Mental/Behavioral Health: High-Cost Claims & Mitigation Solutions
Dr. Michael Lacroix
Medical Director, The Hartford
One of the few silver linings behind the COVID pandemic cloud is that it has drawn attention to the prevalence of mental/behavioral health (MH) challenges, and particularly to their importance in a work context. In The Hartford’s survey of employers and employees over the first three “waves” of the pandemic, employers reported that MH issues among their employees had increased from 56% in wave 1 to 69% in wave 3. Over half (59%) of employees reported that the culture of their company had become more accepting of MH challenges. Among employers, 50% agreed that employees' MH “always or almost always” impacted their productivity, and 80% felt they had become more accepting. [1]
MH conditions in the aggregate rank among the costliest disorders, whether taken on their own,[2] or as co-morbid conditions. For example, The presence of co-morbid depressive symptoms in workers on benefit due to musculoskeletal disorders increases both the number of days on compensation benefits,[3] as well as the number of treatment days.[4] In the California workers' compensation system in 2018, psychoactive medications accounted for 8.3% of all prescriptions,[5] and having these prescribed was associated with an additional $22K in medical cost and $51K in total claim cost, respectively. [6]
What to do? A multi-pronged strategy is suggested: effective mitigating interventions can be introduced on a continuum at various points in an unfolding MH episode.
- Intervene preemptively, if possible: Studies show that even simply providing helpful information to people requesting an FMLA for MH reasons impacts both leave duration and migration to STD. [7]
- Intervene as early as possible. The ADAAA interactive process mandate can be your friend. Potential MH claims can often be avoided/mitigated by making use of the ADAAA. Accommodations for MH are often surprisingly simple (hint: Ask the employee what would help).
- Intervene smartly. Using dedicated MH clinicians on these claims facilitates partnership with treaters. With dedicated MH staff, we averaged 10.71 fewer days per claim in 2019, per our internal data.
- Intervene continuously: Embed MH in the health/wellness plan.
- Intervene for recovery: Psychotherapy is cost-effective. Implementing outpatient psychotherapy coverage under insurance in Germany yielded significant reductions in work disability days (41.8%), hospitalization days (27.4%) and inpatient costs (21.5%) for the first year, and further decreases in the second year (23.8%). [8]
- Intervene for retention. Support from the employer is crucial. Satisfaction with the treatment of a workers' compensation claim by the employer has a huge impact: An increase in worker satisfaction (from Satisfied to Very Satisfied) can reduce claim cost by almost 30%.[9] Workers who are happy with their employers want to get back to work ASAP.
[1] The Hartford Study: Majority Of Employers Recognize Employee MH As A Significant Workplace Issue, Report Stigma Prevents Treatment | The Hartford
[2] Roehrig, C. Mental Disorders Top The List Of The Most Costly Conditions In The United States: $201 Billion. Health Affairs, 2016, 35, 6. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.1659
[3] Lötters, F., et al. The prognostic value of depressive symptoms, … Occup Environ Med 2006;63:794–801. doi: 10.1136/oem.2005.020420
[4] Lacroix, J.M. MH Claims in WC and Disability. WorkCompWire, March 16, 2021
[5] Young B & Hayes S. California WCI Research Update. https://www.cwci.org/document.php?file=4190.pdf
[6] Hunt D et al. Association of opioid, anti-depressant, and benzodiazepines with WC costs. J Occ Env Med, 2019: 61(5):e206–e211. doi: 10.1097/JOM.0000000000001585
[7] Spallone, A., & Lacroix, J.M. Managing MH claims proactively. CLM magazine, October 2020, Pp. 29-31.
[8] Altmann U, et al. Outpatient Psychotherapy Reduces Health-Care Costs: A Study of 22,294 Insurants over 5 Years. Front Psychiatry. 2016; 7: 98. doi: 10.3389/fpsyt.2016.00098
[9] Butler RJ & Johnson WJ Loss reduction through worker satisfaction: The case of WC. Risk Management and Insurance Review, 2011: 14, 1-26
*The views and opinions expressed in the Public Risk Management Association (PRIMA) blogs are those of each respective author. The views and opinions do not necessarily reflect the official policy or position of PRIMA.*
By: Dr. Michael Lacroix
Medical Director, The Hartford
Summary of Qualifications
Dr. Lacroix is medical director with The Hartford. He is a licensed psychologist in Florida. He has worked in the overlapping areas of disability and workers’ compensation for the last 30 years, in a variety of clinical, management, program development and consulting roles. Prior to joining the corporate world, (Concentra, then Coventry, then Aetna, and now The Hartford) Dr. Lacroix held academic appointments and developed a large clinical practice focused on assessment, treatment and rehabilitation of injured and disabled workers. He also carried out grant-supported research over many years, resulting in over 100 peer-reviewed publications and papers. He is a frequent contributor at industry conferences and publications.
Responsibilities
- Clinical review of complex psychological cases
- Staff education
- Program development
- Research
- Thought leadership (publications, conference presentations board memberships)
- General advisory functions related to behavioral health
Business Experience
- 2018 - present: Medical Director, The Hartford
- 2013 - 2017: Associate Medical Director, Aetna Disability
- 2002 - 2017: Director, Behavioral Health Services, Coventry Workers’ Comp Services
- 2000 – 2001: Regional Training Manager, East Region, Concentra Managed Care, Inc.
- 1998 - 2000: Regional Manager / Canada, Concentra Managed Care, Inc.
- 1981 - 1998: CEO and Chief Psychologist, Lacroix, Scher Consultants. Grew private practice into multi-million dollar psychological – vocational practice and ancillary businesses
- 1988 – 1998 Chief Psychologist, and Senior Psychological Consultant, West Park Hospital
- 1978 - 1989 Clinical and Research Consultant to Psychology Department, Ontario W.C.B.’s Downsview Rehabilitation Centre
- 1974 - 1991 Lecturer, promoted to Assistant Professor, then to tenured Associate Professor of Psychology, York University, Toronto, Ontario
Professional Affiliations
- American Psychological Association
- International Critical Incident Stress Foundation
- Licensed Psychologist: FL license PY6750
