Recent estimates suggest that about 8 percent of the working population in
the United States has an alcohol problem, but health plans reported that fewer
than 1 percent of their members are diagnosed with serious alcohol problems.
That means that less than 10 percent of employees with alcohol problems are
diagnosed with the disorder.
For depression, the numbers are only slightly better. It's estimated that
about 9 percent of the working population has a depressive episode in a
12-month period. Surveyed health plans said that 3.6 percent of their
enrollees were found to have depression, which is about 40 percent of the
number who would be expected to have depression.
By comparison, 65 percent of those with type II diabetes were properly
diagnosed, the plans said, and 70 percent of those with hypertension were
Eric Goplerud, Ph.D., director of the program Ensuring Solutions to Alcohol
Problems at George Washington University Medical Center in Washington, D.C.,
presented these findings to nearly 200 health plan representatives attending
an "eValue8" User's Meeting in Chicago in July.
"eValue8" evaluates health plans and is a program of the
National Business Coalition on Health (NBCH), which is a membership
organization of regional employer coalitions. Its purpose is to improve health
care quality. NBCH represents companies that employ more than 3 million people
Health plans voluntarily submit their data annually to eValue8 staff, and
employers use the results of these surveys to compare health plans and
evaluate health plan
Eric Goplerud, Ph.D., director of Ensuring Solutions to Alcohol Problems
at the George Washington University Medical Center, and Clare Miller, director
of the American Psychiatric Foundation's Partnership for Workplace Mental
Health and APA's business outreach project, compare notes while attending the
National Business Coalition on Health meeting in Chicago.
Why do health plans go through the trouble of completing these
time-consuming surveys? Because employers are demanding it. "It's a way
for employers to drive plans toward a higher standard," Goplerud told
Psychiatric News. "Employer expectations are higher than they
were five years ago."
The 2005 survey results included more than 250 health plans in 27 states.
Participating companies and organizations included American Express, General
Motors, Marriott International, Pacific Business Group on Health, Pitney
Bowes, Safeway, Target, Greater Detroit Area Health Council, New York Business
Group on Health (NYBGH), and other state and regional business coalitions.
This year's results showed a wide variability in the services the plans
provide. Within 14 days of being diagnosed, only 44 percent of insured plan
members identified as alcohol dependent attended even a single alcohol or drug
treatment session. Only about 16 percent received the recommended "three
chemical dependency health care services" in the month following
"In some cases, only 1 person per 1,000 individuals is getting what
we would consider standard evidence-based care for alcohol use
disorders," noted Goplerud. Few plans send educational materials to
their plan participants, and only 17 percent make follow-up calls to members
who miss appointments.
For depression, about 25 percent of the plans said they were able to follow
up with between 66 percent and 90 percent of their patients within seven days
of a psychiatric hospitalization; however, 6 percent said they didn't track
Although there was wide variability in the management of antidepressant
medications, 58 percent of the plans, on average, said that they followed
On a more optimistic note, 75 percent of plans responding to the survey
expect primary care physicians and behavioral health care practitioners to
screen patients for alcohol problems. Although employers have routinely
recommended that health plans screen for depression, only 64 percent of the
plans do so.
"Even though it's clear that the diagnosis and treatment of
depression are coming along," said Goplerud, "you'd think we'd be
doing better given the impact of alcohol and depression in the
He noted that the health plans' improved diabetes care and follow-up show
that they know how to improve the diagnosis and treatment of targeted
conditions. "They did it for diabetes," he said.
In response to increased employer scrutiny, such as through the eValue8
program, health plans are taking steps to expand and strengthen their mental
health care services.
For instance, some employers are beginning to work with health plans, as
well as with clinicians and consumer groups, to improve diagnosis of alcohol
abuse and depression and provide follow-up care.
"We find, though, that collaboration is not yet a common occurrence
in the behavioral health arena," said Goplerud. When NYBGH asked
Ensuring Solutions to analyze and compare its performance with national plans,
researchers found that NYBGH did better than average on general education of
plan members and fairly well on outcome measures, but fell way behind on
amount of collaboration with other groups.
Clare Miller, director of the American Psychiatric Foundation's Partnership
for Workplace Mental Health and APA's business outreach project, attended the
users' meeting in Chicago and said that the fact that alcohol use disorders
and depression are now being tracked by eValue8 should raise employer
awareness and lead to positive changes.
"We're encouraged after hearing the response of health plans to the
survey results, and we look forward to working with the NBCH on this important
project," she said.
Information on addressing alcohol problems in the workplace is