From Identification to Action: Employer Strategies to Combat Substance Use Disorders

Join us for Part 2 of our insightful podcast series dedicated to improving outcomes for those affected by substance use disorders. In this episode, we'll explore effective early intervention strategies and the essential steps for building a robust support structure. Additionally, we’ll discuss how employers can ensure compliance with Mental Health Parity laws while reducing unnecessary medical expenses that contribute to wasteful spending. 

Panelists will discuss: 

• Strategies for enhancing early treatment of substance use disorders to prevent progression to catastrophic care. 
• Publicly available resources to help identify the most appropriate treatments and high-quality care options. 
• Provisions in current carrier contracts that enable them to retain a percentage of costs as revenue, while limiting access to in-network providers. 
• Understanding the Mental Health Parity laws and your obligations as a health plan provider.

This episode includes guest speakers:

Kirsten Suto Seckler, Chief Marketing & Communications Officer at Shatterproof

Danielle Capilla, JD, SVP of Compliance and Operational Strategy for Alera Group's Employee Benefits division

Lisa Kugler, Psy.D., SVP for Shatterproof’s Treatment Atlas team

Transcript

HOST

Welcome to the Pulse, produced by Vital Incite, where we keep pace with what's trending in employee benefits. This series was developed to bring together nationally recognized subject matter experts from the health and pharmacy industry, as well as top academic and research institutions. Our goal is to provide unbiased information and offer scalable strategies that give you clarity amid the chaos and provide answers to your most burning questions. I'm your host, Mary Delaney, Managing Partner of Vital Incite and Alera Group company.

In our last podcast, we learned that people seeking treatment for substance use disorders through their health plan increased two and a half times since 2020. And a staggering two-thirds of our entire society has been impacted by substance use disorders in some way. Unfortunately, as demand continues to rise, access to in-network providers remains limited. In our last episode, we also discussed how carriers are benefiting financially from out-of-network services. And because carriers then generate revenue off of these out-of-network services, they are not motivated to negotiate rates to keep providers in-network. In fact, services for substance use treatments are provided out of network 41% of the time. 41%. As employers struggle to find access to in-network care, they're also being asked to comply with health parity laws in addition to keeping their employees healthy and productive. This situation is reaching such a critical point that we thought it deserved a second episode. So today we will explore how employers can develop strategies to enhance early treatment, including how employers can leverage free resources to identify care options. We will also revisit the nuances of the health parity laws. In our previous episode, we had Tim Clement as one of our guests. Tim was involved in writing the law and even he said the law is, and I quote, mind-numbingly complex. End of quote. So today we hope to provide some clarity to help support better strategies.

Let me start off by introducing our panelists. I will start with Danielle Capilla. Danielle is Senior Vice President of Compliance and Operations Strategy for Alera's Employee Benefits Division. Danielle leads Alera's Compliance Department and provides Alera Group clients and employees with timely and easy-to-understand compliance resources, educational program and in-person assistance. Additionally, she is an adjunct professor at DePaul University College of Law where she teaches courses related to healthcare compliance. Exciting stuff, but someone has to do it. Thanks for sharing your knowledge with us today, Danielle.

DANIELLE

Thank you for having me.

HOST

Next we have Kirsten Seckler. Kirsten participated in our first podcast and did such a great job that we asked her back. She is Chief Marketing and Communications Officer for Shatterproof, a national nonprofit dedicated to reversing the addiction crisis. Kirsten has spent her career using marketing to drive social impact. Currently, she addresses the ever-growing substance abuse disorder epidemic. Kirsten is also an adjunct professor at Georgetown University and is the board chair for Special Olympics District of Columbia. Thanks for joining us again, Kirsten.

KIRSTEN

Mary, thanks so much for having me again.

HOST

Last but not least, we have Lisa Kugler with us. Lisa has her doctorate in psychology and is the Senior VP for Shatterproof’s Treatment Atlas Team. The Treatment Atlas platform has been developed with a vision to not only help those families and individuals needing treatment today, but to be the trusted quality measurement platform that transforms the national addiction treatment system. Lisa has promised to spend some time on explaining that resource today. Along with that, Lisa also has a strong background in creating supportive environments to help improve addiction and mental health outcomes. Thanks for rounding us out today, Lisa.

LISA

Thank you so much for having us, Mary. Great to be here.

HOST

I know this is going to be an exciting conversation today. We're going to start right off with the ERISA cases that are out there. There is nothing like lawsuits to create fear. And of course, last year started the year of lawsuits against employers as fiduciaries. Danielle, can you walk us through some of those current cases and what they may mean for employers?

