Transcript Depression and the Employer

Depression and the Employer
William McPeck
Maine State Government
March 2002
Depression – Fast Facts
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Estimated 11 – 17 million Americans
Estimated 5 – 10 % of the population
Women > Men
30,000 suicides/year
Under Diagnosed and Under Treated
Depression in the Workplace
 Greenberg, et al, 1993
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Annual cost to corporate America = $44B
$12B from Lost Productivity
$12B from Lost Work Days
$12B from Direct Treatment Costs
$7.5B from Mortality Costs
Depression in the Workplace
 Druss, et al, 2000
 Employees with depression incurred
annual per capita health and disability
costs of $5,415.
 Employees with depression plus any
other chronic illness cost 1.7 times more
than employees with just the same
medical condition alone.
Depression in the Workplace
 Druss, et al, 2000
 Employees under age 40 with depression
took 3.5 more annual sick days than
those 40 years old or older without
depression.
 Workers with depression were absent
from work at a rate of 1.5 times the
average with a 20% reduction in
productivity.
Depression in the Workplace
 Davidson, 1998
 Depression alone accounts for lost
workdays that total a $12 billion loss per
year.
 The cost of depression alone to
employers is as high or higher than the
cost of many other common illnesses.
HERO Study
Health Enhancement Research Organization
 Research database of 6 large employers
representing 47,500 employees – Risk
factors studied from 1990 – 1996 using
HRAs
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70%
46%
35%
21%
14%
12%
10%
suffered from depression
suffered from high stress
suffered from diabetes
reported being overweight
reported smoking
had an elevated blood pressure
reported a sedentary lifestyle
First Chicago Bank Study
 Depression accounted for 52% of the
mental health claims 1988 – 1991
 1991 claim cost for depression =
$930,000
 62% of the total mental health
treatment days were for depression
 Depression was #1 in treatment days
40 treatment days per event
First Chicago Bank’s Response
Increased EAP awareness and training
Managerial training
Increased corporate awareness
Focus on depression case
management
 Implemented screening program
 Medical plan enhancements
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First Chicago Bank Results
 Direct costs dropped from $1m to $400,000
1992 – 1996
 Depression as a percentage of mental
health claims costs dropped from 62% 45% 1992 – 1995
 Direct treatment costs for depression
dropped from $116 -$58 per member
 Depression events went from 1.8/1000
employees to 4.8/1000 1989-1995
Depression Study Maine State
Government Employee (SOM)
Health Plan 1997
 1,561 active members of plan had
diagnosis of depression – 66% were
employees – 6% of total active plan
members
 Depressed members were 2.5 times
more likely to be female
 Members with depression accounted
for $6.7 million or 14% of total cost
of medical plan
Depression Study – SOM - 1997
 Members with depression
 Cost of $308/pmpm; $206 for medical
costs, $102 for mental health costs
 904 members with depression visited
PCP
 1,908 visits to PCP for mental health
treatment
Depression Study – SOM - 1997
 Inpatient hospitalization rate for nonmental health conditions
 95.1/1,000 in depression group
 67.0/1,000 in non-mental health group
 Members with depression had higher
rates of non-mental health claims in
virtually every medical diagnostic
category studied
Depression Study – SOM - 1997
 In 1997, SOM Plan spent $1,083,279
in anti-depressant medications
 Average cost of $50.00/pmpm
 Employees with depression averaged
16.2 prescriptions per year
 73% of active members with
depression used anti-depressants
SOM Update – April 2000
 1,672 (6.9%) of the active members
had a depression claim;
 1,271 (76%) were employees
 1 in 12 employees had a depression
claim during 1998
 Members with depression experienced
a total of 15,770 mental health visits
during 1998
SOM Update – April 2000
 Depressed members had $1.3 million
in mental health claim payments and
$4.2 million in non-mental health
claim payments in 1998
 Depressed members, regardless of
co-morbidity, averaged higher nonmental health utilization and
payments than members without a
mental health diagnosis.
