Employers asked to consider covering depression treatment

September 10, 2011
| By Pete Daly |
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Depression takes a big bite out of employee productivity, in both absenteeism and low performance on the job. Now a collaboration of health care leaders in West Michigan is developing a new approach for treating depression in the primary care setting, and it is asking employers to include coverage of depression treatment and other behavioral illnesses in their health care plans.

According to Cathy Baase, M.D., global director of health services for Dow Chemical Co., about 30 percent of the total cost to employers of poor employee health is comprised of medical care, pharmaceutical costs and Worker’s Comp. The other 70 percent of the total cost is reduced productivity through absenteeism or “presenteeism” — ill employees who are on the job but seriously underperforming.

“There is no other illness that has as devastating an impact at the individual level as depression,” said Baase, who spoke at a meeting of regional health care leaders at Amway last week.

A key point of Dow’s corporate health strategy is that “prevention can make a difference,” which Baase said could reduce that lost productivity cost by as much as 40 or 50 percent.

The model of care being launched here and in Southwest Michigan over the next six to 12 months has been proven to result in dramatically better outcomes, enabling patients to return to work more quickly and holding great promise to reduce medical costs. The initiative is being facilitated by the Michigan Center for Clinical Systems Improvement in conjunction with the Alliance for Health’s Aligning Forces for Quality Initiative.

The effort is funded partly through the West Michigan Aligning Forces for Quality initiative as well as through contributions from organizations represented on the Mi-CCSI board of directors: Spectrum Health System, Metro Health, Advantage Health (Saint Mary’s Health Care), Lakeshore Health Network (Mercy Health Partners – Muskegon), Borgess Health, Blue Cross Blue Shield of Michigan and Blue Care Network. Mi-CCSI is also working closely with Grand Rapids-based Priority Health. 

According to the Mi-CCSI, depression is one of the most difficult-to-treat chronic conditions, debilitating many individuals. It is estimated to cost U.S. employers $44 billion annually in lost productivity. As a chronic disease, depression often is undiagnosed, misdiagnosed or not treated effectively. The clinical approach being proposed is closely modeled after the nationally recognized DIAMOND initiative in Minnesota that is revolutionizing the treatment of depression with impressive outcomes and return-to-work results, according to the Mi-CCSI.

A cornerstone of both the DIAMOND initiative and the new care model being developed locally is integration of behavioral health and primary care, strengthening the team caring for patients.

Launched in 2008, DIAMOND has been incorporated into 80 primary care clinics across Minnesota and has served more than 8,000 patients. Outcomes for patients participating in the program have resulted in remission and response rates that are two to four times better than usual treatment. Similar care models are also under development to improve the care of other chronic conditions such as diabetes, congestive heart failure and asthma.

Nancy Jaeckels, vice president for Strategic Initiatives at the Institute for Clinical Systems Improvement in Minneapolis, told the group at Amway headquarters last week that depression is “very prevalent and very costly” in the overall health care system. She added that between 7 and 8 percent of employees have a major depressive episode each year.

Jaeckels said ICSI relies on “an evidence-based model” that shows depression can be treated successfully in many cases, bringing it to remission.

Jaeckels leads ICSI’s strategic initiatives for DIAMOND, a depression care management program that has been implemented widely in Minnesota and has dramatically improved outcomes and care for patients.

Paul Ponstein, D.O., a medical director at Mercy Health Partners and president of the Mi-CCSI board of directors, said Mi-CCSI was launched to “facilitate collaboration among health care providers, plans, employers and the patients we serve with a goal of reducing variation in clinical care, promoting systems that improve patient care and lower per capita costs. Our goal is to focus on problems that no one party can solve on its own. We look forward to working together to transform care for patients beginning with this initiative targeting depression.”

“We believe employers have as much at stake in this effort as the health care community,” he added. “They see first-hand the significant impact depression has on their work force. Absenteeism, lost productivity and increasing health care costs make this a very real problem for companies, and one of the most challenging chronic diseases for individuals to manage.”

Other speakers at the event included Patrick Courneya, M.D., and Timothy Hernandez, M.D., both family practice physicians from Minnesota and both instrumental in the implementation of DIAMOND in that state. Courneya conceded that there are very real challenges involving the cost of this depression treatment plan. However, he added that the outcome is a “much higher value product” that more than returns the investment.

Steve Williams, executive director of the new Mi-CCSI, said he is confident some employers such as Amway, Steelcase and Herman Miller will look more carefully when it comes to determining if they can include depression treatment in their employee health coverage plans.

The Alliance for Health is a regional health improvement collaborative encouraging optimal health for all through high quality health care services at the lowest cost. The Alliance is carrying out the West Michigan Aligning Forces for Quality initiative, a major program to improve the overall quality of health care in selected communities across the U.S. That initiative is funded by the Robert Wood Johnson Foundation.

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