Workforce Initiative: Addressing Chemical Dependency in the Workplace

Redimere stands for “redemption”, but serves a double meaning as “resourceful”. Employee Assistance Programs, or EAPs, are one of the most resourceful tools employers can implement in their own practice.

The Redimere Inc. Workforce Initiative is a program designed to address inequities and shortfalls in addiction and substance abuse treatment for employees through an EAP.

These shortfalls occur on both sides, but addressing the problems at the treatment program level can reciprocate benefits to both – by creating a program for addiction treatment that is set up to accept employees utilizing EAP and address the common concerns that human resource departments and employers have.

Challenges Facing Human Resource Departments and Employers Offering Employee Assistance Programs (EAP) for Substance Abuse

Human Resource professionals who work in behavioral health settings are usually responsible for selecting an employee benefits package for themselves and their colleagues.

Employee Assistance Programs (EAPs) are long-term policies designed to help workers during times of stress. Adopting an EAP for substance abuse treatment can be daunting in the era of shady and unethical healthcare practice. Open exchange networks and out-of-network providers are landmines when choosing EAPs. The last thing an HR professional wants to do is create additional stress for the employees they are paid to look after.

It’s important to select a diverse range of services before implementing an EAP for your staff. An experienced behavioral health consultant can help you accomplish the following:

• Design and choose the most suitable EAP
• Measure costs and benefits of EAPs
• Select certified and ethical treatment centers where employees can seek medical care or rehabilitation
• Coach professionals about the laws associated with EAPs and Return-to-Work policies as illustrated by the Equal Employment Opportunity Commission (EEOC)

However, treatment centers have failed to offer a sufficient program that meets the needs of employees and their employers. Several challenges make the process of getting help for an employee through an EAP approved treatment program less than ideal.

The aim of the Redimere Inc. Workforce Initiative is to help treatment centers develop and implement a treatment program that not only effectively treats the employee in a timely manner but at the level of clinical care that is needed.

Human Resource professionals are often unsung heroes and heroines; not only for helping companies provide more incentive for employees but also for protecting employees from receiving care from illegitimate organizations who do not follow industry best practice.

Before choosing an appropriate EAP, HR pros need to be aware of the ways they can fall victim to exploitation:

1. Balance Billing – when insurers refuse to cover a provider’s claim for medical care, the cost falls onto the patient, or in this case, the employee
2. Fraudulent/Abusive Billing and Coding Practice: In an effort to collect maximal reimbursement, unethical providers will deliberately seek loopholes in an effort to rob insurers and increase their bottom line

Treatment Centers Balance Billing the Employer

The billing point is where the majority of treatment centers fail to create a mutual benefit for themselves and the employers or programs referring their employees for treatment. Balance billing practices by treatment centers create a predatory aspect to accepting patients from EAP programs. Without a program or treatment plan set up to meet the specific needs of patients coming in from an EAP program, there is no standard of treatment.

If the treatment plan costs a total of $3000.00, and insurance covers $300.00 of the balance, the remaining $2700.00 balance is then billed to the employer. This balance can be detrimental to the employer, and while the treatment center may ultimately receive the balance paid in full, this practice is unsustainable and bleeds small businesses dry.

Instead, a treatment plan unique and individualized should be set up to meet the needs of the employee and can utilize the maximum coverage offered by the insurance plan. This leaves less of a financial burden on the employer and makes getting substance abuse help for employees more cost-effective.

In short, it is a win-win-win situation for the employer, the employee, and the treatment center.

Treatment Centers Involved in Fraudulent Billing

Fraudulent billing practices in addiction treatment centers have run rampant over the past several years. Treatment centers that engage in these unethical and illegal practices may attempt fraudulent billing in several ways including fraudulent toxicology and testing.

A treatment center, when it comes time to bill for the services rendered, may state that toxicology testing was performed weekly or even daily. Testing could be done through drug and alcohol urinalysis, breathalyzers, and other forms of testing. A treatment center that misrepresents the toxicology services rendered could state that drug tests were administered weekly when the patient was only tested once over thirty days – or the tests might not have been administered at all.

When an insurance company or the employer is billed for services that were not rendered, that is not only fraud but creates an inflated cost for treatment. That cost may give the treatment center more of a profit, but the cost has to be passed on to someone.

With these inflated costs, treatment is unsustainable. Eventually, everyone loses, including the treatment center, which will eventually lose out on future EAP referrals.

Treatment Centers Don’t Offer a Clinical Care Model or Program that Employers Are Looking For

Some of the most important regulatory bodies Human Resources should become well-versed in before implementing an Employee Assistance Program include:

Clinical Care Regulatory Bodies

• Centers for Medicare and Medicaid (CMS)
• CMS is responsible for auditing reimbursement bills issued by providers
• Family and Medical Leave Act (FMLA)
• Offers services to cope while saving corporate expenses by assisting employees to return to work
• Health Insurance Portability and Accountability Act (HIPAA)
• HIPAA ensures the private and confidential reporting and preservation of patient healthcare information, which also applies to employee health records
• Joint Commission on Accreditation of HealthCare Organizations (JCAHO)
• JCAHO oversees the accreditation and certification of healthcare providers and treatment centers to prevent unethical operations
• Equal Employment Opportunity Commission (EEOC)
• EEOC protects employees from discrimination in the workplace, which manifests in unjust working hours and lack of emphasis on employee health and wellness
• Americans with Disabilities Act (ADA)
• ADA upholds the fair treatment of workers with diagnosable physical or mental disabilities
• Health and Human Services (HHS)
• HHS provides access to essential health services to the American public, including active members of the U.S. workforce.