SOM Update – April 2000
 Over $1.1 million in payments for
antidepressants
 Following AHCPR Depression
Guidelines:
 50% of members with a new episode of
depression, who received an
antidepressant, did not receive the full 6
month course of treatment
 58% of new cases did not receive
antidepressant treatment at all
MHMC Depression Initiative
Maine Health Management Coalition
 Employee Interactive Screening
Program
 Two versions available:
 Telephone Screening (ETAP)
 Online Screening
 Nurse Call – Patient Follow-up
 Pilot study with selected PCP practices
MHMC Depression Initiative
 Employee Interactive Telephone
Screening Program (ETAP)
 SOM one of 19 MHMC employers
participating
 96% of MHMC member employees
covered
MHMC Depression Initiative
 Why an ETAP Program?
 Prevalence of depression
 Costs associated with depression
 Depression and co-morbidity
MHMC Depression Initiative
 ETAP Program
 Maintains a consumer orientation
through:
 Anonymity – No personal information
recorded
 Confidentiality – Employee responds to
questions using telephone keypad; no
conservation to be overheard
 Only aggregate demographic and results
data shared with employer
MHMC Depression Initiative
 ETAP
 Two Screening Programs Available
 Depression and Manic-Depression
Screening
 Alcohol Use
MHMC Depression Initiative
 Depression and Manic-Depression
Screen
 10 question depression screening
instrument developed and validated by
Harvard University
 3 question manic depression screen also
developed and validated by Harvard
University
MHMC Depression Initiative
 Alcohol Use
 10 question Alcohol Use Disorder
Identification developed in 1982 by the
World Health Organization
 Screens for alcohol behaviors and problems
ranging from risky drinking to alcohol
dependence
MHMC Depression Initiative
 ETAP
 Dedicated 800 toll-free number for each
organization
 Immediate caller feedback
 Weekly and quarterly reports
 Educational and promotional materials
 Special emphasis programs
 Alcohol Awareness Day – April
 Depression Screening Day – October
 Automatic Transfer to EAP or MH insurance
carrier
MHMC Depression Initiative
 ETAP National Results
 Depression Screening
 73% of callers score positive for depression
 80% of positives score in the mild to
moderate range
 90% not in treatment at time of call
 87% of callers are employees
 75% of the female callers score positive
 70% of the male callers score positive
MHMC Depression Initiative
 ETAP National Results
 Alcohol Screening
 70 % of the callers score positive for an
alcohol problem
 96% of those who score positive score in
the harmful/hazardous or
harmful/dependence range
 95.4% are not in treatment at the time of
the call
 81% of the callers are employees
MHMC Depression Initiative
 ETAP National Results (continued)
 72% of the male callers score positive
 98% in the harmful or above range
 61% of the female callers score positive
 93% in the harmful range and above
MHMC Depression Initiative
 MHMC ETAP Results for 2001
 1.3% of the MHMC membership calling
 Ranges from 0.3% - 7% per organization
 Total of 730 calls
 505 for depression screening
 225 for alcohol screening
 71% of the callers female
 70% of the callers depicted depression
symptoms
 85% of the callers with depression not in
treatment at the time of the call
MHMC Depression Initiative
 MHMC Nurse Call Program
 Nurse Case Management of Depression
Treatment – costs approx. $150/patient
 6 month patient telephone follow-up
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Patient education on depression management
Assess treatment progress
Screen for suicide
Help to develop an activity schedule
Keep the provider (PCP) informed of progress or
complications
 Psychiatric consultation and bi-weekly review
MHMC Depression Initiative
 Nurse Call results
 74% of patients still taking antidepressant medications at 6 months
 57% of patients showed at least a 50%
improvement in their baseline Hamilton
Depression Severity Score
 18% self-reported an improvement in
their baseline work role functioning
 Improvements translate into a $2,600
savings/employee
For Further Information
 William McPeck, MSW
Director, Employee Health and Safety
Maine State Government
114 Sate House Station
Augusta, ME 04333
207-287-6783 (voice)
207-287-6796 (fax)
[email protected]