DANIELLE

Absolutely. So in the last year we've seen a renewed interest in ERISA based lawsuits, probably in part due to the very large-scale news coverage on the Johnson & Johnson case and the Wells Fargo case, which don't have anything to do with what we're talking about today, but have certainly piqued folks’ interests in this area of law. And we can take a look at ERISA cases having to do with mental health parity. And the case docket is just neverending. I was actually looking at a recent case docket and started printing it and ended up having to stop my printer because there are just so many cases out there in all sorts of district courts around the United States. It's important to keep in mind that ERISA is also a very complicated law and so many of these cases really have to do with the nuance of the case and the plan design and might be something that you would consider to be more academic in nature and less about the actual underlying benefit. But that does not take away from the fact that we do have a lot of cases having to do with things like wilderness therapy, what's in-network and what's out-of-network, and how plans set these benefits up when we're comparing the mental health side of the benefits and the substance use disorder side to the medical surgical side. A lot of these cases seem to be in Utah and there's, you know, different reasons as to why. And there was a pretty big case that we saw in the fall of last year in which the court held that the denial of wilderness therapy benefits was not compliant with ERISA, and it had to do with a categorical exclusion of wilderness therapy as being investigational. And the court sent it back and said that this needed to be looked at, that maybe that wasn't an appropriate denial.

HOST

So it is difficult, I feel like, in the mental health world to really say what is experimental, what's defined. Other panelists, have you run into that, or what are your thoughts relating to that? Lisa?

LISA

I think that that's one of the almost biggest challenges is there's a lot of things that are emerging in the field, which is really exciting because there's so much creativity and so much exploration of what can be done. And yet that also brings up challenges for families, individuals and employers looking to search for services and search for treatment because they may not know what of these things are experimental and what may even actually have negative impacts on mental health and overall recovery trajectories. As a psychologist, I remember a number of years ago that there was a large group of individuals really looking towards rebirthing, and that was not proven out within the literature. And some people were harmed during that period of time. Know that there's a lot of investigations going around psychedelics and impacts and ways to utilize psychedelics in treatment. That as well is still exploratory. So, you know, within Shatterproof, we really encourage the utilization and finding out what is actually evidence based and what has been shown to be evidence based at this point in time and what is really designated to be shown as having positive treatment outcomes from multiple peer-reviewed cases, multiple articles, and really showing that support, especially if you're seeking care for yourselves or a loved one.

HOST

Go ahead, Danielle.

DANIELLE

I was going to say a great example that we can look to for this is ABA therapy. We went through this both on Lisa's side of the business as well as from a legal perspective, where maybe 15 or 20 years ago, ABA therapy was very expensive. It was still considered investigational by many plans. It wasn't covered by many employers. Then we saw a big swing of the pendulum. We saw ABA therapy become a reputable source of treatment, and we saw that pendulum swing on the plan side as well. And now the vast majority of health plans, both fully insured and self-funded, cover ABA therapy. And so, you know, that might be something that we see in other types of treatment and forms of treatment. But it remains to be seen on some of the things like wilderness therapy and some of the inpatient versus outpatient settings that various disorders can be treated in to see, you know, what kind of rises to the top and plans continue to cover, and what maybe falls by the wayside.

HOST

It's a great point. So of course as an employer, you're concerned that you're going to waste money on something that's not successful. You know, Lisa, you pointed out, and I think I've forgotten because I'm looking at claim stuff, there's also things that could cause harm, and that is the last thing anyone wants to have happen. So we appreciate what Shatterproof has put together as far as your resource to look at quality or to be able to find quality programs. Do you mind explaining that a little bit in more detail?