Clinical Care Model for Treatment Centers

Recidivism, relapse, and recovery failure is a prime concern for employers. The basis of helping their employees to recover from their personal substance abuse and addiction issues is so that they can return to work as a productive member of the company’s family. If the treatment is unsuccessful, that equates to lost time and money.

Employers want to feel confident that they are sending their employees to a program that will offer the highest chance of success, and help the employee to not only work on their personal problems that were affecting them at work, but also any work-related problems that may have contributed to the worsening condition and substance abuse.

Will the treatment program teach the individual to deal with stress in a healthier way? Will the program be able to strengthen the employee’s personal skills, better their attitude and leave them more adept to dealing with the challenges of the work environment? Treatment centers that are treating individuals as a part of an EAP program need to realize that the employer is also a client in these situations, and should establish and implement a program that sets expectations for the employer, just as it would set for the families of individuals being treated outside of EAP.

Treatment Centers Extend the Recovery Time of the Employee

Recovery from substance abuse, chemical dependency, and addiction takes time. Dealing with the emotional, mental and physical effects of drugs and alcohol could take anywhere from 30 days to over a year. However, we need to be very real about the length of time a person can be out of work and dedicate themselves to full-time treatment.

Another of the major concerns that employers have with treatment programs accepting patients as a part of EAP and FMLA is the length of time the treatment centers want to commit the individuals too. It is essential for treatment centers to utilize individualized treatment plans to meet the needs of the individual.

One of the prime needs of the individual in an EAP program is to get back to work as soon as possible. This doesn’t mean that shortcuts should be taken, a program should be rushed, nor should an individual receive substandard care. However, not every person should be mandated a six-month stay in residential treatment that keeps them out of work.

Treatment centers need to be able to be flexible with their treatment plans and make options available for the individual to receive treatment and care for long-term recovery that works with their need to return to work. A program that offers only a set amount of time for treatment before releasing the individual back to work, and back to deal with early sobriety on his or her own is not an effective “one size fits all” solution. The individualized plan should offer some form of follow up using outpatient treatment, aftercare, ongoing help, and a thorough discharge plan.

Treatment Centers Do Not Offer a Thorough Discharge Plan, Aftercare, or Ongoing Help

Many of the shortfalls specific to the program that treatment centers offer is their follow-through. Not just with EAP, but with anyone seeking treatment. Relapse rates are well known in the treatment community, and it is widely accepted that in order to make a full recovery it takes work that continues even after initial treatment.

If the treatment program offered is only focused on keeping the individual sober for a set amount of time, and trying to teach all of the facets of recovery and sobriety into that short time frame, then the program is not a good option for employers or the employee. In order to offer an effective EAP treatment program, the treatment provider should make available to the individual resources for continued treatment and therapy.

This is what employers want to see in a solid EAP program – a program that follows through and offers an alumni program, aftercare, and ongoing treatment in an outpatient program that will continue where the initial treatment left off. Relapse is always a concern for those in early recovery, and employers offering employee assistance want a program that offers options that extend beyond the initial treatment.

Connecting Employers to Treatment Providers Offering Programs That Meet These Needs and Concerns

The Redimere Inc. Workforce Initiative helps both sides of the EAP addiction treatment spectrum. First, we help treatment centers to layout a treatment program that meets the needs and expectations that employers have. This makes the treatment center a qualified candidate for accepting EAP clients, offering a treatment program that shows true potential for addressing both the personal and workplace concerns of individuals dealing with mental health, substance abuse, and addiction issues – as well as the ancillary issues that arise.

This is only the tip of the iceberg. Human Resource professionals can rely on Redimere Inc. to navigate EAP implementation. Even organizations with existing EAPs need guidance before deciding where to send employees for treatment.

Redimere has a track record of assisting unionized businesses to understand the laws associated with regulatory bodies in healthcare, which is especially relevant for enrollment and discharge from Workers’ Compensation programs.

We also connect employers and human resource departments with treatment centers that have either established programs based on our standards and criteria or met the high standards we set. All of the aforementioned challenges are very real concerns between employers and treatment centers regarding EAP, and it is very possible to create solutions that benefit each side.

Our Workforce Initiative lays the blueprint for implementing what employers are asking for, and treatment centers have fallen short of delivering. It holds true to the philosophy of providing safe, effective clinical and medical care, and helps to make available honest and sustainable addiction treatment solutions when they are needed most. If you are an HR professional or PHR looking for an EAP consultation, call Redimere today at (949) 558-1665.

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