making life better: purchasing depression care to improve clinical and work outcomes
DESCRIPTION
Making Life Better: Purchasing Depression Care to Improve Clinical and Work Outcomes. Donna Marshall, MBA Kathryn Rost, PhD. Overview. Depression in the Workplace Depression Burden with Usual Care Employee Organization - PowerPoint PPT PresentationTRANSCRIPT
104/19/23
Making Life Better: Purchasing Depression Care
to Improve Clinical and Work Outcomes
Donna Marshall, MBAKathryn Rost, PhD
204/19/23
Overview
• Depression in the Workplace• Depression Burden with Usual Care
Employee
Organization• Reducing Depression Burden to Employees by
Purchasing Value
Employee
Organization
304/19/23
Depression in the Workplace
Depression is common in the workforce
7.2 % of American employees
experience a depressive episode each year
404/19/23
More Than Just a Bad Day…
Clinical Criteria• sad or blue• loss of interest• change in sleep• change in eating• fatigue• self-doubt/guilt• concentration
problems• hypo/hyper-activity• self-harm
Behavior at Work • negative/irritable• withdrawn
• trouble with deadlines • apologizing/shirking• increased mistakes
• black humor
504/19/23
Depression Burden in Usual Care: Employee
Depression reduces the individual’s biological,
psychological, and social functioning
Impairment is so severe that
depressed individuals cut back
on their usual activities
or stay in bed 66.4 days a year.
604/19/23
Depression Burden in Usual Care: OrganizationDepression Burden in Usual Care: Organization
•Major depression increases absenteeism
– Depressed workers report an extra 1.6 days of absenteeism each month
•Major depression reduces productivity at work
– Depressed workers report 70% of peak productivity
704/19/23
BOTTOM LINE
Each year depression costs American employers
•$36 billion in absenteeism and reduced
productivity at work
•$27 billion in treatment costs
Kessler RC, Akiskal HS, Ames et al. Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. American Journal of Psychiatry, 2006: 163:1561-1568.
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What’s wrong?
904/19/23
Aren’t antidepressant costs rising? Yet…..
* 5 of 10 depressed individuals who visit a primary care provider during their episode fail to start any treatment.
* 4 of every 10 depressed individuals who start antidepressant medication discontinue taking it before they can realize any clinical benefit.
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REDUCING DEPRESSION BURDEN
PURCHASE VALUE
Design health benefits to assure depressed employees receive the
treatment shown by research to improve clinical and work outcomes
1104/19/23
HEALTH BENEFIT
1. Employees complete depression screening
each year*
2. Employees who screen positive receive
depression management
* Some employers identify depressed employees through pharmacy database records
1204/19/23
Depression Management in the Workforce
DMW Care
Specially trained nurses confidentially
* provide depressed employees education
about the disorder and its treatment
* systematically monitor employee response
to treatment over 24 months
* contact PCP to cue treatment change if
employee fails to improve or relapses
1304/19/23
DMW Care: Effects on Remission
DMW Care reduces the number of individuals who are depressed by 17.4% on average each year over usual care.
Results may vary by employee characteristics, organizational policies and depression management vendor
Depression Remission (n = 479)
0
20
40
60
80
100
6 12 18 24
Months
% P
atie
nts
in R
emis
sion
Usual Care Depression Disease Management
1404/19/23
DMW Care: Effects on Impairment
DMW Care reduces emotional impairment days by an average of 31.0 days per participant each year over usual care.