LISA 

Oh, happy to. And since I’ve worked so closely with Treatment Atlas, I love talking about it and so excited by this resource that we can bring currently to 14 states and really looking to expand that. Treatment Atlas is a free-to-the-public and free-to-employers resource that is located at www.treatmentatlas.org, and currently we are live in California, Oklahoma, Louisiana, Florida, North Carolina, West Virginia, Indiana, Wisconsin, Pennsylvania, Delaware, New Jersey, New York, Connecticut and Massachusetts. So what Treatment Atlas has on it is a list of the SUD treatment facilities within that state. There is also an American Society of Addiction Medicine assessment that is embedded into Treatment Atlas. So if you're not sure what level of care yourself or a loved one may need, the assessment can really help guide an individual to whether it's residential or outpatient services may be best supportive of that individual in their recovery journey. There's oftentimes a myth that's still promulgating in the public that to get into recovery, a person must go to residential and it must be away from their family and their supports, etc. And research is showing that sometimes outpatient services can be incredibly effective because that structure can be there, because those supports can be there, because an individual can learn coping skills where they live, work and learn, and those supports then can be ongoing. There also is some predatory marketing that is sometimes out there from some of these facilities that are trying to prey upon a quick fix for family members, etc. And they will offer a flight ticket and to take the person out of the state. It's even been called the shuffle because people are shuffled from one level of care, one location to another, oftentimes racking up hundreds of thousands of dollars’ worth of bills that are paid then or that are given to insurance, sometimes to the families. And it's such a sad state of affairs. So Treatment Atlas helps support individuals and families by guiding them to those facilities that are near them that will meet what their requirements are. So if someone is looking for evidence-based care, you can look and see how aligned is that facility with the National Principles of Care which are based on the 2016 Surgeon General's Report of Best Clinical Standards in SUD Treatment. It also looks at very specific evidence-based care on medications for opioid use disorder, the therapies that are have been shown to have the most efficacious outcomes in substance use care. It looks at support services to help support an individual who may be seeking substance use disorder care, including transportation, job assistance, legal aid, support for domestic violence, and really looking at how best to support an individual in all of their needs as they're seeking substance use disorder care.

HOST

Really an incredible resource. So thank you first of all for putting that all together and having it available – at no cost – because I think it's really critical. As I listen to you, I keep thinking of, you know, you just mentioned all the different ways that people could be directed into the wrong treatment and the harm that can be done both financially and emotionally. So in our last podcast some of our panelists talked about SAMHSA as another free resource. Do you mind explaining that a bit to us?

LISA

SAMHSA resource at findtreatment.gov is an amazing resource for individuals. This resource is different than Treatment Atlas as it does not have in it the American Society of Addiction Medicine assessment. It also is inclusive of both of all behavioral health. So it's both mental health and substance use disorder services. There are slightly different filters that are utilized and it does not have kind of the Principles of Care and how aligned those facilities are with evidence-based best practices. But I know several individuals over at SAMHSA; they do an amazing job with findtreatment.gov. It is national. There is some educational material resources on their website as well. And as I mentioned, it is both…it is the totality of behavioral health services. So both mental health and substance use services. It does not have some of the unique features the Treatment Atlas does. So in the 14 states, especially if someone's looking for substance use disorder treatment, strongly encourage Treatment Atlas. But looking for a wider breadth or outside of those 14 states, definitely findtreatment.gov is a reliable option to utilize.

HOST

Good. Well at least that's another option for them to cross reference or utilize in the states where we don't have access to Treatment Atlas, and certainly that's better than them getting marketing materials or campaigns or promotions from specific facilities. So I appreciate that approach, and thanks for explaining that. Now, Kirsten, the last episode we talked a bit about early intervention, including creating a supportive environment at work. You provided some crazy stats on the number of people that are impacted, either directly or indirectly, around substance use disorders. Do you mind reviewing those stats with us again and then talking to us more about what does it mean to create a supportive work environment?

KIRSTEN

Mary, you know, it's really important that we think about the breadth of this, of substance use disorder as a public health crisis in our country. About 49 million people ages 12 and older are impacted by substance use disorder directly. So assuming everybody has, you know, 3 people in their lives, that's about 150 million people totally impacted by this because it really is a family disease. And the fact of the matter is, about 75% of the country doesn't even understand that substance use disorder is a medical condition. They believe it's a moral failing. And so it's important that we as a society, including employers, start to really look at this as a wellness issue, as a health issue, and start to really change the mindset of our employees, our society, our communities around substance use disorder in our country. 

The numbers have grown. And when we talk about substance use disorder, we're talking about drugs and alcohol. And, you know, as we know, the Surgeon General just came out with a report on the dangers of alcohol. So this is a pervasive issue that has grown since the pandemic and continues to grow. The good news is we are, we are seeing decreases in deaths, about 17% decrease in death. So we went from over 100,000 deaths from overdoses in 2023 down to just under 100,000. But just keep in mind that those numbers are way higher than they ever were before the pandemic happened. So just to give perspective, in 2019, we had about 68,000 deaths. So we're still dealing with a very pervasive public health crisis in our country. And employers are really critical at being a solution in this, because about 60% of those employed have substance use disorder. And if you think about just the numbers I shared, when you have children at home who are impacted, that's impacting somebody who may be a caregiver of somebody who is struggling. And so you want to make sure that you're providing education, information and support for those directly impacted who have SUD, but also for those who may be a caregiver of someone. So that's really the breadth of this crisis that we're dealing with as a country in this public health issue.

