Mental health care gets employees back to work

Care coordination for mental and physical issues

Aetna’s disability behavioral health clinicians educate primary care physicians on the employees’ disability plans and requirements, along with stressing the importance of a referral. Employees who were on short-term disability because of a behavioral health condition averaged 11 fewer days out of work than an industry benchmark when their claims were managed by Aetna’s disability behavioral health unit, a study by Aetna’s Disability and Absence Management Services determined.

The results translate into a savings for employers of $1,177 per employee when compared to the benchmark, according to Adele Spallone, LMHC, LMFT, clinical services head for Aetna Disability and Absence Management services.

The behavioral health unit is staffed by licensed behavioral health clinicians who work with employees, employers, and physical and behavioral health care providers by telephone to coordinate care and see that employees receive the care they need for a safe and successful return to work.

Most of the claims referred to the unit are for employees who see multiple providers, have complex return-to-work issues, and need frequent interventions and assistance with medication management.

"When employees have a primary or secondary diagnosis of mental health issues, it may impact their health recovery or return to work. We take a holistic approach to managing return-to-work and help our members deal with both physical and emotional health issues and return to work sooner," Spallone says.

When employees file claims for disability because of behavioral health issues, the claims automatically are referred to the disability behavioral health unit for assessment and management. If they file medical claims and the medical disability management unit uncovers a psychiatric issue, the claims are referred to a behavioral health clinician for review and consultation.

In some cases, employees call in to the disability management unit to file a claim because of a medical event and speak only about the medical condition, but they may also have behavioral health comorbidity, Spallone says. "Often there are also psychosocial issues, such as financial problems or childcare issues that go along with the medical event," she says.

For instance, if an employee calls in about a back problem, the claims processor asks the employee about other problems that may be going on that could exacerbate his or her physical condition and prevent a return to work, such as if the employee feels anxious about returning to work or is concerned about loss of income if he or she doesn’t recover sufficiently to return to work. People with long-term back problems tend to suffer from depression, she points out.

"We look at the person holistically and deal with more than just the primary medical condition. We identify the non-medical drivers upfront that can impede treatment and return to work. For example, we go beyond making sure the employee has an MRI and takes his medication but look at all the other factors that could make the duration of the claim longer," she says.

When disability claims analysts don’t identify non-medical issues, employees may improve medically but say they still aren’t ready for work. The disability claims analyst may uncover depression or fears of returning to the job and will have to help the employee overcome the psychosocial issues, which sometimes lengthen the time out of work, she says.

Many times employees who are out of work with a psychiatric issue don’t have a relationship with a behavioral health physician and see a primary care physician. "When patients are treated for behavioral issues by a primary care physician, they often don’t get the follow up they need. Some doctors just write medication prescriptions to address the psychological symptoms. But when people are dealing with depression and are out of work for any reason, they need to see a behavioral health professional regularly who will assess the patient’s coping skills and their ability to function and help the individual work on things that affect their lives," Spallone says.

Aetna’s disability behavioral health clinicians educate primary care physicians on the employees’ disability plans and requirements, along with stressing the importance of a referral for specialty behavioral health treatment, she says. Many times primary care physicians don’t realize that patients have behavioral health benefits and don’t consider making a referral for that reason, she adds.

Some disability claims are subjective in nature and driven by the patient, Spallone points out. "Patients will go to their physician with whom they have a long-standing relationship and say they don’t feel like they can work and the physician will concur. The physicians are not trained in disability benefits and often don’t know what the patient’s responsibilities are at work or what their job entails. Our clinicians educate physicians on the employee’s job description and the national benchmarking tool used to determine how long people with a specific diagnosis are typically out of work," she says.

If patients stay out of work longer than the norm, it’s usually because of other factors. "Some employees go out of work because of a non-physical problem such as getting a bad performance evaluation or if they don’t like their work shift. We’ll have a conversation with the physician to find out why patients can’t work and don’t feel they are ready to return to work and work with them on a return-to-work plan," she says.

When a claim is referred to Aetna’s disability behavioral health unit, a clinician immediately makes contact with the employee and the primary care physician as well as all of the other providers who are treating the employee.

"We believe it’s important to get the right clinical resources and right clinical interventions in place up front," she says.

When they talk to employees, the clinicians conduct a functional assessment and ask a series of questions, including how long the employees have had the condition, what happened to exacerbate it, who their treating physician or physicians are, when the employees last saw their doctors and the date of their next office visits, and what the employees think are the barriers to going back to work.

The clinician also asks questions about the employee’s ability to perform activities of daily living. When an employee is out of work due to chronic or major depression, the clinician looks for any potential suicidal ideation. "If the employee voices a threat to themselves or others, the clinicians have a threat protocol to follow," Spallone says.

The disability behavioral health clinicians identify all the physicians treating the employee and contact each of them. "We want to gather information from everyone to get a holistic view of what’s going on," she says. The team created a behavioral health questionnaire that asks each treating physician to assess the patients in three areas: cognitive, emotional, and behavioral impairment.

"When we talk to the treating physicians, we want to go beyond the diagnosis and make sure that the employee meets the requirements of their disability contract and is not able to perform core elements of their job. We talk to the physician about the employee’s job description and educate them about duration guidelines. We become their partners in determining the best approach for the patient getting back to work," she says.