By Cristie Upshaw Travis
I’ll call him Rick. This is not his real name, but he was a real person, son, brother, friend, colleague, and a favorite employee at a fine dining restaurant where his natural talent of hospitality was recognized and appreciated by customers and management alike.
A couple of years ago, when Rick didn’t come down for dinner, his Dad went upstairs to get him and then life changed forever. An accidental overdose not only took Rick’s life, but impacted all of those around him in profound and lasting ways.
Clearly the impact was greatest on those who loved Rick, but the ripple effect on his work colleagues and his managers at the restaurant was also significant.
Let’s start with the business impact. Research from the National Safety Council and Shatterproof tells us that for Rick’s employer (who I can imagine operating a regional chain of restaurants with 1,000 employees) about 13% of his employees suffer with addiction. Opioid addiction accounts for about 9% of those with addiction. The total cost of all kinds of addiction is estimated to be $350,000 a year.
A recent report from the Health Care Cost Institute shows that for commercially insured, inpatient treatment utilization for substance use has increased 18% since 2013 and the total spend has increased 64%.
But health care cost only accounts for $100,000 of Rick’s employer’s costs. Other costs include about $103,000 in lost time and $146,000 in job turnover and retraining.
Research also estimates that approximately 14% of his colleague’s family members also suffer from addiction. Employees with addiction in the family tend to miss more work and their own productivity suffers due to preoccupation and worry about their loved ones.
But the impact is not just financial. Rick’s colleagues and his employer are his work family and they want the best for him. They see him every day until one day they don’t. The personal impact at work is also high.
So what should employers like Rick’s be doing about this addiction epidemic?
At the Memphis Business Group on Health we have adopted a nationally endorsed framework to guide our work and to ensure that employers are addressing all the major components needed to have a comprehensive strategy. This framework includes:
- Know the Impact
- Break the Silence
- Provide Access to Affordable, High-Value Care
- Build a Culture of Well-Being
Know the Impact
Employers should understand how addiction is impacting their business.
- Use the calculator at shatterproof.org to estimate the employee and financial impact at your business.
- Review your health care claims (including pharmacy) for addiction services, but remember that health care costs maybe less than 1/3 of your total costs.
- Include use addiction questions on health risk assessments.
Employers should also identify specific worksite safety issues associated with addiction, especially opioid use since it is accompanied by impaired thinking and slower reaction time.
- Download the Prescription Drug Employer toolkit at nsc.org to get more information.
Break the Silence
The 2017 National Survey on Drug Use and Health revealed that almost 40% of respondents indicated they didn’t seek treatment because of stigma and bias!
Many are beginning to think about substance use as a chronic condition, much like diabetes or high blood pressure. Recognizing the chronic nature of a clinical addiction helps employers breakdown the silos of physical health (such as diabetes) and substance use (such as opioid addiction) and integrate addiction treatment and recovery into the mainstream well-being and health insurance programs. Creating an environment where employees with substance use disorder feel as comfortable as a diabetic to seek treatment is the goal.
The National Safety Council suggests several steps employers can take to reduce stigma at the workplace include:
- Openly discuss and provide educational programs on opioid use
- Provide a confidential employee assistance program and help employees know they have this free resource!
- Use inclusive, non-stigmatizing language: instead of substance abuse, use substance use; don’t refer to addicts but to a person with opioid use disorder
You can also consider establishing employee resource groups for peer support for those concerned about their own substance use or use among family members. Seek legal advice to ensure you are setting these groups up appropriately.
Provide Access to Affordable, High-Value Care
Recent results from a National Association of Healthcare Purchaser Coalitions deep-dive into mental health and substance use practices within health plans shows there is significant work required to have the spirit of parity actually be realized.
The Center for Workplace Mental Health, a program of the American Psychiatric Foundation, has identified specific aspects of the treatment delivery system and insurance that need work:
Network adequacy: having sufficient in-network options of essential mental health and substance use professionals is critical to reduce out-of-network use and the accompanying added costs.
Promoting mental health parity: although parity is the law, the deep dive showed that out-of-network use for mental health and substance use was higher than for physical health; recent court decisions have held plans responsible for using different approval/denial processes for mental health/substance use than for physical health; and the reliance of employers on their plans to conduct compliance audits (of themselves) all point to significant work needed in achieving parity.
Advancing measurement-based care: Today it is impossible for patients, families, and employers to identify high-value providers – those that provide treatment that results in sustainable recovery over time. Having a measurement system that compares providers on key metrics will help in treatment selection and use.
Expanding a collaborative care model: Rethinking the role of primary care in mental health and substance use is essential to having sufficient numbers of providers to get care to people when they need it.
Expanding tele-health treatment approaches: Technology can connect people remotely and virtually with treatment thereby providing another resource to increase access to care.
For a full description of these priorities go to workplacementalhealth.org
Build a Culture of Well-Being
Employers now realize that creating a culture of well-being incudes focusing on the physical, mental, emotional, social, and financial health of employees and creating an environment that equally supports all of these.
Steps employers can take to successfully make this transition include:
- Have genuine and visible support from leadership, which includes allocating adequate staff and financial resources to build and support this culture
- Train managers to recognize signs and symptoms of substance use disorders and how to connect employees to the right resources
- Deploy a comprehensive employee communications plan that addresses employees’ education, awareness, and understanding of stigma, psychological illness, substance use and safety relating to mental health and substance use.
- Involve employees in workplace decision making; identify and include employee champions in providing input into well-being programs; incorporate feedback from employees to refine strategies
Check out the American Heart Association’s Mental Health: A Workforce Crisis at ceoroundtable.heart.org for more best practices.
Would Rick, his family and friends, his colleagues, and his employer have had a different outcome if this framework had been fully implemented? We can’t know the answer. But we do know that a workplace culture that promotes and sustains well-being and provides opportunities for treatment and recovery will make it easier for those like Rick to seek help and that is the first step in making a life-changing decision.
