A study of outpatient mental health treatment using standardized testing instruments to measure functional impairment shows fairly rapid reduction in worker impairment.
The study appears in the August issue of Employee Benefit Plan Review.
Edward Jones, Ph.D., vice president and chief clinical officer of PacifiCare Behavioral Health in Santa Ana, Calif., and an author of the article, told Psychiatric News that results of the study should demonstrate to employers the value of paying for mental health treatment—a message that APA has been conveying to business through an initiative established in 1999.
"Employers have not historically been presented with these kind of data," he said. "That’s the problem with health care services in general. We get double-digit increases in premiums, but employers don’t get good information on the value of what they are paying for. We argue that if we can begin to produce information like this, [insurance] purchasers will be able to move to value-based purchasing. In behavioral health, purchasing is too often based on price."
In the study, more than 19,000 patients in outpatient treatment with PacifiCare clinicians were evaluated using an abbreviated, 30-item version of the Outcomes Questionnaire (OQ 45, normally a 45-item instrument).
"We wanted to use well-tested standardized instruments, but we wanted them to be easy to use in a routine outpatient setting," Jones said. "Basically, the process was one of working with our network of practitioners to administer the patient self-report questionnaire at set intervals in treatment, usually prior to the first visit and every five sessions thereafter."
Data were collected over the four-year period from 1999 to 2002.
Jones said that five of the items on the 30-item questionnaire measured work impairment.
"What we were able to identify is that as people begin outpatient treatment, 31 percent met criteria for being work impaired," he said. "We were surprised at how high that figure was. But the good news is that with behavioral health treatment, people very quickly begin to respond and show a reduction in their problems of everyday functioning."
After nine weeks of treatment, the group of employees reporting work impairment was reduced to 15 percent, Jones reported.
"However, after five months of treatment, you still have 13 percent showing work impairment," Jones told Psychiatric News. "That is consistent with the idea that there are people who have more severe problems and require ongoing treatment and monitoring."
The June 18 Journal of the American Medical Association thatfocused on depression showed that much of the cost of depression to employers was in lost productivity, not absenteeism, Jones noted.
"When you get at work savings, typically people want to see something solid like lost days at work," he said. "But what you really need are clinical data on [reducing] work impairment."
Underscoring the importance of value-based outcomes research, Jones and colleagues referred in their study to a February 2002 article by psychiatrists Lloyd Sederer, M.D., and Norman Clemens, M.D., in APA’s Journal of Psychiatric Services titled "The Business Case for High-Quality Mental Health Care." At the time Sederer was director of APA’s Division of Clinical Services, and Clemens was chair of APA’s Committee on APA/Business Relations.
In that article, Sederer and Clemens wrote: "Demonstrating the medical and social benefits of psychiatric care is a compelling argument, but it is not sufficient. We must also show that a dollar spent on mental health care returns more than that dollar to the purchaser of care—the employer. . . .When we can consistently show that high-quality mental health care results in clinical improvement, enhanced social and occupational functioning, and increased corporate profits, we will have the power to persuade those who have so much control over the services that our patients need. ▪