The following are guidelines to look for when selecting abehavioral health provider.
- As the human resources manager, remember that you are in control of theprocess, not the insurance company or the provider network.
- You have to be a very well informed, very aggressive consumer in order toget the best service while containing cost.
- Keep your eye on quality first, not the dollar sign.
- Consider what the experience of the employee going to be like when he orshe tries to access the benefit. Remember your employee will need a systemthat advocates for him or her.
- Are you buying a benefit which the service provider thinks the job is tosave you money or provide service? If the benefits provider perceives thatcost is the main issue, employees who need help will find that the systemprevents them from getting help or sends them to the cheapest help possible,instead of a skilled person on the other end determining what kinds of carethe employee really needs.
- Do your homework and learn how to evaluate the service before you buy.Call current clients of the provider and ask what the experience is like forthe employee. When they try to get help, do they access the system rightaway or are they put on hold for a long time? Do they hear a human being oris it a cold, impersonal computerized system?
- Educate yourself. Find out as much as you can about the types of services,but also beware that it is a cutthroat, competitive business in which youwant to be sure that what is presented to you is the truth. For example,will your employees actually be able to access in-patient treatment? Or willfacilities be too crowded? Are those who qualify for inpatient substanceabuse programs able to access them or are they put into day treatmentprograms?
- Consider hiring a consultant to help educate you. Be sure that theconsultant knows more than just the business angle, that he or she has theexpertise in mental health and substance abuse.
- If you’re considering carve-outs, be careful about the plan you choose.Do you buy mental health separately or as part of the overall health carepackage? (A carve-out plan is a managed care approach that provides uniformcare for mental health and substance abuse treatment, regardless of the typeof plan your company provides for general health benefits. They are tightlymanaged and care must be pre-approved by a case manager.) Some carve-outsare like insurance companies, which can be good or bad, depending upon themotivation of the company. So explore first. You don’t want employees tobe caught in a system where the provider is trying to cut corners on yourworkers’ well-being.
- Check emergency care benefits and accessibility too. If an employee issuicidal or homicidal, he or she needs care immediately. Some of thesesystems will try to keep people from being admitted to hospitals becausethey’re trying to save dollars.
- Offer a wide range of care — for example, care that specializes in eatingdisorders.
- You want to be sure the provider network is right for your company. Anational network may seem impressive, but if your employee is located inBoise and the closest therapist is 50 miles away, it doesn’t do youremployee any good.
Source: Mark Braverman, Ph.D, is founder of Newton, Massachusetts-based CMGAssociates Inc.
Workforce, February 2000, Vol.79, No. 2, p. 50 — Subscribenow!