In 1983, mental health costs accounted for 14% of total medical plan costs. They ran a third only to women's health and musculoskeletal injury as a percentage of total medical costs. At that time, management decided that there should be no significant change in the liberal mental health benefits, and, consequently, a strategic program was designed and implemented to address specific mental health costs.

 

First Chicago's mental health quality and cost effectiveness program includes four major components:

* Employee Assistance/Health Promotion Program. A primary goal of the mental health program is to prevent long- and short-term disability by providing early intervention or prevention. Assessment, short-term counseling, and referral to community resources are obtainable at no cost. One of the main subject areas of health promotion is education regarding depression and other mental health issues. The Health Promotion Program provides primary prevention through education and serves as a conduit to the Employee Assistance Program.

* Psychiatric hospital utilization review. For certification of benefits, the patient's physician contacts the Bank's medical director by the sixth day of hospitalization. A mental health treatment report is submitted for any hospitalization anticipated to last more than ten days.

* Consulting psychiatrists. Psychiatrists serve the mental health program by reviewing the appropriateness of psychiatric hospitalization; assisting employees and dependents in obtaining appropriate care; and visiting treatment facilities where appropriateness of care is a concern.

* Benefit plan design. Changes were made in the mental health benefit plan to ensure that quality and cost effective options to inpatient care are available, e.g. partial hospitalization, evening outpatient chemical dependence programs, and outpatient day treatment. These options are especially important for the treatment of depression, which can be most often done in an outpatient setting. This also facilitates an earlier return-to-work of the employee, even on a part-time basis, which in turn reduces disability costs.

As a result of this program, there has been a significant decrease in inappropriate inpatient mental health care related to depression and other mental health diagnoses, while the availability of outpatient ambulatory services has been enhanced and improved. Between 1991 and 1995, the direct treatment costs for depressive disorders dropped from just under $1,000,000 to a little over $400,000. As a percentage of total mental health claims, the cost of depressive disorders fell from 62% in 1992 to 45% in 1995. Furthermore, indirect costs have not risen as direct costs have declined. The average duration of short-term disability cases for depressive disorders has remained relatively stable over the past several years. According to the Washington Business Group on Health, the key is in successful management to ensure appropriate and medically necessary treatment.

 

Additional corporate experiences and Innovations

 

INFORMATION MANAGEMENT

Accessing company data on the prevalence, cost, treatment, efficacy, and attitudes regarding depression provides information about how to allocate corporate resources and design health and disability benefits to better manage the impact of depression in the workplace.¹⁶ For example:¹⁷