Results may vary by employee characteristics, organizational policies, and depression management vendor
Emotional Impairment Days (n = 479)
0
1
2
3
4
5
6
7
8
0 6 12 18 24
Months
Em
otio
nally
Im
pair
ed D
ays
in P
ast
Mon
th
Usual Care Depression Disease Management
1504/19/23
RETURN ON INVESTMENT: EMPLOYEE
Employee Receives Additional Clinical Benefit
Organization Pays $16 to Purchase DMW Care
Depressed Employee Realizes an Additional Day with No Emotional Impairment
Organization Pays Additional Dollars to Purchase a New Health Product
1604/19/23
RETURN ON INVESTMENT: EMPLOYEE
10,000 Employee Transportation Firm
Annual reduction in impairment days: 3,627 daysAnnual reduction in impairment days: 3,627 days
Annual cost: $58,500Annual cost: $58,500
Annual cost per reduced impairment day: $16Annual cost per reduced impairment day: $16
Rost KM, Pyne JM, Dickinson LM, and LoSasso AT (2005). Cost-effectiveness of Rost KM, Pyne JM, Dickinson LM, and LoSasso AT (2005). Cost-effectiveness of enhancing primary care depression management on an ongoing basis. enhancing primary care depression management on an ongoing basis. Annals of Family Annals of Family MedicineMedicine, , 33, 7-14., 7-14. Annals of Family MedicineAnnals of Family Medicine 3: 7-14, 2005 3: 7-14, 2005
Results may vary by employee characteristics, organizational policies and depression management vendor
1704/19/23
DMW Care: Effects on Absenteeism
Intervention Effects on Absenteeism (n=198)
2
6
10
14
18
22
0 6 12 18 24
Months
Hou
rs W
ork
Los
t in
Pas
t Mon
th
Usual Care Enhanced Care
DMW care reduces absenteeism by 6.1 days (28.4%) each year at an annual economic value of $619 per depressed participant. Results may vary by employee characteristics, organizational policies and depression management vendor
1804/19/23
DMW Care: Effects on Productivity
DMW management improves productivity by 8.2% (18.0 days) each year at an annual economic value of $1982/depressed participant. Results may vary by employee characteristics, organizational policies and depression management vendor
Intervention Effects on Productivity
60
65
70
75
80
85
90
0 6 12 18 24
Months
% m
axim
um p
rodu
ctiv
ity
in p
ast t
wo
wee
ks
Usual Care Enhanced Care
1904/19/23
Return on Investment: Organization
Organization Receives Additional Dollar Value from Product Purchase
Organization Pays $1 to Purchase DMW Care
Organization Realizes $3 of Additional Work
Organization Pays Additional Dollars to Purchase a New Product
2004/19/23
RETURN ON INVESTMENT: ORGANIZATION 10,000 Employee Transportation firm
•Annual savings to company: $423,112
•Annual cost to company: $58,500
•Annual return on investment: 3.6:1
Rost KM, Smith JL, and Dickinson LM. The effect of improving primary care depression management on employee absenteeism and productivity: a randomized trial. Medical Care 42: 1202-1210, 2004.
Results may vary by employee characteristics, organizational policies and depression management vendor
2104/19/23
Results potentially vary by……..
• Employee Characteristics
willingness to participate
• Organizational Policies
policies/practices re: missed work
• Vendor Selected
provision of key components of care
participation rates
cost
2204/19/23
Vendor Selection
“ “Close counts only in horseshoes and hand grenades”Close counts only in horseshoes and hand grenades”
DMW Care – Key ComponentsDMW Care – Key Components PCP EducationPCP Education Protocolized educationProtocolized education Short-term monitoringShort-term monitoring Long-term monitoring*Long-term monitoring* Protocolized PCP contact if employee Protocolized PCP contact if employee fails to improve or relapsesfails to improve or relapses
2304/19/23
VENDOR CHOICES
Vendor Types:– Health Plans– Disease Management Firms– Managed Behavioral Health Organizations– Employee Assistance Programs
– Pharmaceutical Benefit Managers
2404/19/23
TECHNICAL ASSISTANCE
What is Technical Assistance? Unbiased and experienced health benefits consultant willing to consult over the next 24 months with companies interested in purchasing depression management
What’s the cost? Free to study participants
What’s the goal? To aid companies interested in depression management to develop/monitor performance management standards to assure they get the product they pay for
2504/19/23
“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, that is the only thing that ever has.”
Margaret Mead
2604/19/23
CALCUATING VALUE IN YOUR ORGANIZATION
THE EMPLOYER CALCULATORTHE EMPLOYER CALCULATOR
Input:Input: Workforce size and industryWorkforce size and industry Policies/practices regarding missed workPolicies/practices regarding missed work
Output:Output: Reduction in impairment/lost work days with DMW CareReduction in impairment/lost work days with DMW Care Annual cost of DMW Care Annual cost of DMW Care Return on investment to employee and organizationReturn on investment to employee and organization