To the Rescue

February 1, 2005

The uses and costs of employee assistance programs

The birth of a first child is usually a time for celebration. But when the new mom is your receptionist, your joy may be tempered by the realization that she must find daycare so she can rejoin your staff as soon as possible.

Caring for aging parents is a fact of life these days for many workers. However, if your lead nurse's mother suddenly moves in with her, you may worry that the strain will show in the way she relates to patients. 

As physicians and practice managers know, these are common occurrences in the life of any office, and perhaps your employees are well equipped to handle them on their own. But at Community Care Physicians in Latham, N.Y., and at other practices around the country, staff can turn to employee assistance programs (EAPs) for childcare referrals and information on coping with elderly parents as well as counseling sessions and legal services.

Michelle Ryan, Community Care's human resources director, says the EAP has been a helpful resource for the practice. "It has been successful so far. We know people are using it," she says.

Statistics back up her contention that EAPs are worthwhile. "The reason you want to have an EAP is that one out of five employees has some sort of significant personal problem during the year that is going to distract them from doing their job," says Jim Walter, chief executive officer of Employee Services Inc., of Wellsville, N.Y., Community Care's EAP. "What an EAP will do is present a broad array of solutions to a broad array of problems."

Avoiding long-term problems

The philosophy behind EAPs is to make services readily available so employees experiencing life-changing events or wrestling with day-to-day problems such as parenting difficulties get help before the issues escalate and begin to affect their job performance.

Such programs typically function in tandem with the office's mental health insurance benefit, although they are usually offered by a separate entity. Employees access the EAP benefits by calling a phone number that goes directly to an EAP representative, who is not part of the employer's workforce.

Workers who still need assistance with a problem after they have completed the allotted number of meetings with an EAP counselor would be referred to another provider through their health insurer. The EAP sessions, which can range from one to a half-dozen depending on the benefit, are usually free to the employee. The employer pays a capitated, or per employee/per month, fee for the program. The cost starts at $2 to $3 per employee/per month, and will vary depending on the level of benefit.

EAPs are worth the price, supporters say, because the cost of recruiting and training a new employee far outweighs the cost of the program. They also argue that medical offices in particular can benefit from an EAP.

"There is no doubt that healthcare workers are some of the most stressed out in the workforce today, particularly given the nursing shortage. That puts extra strain on [them]," says Paulette Hannah, director of business development for CONCERN: EAP, a national program based in Mountain View, Calif.

What might prompt a practice to add an EAP is the "recognition that a doctor's office really gets into difficulty when someone is away from work, or isn't working up to speed, especially if it is a well-run office," adds Walter.

Scope has grown

In many ways, the EAPs on the market today barely resemble their forerunners that became popular among employers in the 1970s.
"EAPs started because employers recognized drug and alcohol [abuse] was a significant problem, but over time people began to realize that there are a lot more problems than drugs or alcohol to distract us," Walter explains. "There are problems in relationships between parents and children, between spouses. There are physical health issues, legal, financial issues."

Employees can access the services on their own, as can their family members. Workers who are showing signs of stress also can be "administratively" referred to an EAP by their supervisor, says Walter.


"If you have someone who is not showing up to work because they are having trouble finding dependent care ... if it is someone who has been a reasonable employee and it comes down to having to let them go ... We strongly urge all our clients to do an administrative referral," he says.

Along with counseling services, most, if not all, EAPs operate Web sites that provide extensive information on many topics, which are updated to deal with recent health threats such as the flu and seasonal health issues.

On the Employee Services' Web site (www.theeap.com), categories of resources and services include professional and personal development and financial planning. "We offer over 50 personal development and training programs that you can access over the Web or by phone," says Walter, adding that the site also has thousands of streaming videos, tools, and calculators.

"Our job is not just to provide counseling but to provide solutions to these problems," says Walter. "We take a holistic approach."

Benefit enrichment

Ryan, of Community Care Physicians, says she has been impressed with the array of services her EAP offers.

"I was aware of [EAPs] and had worked with them minimally in the past. I was surprised to see how many more services they offer than I remembered," she says, adding that she thought "services were more around counseling specific to behavioral health and drug abuse. What I found in researching EAPs was that they offer a lot more -- legal counseling, financial services, day care ... ."

In addition to the basic benefits offered, some EAPs will tailor programs to meet their clients' specific needs. Account executives at CONCERN, for example, will meet with representatives of each company "to help promote the use of the benefit," says Hannah.
EAPs will also provide staff to come to the office and give talks on a variety of subjects, from stress management to combating sexual harassment.

Ryan's practice, which has more than 180 physicians and 900 employees, added Employee Services Inc.'s EAP in April 2004, to help enrich the employee benefits package. "We have been trying to add benefits that promote wellness and security because we are a medical organization," she says. For example, the 20-year-old practice, which has 35 locations, recently added group life insurance.

The organization's board was unanimous in its support of the EAP, believing the program to be cost-effective and helpful in reducing staff turnover. The practice has a turnover rate of about 10 percent, which Ryan says is low for the healthcare industry. (Voluntary turnover in healthcare is just over 17 percent, according to U.S. Department of Labor statistics.)

To make sure employees know about the service and how to access it, Ryan and others held meetings at all practice locations and placed information about it in the employee newsletter.
"It's hard to get a lot of feedback" [from staff], Ryan adds. "We don't want the perception that we are [closely] monitoring it. The limited feedback I have is that it is helpful to staff. It has been useful to supervisors to say, 'We might not be able to help you because it's personal, but don't forget we have the EAP.'"

Summary data about Community Care Physicians employees indicate they most often access information about alcohol and substance abuse, child care, financial and legal services, and relationship issues. Also popular with employees are stress reduction materials, parenting tips, and financial information on topics such as how to pay for college.

Right for your office?

It's not just big practices that offer EAPs. Island Coast Pediatrics, a seven-physician group in Fort Myers, Fla., has had one for several years. Human resources director Annette Goldwyn says the program is useful for both employees and managers, and notes that it carries a "very, very minimal cost."

While the EAP staff meets individually with employees, Goldwyn likes the idea that a representative can address the entire office upon request, and she values the fact that employees' immediate family members can also access the program.


Even if the program helps just a few employees, it is still useful, says Goldwyn. "Hopefully whatever personal issues they have are not going to affect them in the office" if they find support through the program, she says.

According to Goldwyn, HR directors universally acknowledge that "we all need something where employees can get quick help without costing us a lot. We want to keep our employees healthy."
Whether to add an EAP is obviously an individual decision for each practice, and the size of your practice may play a role. Some EAPs will only work with firms that are of a certain size, such as 50 employees or greater, while others will work with any size practice.
In selecting a program, it is important to investigate an EAP's approach to assessment and referral. Some programs may provide only one visit and then refer the employee to his or her insurance plan to receive more care through the mental health benefit. "That can add to medical costs in the long run," says Hannah.

Instead, it may be worthwhile to structure the program to offer more sessions. "Usually the issue can be resolved in four to six visits," Hannah says.

You may decide you are not ready for a full EAP, but that your office could benefit from some of their services, such as child-care or legal services information, and make a list of health-related Web sites that offer general information to make available to your staff.
Similarly, you can work with your insurance carrier to ensure its providers can see patients on an urgent or emergency basis if they are facing a mental health crisis.

Either way, it's important to remember that your employees are an investment worth protecting. An EAP is one good option.

Theresa Defino, editor for Physicians Practice, last wrote about saving on office supplies in the January issue. She can be reached at tdefino@physicianspractice.com.

This article originally appeared in the February 2005 issue of Physicians Practice.