis. Standard reports typically contain data on participation rates, types of problems addressed, demographics of EAP users, services used, trainings or promotional activities completed, utilization trends, intervention strategies used, and recommendations for the future. The reports are often provided on a country or site or global basis. Vendors may also be able to sort the results by division or job function where desired.

Some employers were concerned about a vendor’s ability to provide the reports in a timely manner. One employer said, “…we have to pull teeth to get it. We have to show ROI on everything we’re spending here…if I can’t even get the basic reporting so I can put a communication plan together…it’s really difficult.” This same employer mentioned that if they could do it over, they would include stronger performance guarantees in their contracting so that they can hold their vendors accountable to their promises of delivering regular and timely reports.

Even when employers are receiving utilization reports from their vendors, they may not be getting an “apples-toapples” comparison. This can even be true when an employer uses one global vendor because the vendors themselves are often receiving their utilization statistics from various affiliates. The Employee Assistance Professionals Association (EAPA) lists the following questions that need to be answered regarding utilization reports:²

• What constitutes a case? Are an employee and his or her family members counted as one case or several cases?
• Is a case opened at the point of first telephone contact or at the point of receiving an in-person service?
• When is a case closed?
• When is a case re-opened?
• If an EAP client comes in three different times during the year for three different problems, is that one case or three?
• How are activities in areas such as health promotion, elder care, child care, legal and financial counseling counted?

Unless an employer has a good sense of how these questions are being answered, it would be difficult to get a clear picture of utilization in all locations and how utilization compares with that of peer companies. Employers should talk with their EAP vendor(s) about how these statistics are calculated and whether they are uniform across the board or vary by location or affiliate. If they have numerous EAP vendors, employers should ensure that all are using the same definition of utilization to the degree possible.

Employers should also be aware of what formula their vendors are using to calculate the actual utilization rate itself. Is it based on sessions with a provider or attendance at webinars? Does it include dependents or only employees? Clarity is important for accurate understanding of usage.

Client Satisfaction Reports

One employer said, “We always use customer satisfaction surveys. We ask, ‘do you feel that the issue that you were talking to us about has been resolved? Do you feel that when you called the counselor, [he or she] was specific to your needs? Do you feel [that the counselor was] knowledgeable?’ We also ask specifically about resolution. ‘Was the problem resolved? What was the referral like? Did we refer to a community resource? Inpatient? Intensive outpatient? Or was the case unresolved?’ Those are the kinds of things we look at.”

Outcomes Improvement: Employee Health Status and Productivity

Some employers and vendors are starting to try and get a sense of an EAP’s return on investment by using pre- and post-assessments of clients. These may be self-administered and/or administered by a counselor. In order for these assessments to be helpful to employers, the results must be directly tied to functioning in the workplace. They must also be short enough so as not be burdensome to the employee and must be able to show changes over time. Some of the potential metrics include:

• Improved work productivity
• Improved retention rating
• Increased workforce capacity associated with work attendance
• Improved clinical outcomes among all problem categories

One employer said, “We constructed something that was a specific return-on-investment model in which we ask three questions in the beginning of someone’s involvement with EAP. [First] we ask their permission to call them 90-120 days after they’ve finished their EAP treatment and ask the same questions. We do all of the confidentiality things, like what is a safe number to call you at the end of your sessions? Then we ask them whether or not the issue for which they’re calling the EAP has caused them in the last 30 days to be absent from work and if so, for how many days.

The second question we ask is about productivity. This cannot feel like a questionnaire for someone calling the EAP, so we will say something like, ‘You called today about the fact that you’re going through a divorce and clearly this is a difficult transition for you. In the past 30 days, if you think about it, do you think there were days you came to work but you really probably weren’t as productive as you would usually be because of the distraction or phone calls you had to make, or just the emotion of what you’re going through?’ If they say yes then we say, ‘Would you be able to guess how many days in the last 30 days you were probably less productive?’

The third question we ask is, ‘If I asked you today on a scale of 1-10, with 1 being really unhappy and 10 being OK, where would you rank yourself?’ Those are our primary three questions. We ask the same questions at follow-up of EAP. We can assign a daily salary to the number of days they have identified as either having been absent or having dealt with presenteeism. With presenteeism, we use the NCQA formula that says when folks come to work they’re preoccupied, they still may be doing some work so you’re not going to take away 100% of their salary that day. So we’ll only take away 20% of their salary day and assume for the other 80% they were still doing something. Then we do a pre- and post-assessment and sum up what it looks like. That’s the model in terms of actual dollars and cents that we use.”

It is important, though, that employers and vendors conduct these pre- and post-surveys in an appropriate manner, and companies should consult with their legal and labor teams to determine if this is an approach they want to consider. One employer said, “This is very sensitive. So the difficulty we have is in completing the surveys because we’re not going to stalk you. We’re going to make a couple of outreach calls [and] that’s it. I don’t want a counselor leaving a voice mail for someone six times over a two-week period.” It’s also crucial that confidentiality is assured so that employees feel that they can speak freely without any fear of their employer finding out about their responses. For that reason, a clinician may be most effective at conducting these surveys.

Another way that employers are attempting to quantify the impact of their employee assistance programs is by using their health assessment. “What we often do is utilize the health risk assessment data because it has presenteeism or productivity loss included. We know that the highest productivity loss in terms of dollars comes around emotional health and…that’s typically how we look at the program value,” one employer said. For employers just implementing an EAP, they can compare their pre-program implementation health assessment scores versus their post-program implementation scores as related to productivity and emotional health to gauge whether their programs have had an impact. While it may not show causality because one cannot definitively account which factors may have played a role in score changes, it does give employers one more piece of information they can use to judge the usefulness of their EAP. As one vendor said, “When we introduce HRAs, we have a more objective baseline of the health profile of a population. Measuring that year-to-year, we can definitely clearly see a healthier population shift in the health profiles of the populations we’re serving.”

Some vendors are using more formal processes in order to gauge outcomes related to their programs. One example is the Workplace Outcome Suite (WOS). The WOS evaluates the workplace impact of EAP intervention through five scales: absenteeism, presenteeism, work engagement, life satisfaction, and workplace distress. This is only one version of a pre- and post-assessment survey so employers should begin initiating conversations with their vendors about their capabilities in this arena. The Vendor Materials section of this toolkit outlines reporting capabilities by company.

In addition to evaluating the utilization, satisfaction with and impact of their global EAPs, employers may also want to measure how well their vendor is assisting them in meeting their overall mental health/emotional well-being goals. Doing so can be very beneficial when an employer is deciding whether to renew a contract with a vendor versus issuing a new RFP. It can also set the stage for new performance guarantees when a contract is renewed. This measurement is often done through a regular business or supplier process. One employer said, “We do a formal onsite audit at the end of the first year of the contract and then every three years thereafter. It is very thorough. We visit the affiliates, look at their policy and procedure manuals, and make sure that they actually are following their own policies and procedures because it’s amazing how many times they’re not.”

Employers may want to consider the following during the business review process:³

Conclusion

The expansion of EAPs around the world means that employers need an effective way to gauge utilization, client satisfaction and impact globally. Although there are a variety of challenges associated with analyzing EAP outcomes around the world, employers and vendors are developing creative ways to solve these problems and assess benefits. Demand from large global employers, and the fact that in some geographies, employers are required to comply with emotional health and stress regulations, will inevitably lead to more solutions in this area over the next few years. Setting goals upfront and outlining what measurement needs to take place will only help vendors in creating the tools that employers need to evaluate the real impact of their programs.

More Topics

Articles & Guides Virtual Solutions Mental and Emotional Well-being