A Measure of Success: A Checkup for Your EAP and Wellness Programs
David A. Sharar, Ph.D.
Businesses are increasingly using analytics to mine “big data” to get refined insight into everything from product design to marketing, customer service to manufacturing processes and, more recently, workforce management. They are also using workforce analytics and outcomes measurement to manage a variety of human capital-related issues—from candidate assessments to performance reviews. But there is one area where analytics and outcomes have not been consistently or effectively applied—behavioral health and wellness. And that could be a costly mistake.
Issues ranging from depression to anxiety affect almost 58 million adults in the U.S. That means that just over 26 percent of Americans ages 18 and older (the demographic which makes up the American workforce) suffer from a diagnosable mental disorder. It is estimated that untreated mental illness costs the U.S. a minimum of $105 billion in lost productivity each year and results in $200 billion in lost earnings per year. Depression alone is estimated to cause 200 million lost workdays each year at a cost to employers of $17 to $44 billion. The comorbidity of mental health and physical conditions, such as obesity, is also well documented.
While most agree that a proactive approach to addressing behavioral health and wellness issues by way of counseling or coaching is a business imperative, organizations are left wondering whether Employee Assistance Programs (EAPs) or wellness programs are effective in their unique work settings. At issue is that few readily available tools measure and validate outcomes, and too few employers require their EAP and wellness vendors to measure outcomes in a credible way.
What’s Not Working?
Employers have not traditionally viewed outcome measures as highly persuasive or credible; leaving price as the one measure that is understood. In theory, no employer is willing to pay for a service that does not produce positive workplace outcomes. However, in the absence of validated, uniform, or monitored outcomes reporting in the industry, no link has been established between price and expected results.
When looking beyond a pricing structure (traditionally, per-employee-per-month or PEPM rates) to select a provider based on other factors (i.e., quality), most typically turn to utilization reports to assess the effectiveness of a provider and its services. Obviously, employees or members must use EAPs and health coaching services in order to attain any meaningful results. However, utilization or engagement rates fluctuate wildly—from lows of less than 1 percent to highs of more than 30 percent—and what is being measured is not universal. Is utilization simply about the employee accessing services, the number of counseling or coaching sessions, the number of times resources are downloaded from a web site, or a combination of these and other measures?
Absent an industry standard for measuring and reporting utilization, employers are left to question what these rates mean, as well as how effective the program and services truly are. The simple use of a program does not equate to achieving outcomes that are relevant to your workplace.
What Does Work
The Workplace Outcome Suite (WOS) is a scientifically validated survey tool that provides Human Resources and benefits purchasers with the ability to measure the role of an EAP or wellness initiative in driving employee behavior change, and a program’s impact on various levels of employee productivity.
The WOS, which is available at no cost to both EAPs and purchasers alike, is a self-reporting survey that measures the effects of programs with respect to their impact on the employee’s absenteeism, presenteeism, work engagement, life satisfaction and workplace distress. The outcomes data can be used in a comprehensive report that not only analyzes the average change in employee behavior, but also documents the impact on their participation and contribution in the workplace on different levels. For example, the absenteeism measure asks users to report the hours they have missed work (from missing work altogether to being pulled away for a phone call) over the past 30 days because of a personal issue.
Here’s the Difference
While HR has easy access to absentee records, there is no way to determine what portion of missed days is due to an EAP or health-related issue. Determining whether an employee’s presenteeism is compromised because of an EAP or health-related issue is also inherently subjective. In addition, while you might ask a supervisor about an employee’s work engagement, he or she would probably not be able to gauge that person’s life satisfaction and/or level of workplace distress.
The WOS stands apart from other outcome measures as it is; psychometrically tested, validated, workplace-focused, short, easy to administer and free. The WOS brings EAP and health and wellness in line with the data-driven approaches that are changing the way organizations conduct all phases of their business. This approach translates improved productivity into quantifiable results and makes the business case for investing in EAP and health and wellness coaching.
The Colorado State Employee Assistance Program (C-SEAP) contracted with OMNI Institute, a nonprofit social science agency that provides integrated evaluation research for nonprofits, foundations, and government agencies: to collect and analyze retrospective data on its workplace productivity, behavioral health and healthcare utilization, which included using the WOS as a tool.
During the initial client intake process, employees who were seeking EAP services were given the WOS, focusing on the workplace distress, presenteeism, and absenteeism scales. Three months later, the WOS (along with other measures) was readministered.
As Melissa Richmond, Ph.D., an independent researcher with OMNI, explains, the other tools that were used for this study were more clinical as compared to the WOS. However, being able to merge clinical data with the WOS illustrated the impact on productivity experienced by someone who is suffering from depression and distress. In turn, C-SEAP is able to identify interventions to promote improvement.
As an example, a lot of people do not miss work because of an EAP issue and it is easy to confuse general time off with time off that’s taken because of a personal problem. Tying lost productivity to personal issues is a better measure than looking at general absenteeism.
As C-SEAP serves a large workforce representing different State departments, aggregate data from the study is representative of a cross-section of employees who may differ by industry, job classification, and job description, among other characteristics. In short, C-SEAP’s experience with the WOS demonstrates that it can be used in any workplace and any industry.
A large number of EAP vendors and organizations with internal EAP departments have also turned to the WOS to make the business case.
While utilization has historically been presented as a way to demonstrate value, Empathia, a leading EAP provider, was looking for something more substantive.
Since rolling out the WOS in the spring of 2011 to more than 1,250 of its clients in the U.S. and North America, Empathia has validated outcomes that demonstrate the effectiveness of its programs and services.
Empathia reported the following outcomes after analyzing WOS data over one year:
- The average absenteeism scores for all clients showed a significant reduction from 14.32 hours to 9.20 hours.
- The average presenteeism score for all clients showed a significant decrease from 3.49 to 2.59
- The average level of work engagement score for all clients showed a significant increase from 3.13 to 3.44.
- The average life satisfaction score for all clients showed a significant increase from 2.63 to 3.43.
- The average workplace distress score for all clients showed a significant decrease from 2.51 to 2.10.
Previously, Empathia had used the global assessment of functioning, which is more of a screening tool. The WOS has now become the standard of care in the whole health assessment process.
A Benchmark for Change
At all levels of management there’s broad agreement: EAP and wellness initiatives can have a significant business impact. How unaddressed personal problems and lifestyle issues affect workforce performance is widely understood. What is less well understood—and much less clear—is whether these programs are actually working within your work setting. That determination should not be based on whether programs are being “utilized,” but more meaningfully, whether they can be correlated to reductions in absenteeism, decreases in presenteeism, and improvements in work engagement.
To date, more than 400 organizations are using the WOS to demonstrate the impact of EAP and health and wellness coaching on employee productivity and operational performance. While old methodologies for measuring the effectiveness of EAPs and heath/wellness coaching seem entrenched, the outcomes-based model represented by the WOS is fast becoming the industry standard—giving organizations the ability to precisely gauge the impact EAP- and health and wellness programs are having on their specific workplace. The time has come for purchasers of benefits to require their EAP and wellness vendors to deploy defensible and transparent workplace outcome measurement strategies using validated and accepted tools such as the WOS.
About the Authors
David A. Sharar, Ph.D. is Managing Director of Chestnut Global Partners, a not-for-profit behavioral health organization based in Bloomington, Illinois. Richard Lennox, Ph.D. is a research psychologist and the Vice President of Chestnut Global Partners’ Division of Commercial Science. The Workplace Outcome Suite can be downloaded at no charge at http://www.chestnutglobalpartners.org/ResearchTools/Tools.