You asked about things that employers could do. It's as simple as making it safe to talk about in the workplace. A lot of times employers look at substance use as a very punitive issue. Because of that, a lot of people don't want to disclose that they may be struggling, that they have a family member struggling. So it becomes not safe to talk about in the workplace. There's judgment there could be issues with employment. So it's important that as an employer, you start to look at the culture of your company, your organization, and think about ways in which you can really address this as a wellness issue. And there's simple things that you can do. It could be as simple as educational materials that are available, whether that's break room materials, online education materials such as the Shatterproof Just 5 Education Portal, or other materials that are available from a variety of different sources. It could be as simple as having a town hall discussion about this and invite experts to come in and talk to employees about substance use disorder. There's a lot of experts, and Shatterproof has worked with a lot of companies to help them navigate how to really make this safe to talk about in the workspace and invite those who may be impacted, who are living in recovery within the workspace to share their stories. We've seen companies also create employee resource groups specifically to those who may be impacted, whether they're in recovery themselves or they have a…they're struggling with someone at home that they want to help. And so these are just simple things that companies can be doing. But then there's more direct support, obviously with EAP programs and the benefits that are offered that really will help someone, and making it understand that you're there to support them and help them through this health issue versus really looking at it from a perspective of morality. And that's really the shift that we need to see in this country. And workplaces can be so critical in making that shift happen.

HOST

Really a good point. So we've done better shifting that around mental health, like depression, anxiety, all of that. I believe that's why we're seeing an uptick in so much more progressive treatment or proactive treatment. And people are not afraid to raise their hand to say they need help. This is a little bit harder, as you said. So I'm kind of thinking about what happens when an employer does drug testing and that they depend on that to make sure they're safe at work. How does that all come together? Danielle, do you have any thoughts on that?

DANIELLE

Absolutely. Employer drug testing can be very important, particularly in manufacturing, transportation industries, airline pilots. I think we all, we all want our airline pilots to be clean and sober and they have very strict rules around that. I would say any employer, though, that's considering drug testing needs to do so with the advice of very competent and experienced counsel, make sure that their policies are written in an appropriate manner. If they have a union population, that will absolutely play into it as well. But from the other side as well, to consider outside of disciplinary action, what supports are you going to have in place for an employee who has a positive drug test? And you know, are you going to have an EAP? Are you going to have other services available for them in case, you know, that's needed as well? So there's kind of two aspects to approach that from, I would say.

HOST

Yeah, those are really great points. Anyone else have thoughts around this? Yeah, go ahead, Lisa.

LISA

I was just going to jump in very briefly. If there are any employers that are interested sort of in learning more, there is the Recovery-Ready and Recovery-Friendly Workplaces. This, there is a toolkit that has been put out by the US Department of Labor. It's free of charge on the Internet to help support employers that would like to become more recovery friendly. Because as we're talking, I just want to really encourage everyone to remember the human side as well, especially with the caregivers or an individual that is struggling with substance use disorder. As Kirsten mentioned, there is still a large proportion of the United States that sees this as a moral failing. So one of the things that we see as the biggest challenge with people getting and accessing care is either they don't think that they need it because there's an innate shame there, or they don't want to ask for the help because they feel like they're going to be judged. So this does come about even from the caregiver spot as well, especially from a parent sort of perspective, feeling like they failed, oh my gosh, I did something wrong. And that is such a huge burden for that individual to carry around with them and wonder what should I have done differently? And plus all the chaos that can come along with a substance use disorder, as you look at potential justice involvement and overdoses, etc. So really fostering that compassion, especially for the caregivers and, you know, it's, it's such an odd dichotomy because if a child was diagnosed with cancer or anything else, it wouldn't be the parents blamed, oh my gosh, you're a bad parent. But with substance use disorder, that's another full layer that is infiltrated, that is taken on by the parent. And then whenever they're sort of left swimming, going, oh, my gosh, what should I do now? And what is really the best path for my loved one? It can really be overwhelming, and they likely are putting on a great face at work and trying to muddle through the best that they can. But there's a real human side to this as well.

HOST

That is a great example of how critical this is, Lisa. So thank you for sharing that. I will tell you, within our data, we do see a significant uptick – and it's obviously been in the press – with dependents and their mental health issues and then substance use disorders. And when we talk to employers about this, we remind them that those parents who are at work, you know, you're only as happy as your saddest child. So your child's struggling, you're struggling, maybe sometimes twice as much. So if they're not willing to talk about it and provide support, you're not going to get anywhere. Those people are not…you think of the cost of lack of presenteeism. We definitely would have it in all of those cases. If it's anyone in your family. And when I listen to you talk, it's interesting to get the perspective that an employer needs to help educate, just as we did with anxiety and depression. It's not their fault, it's not a moral failing. And we all need to support each other. This is a hard world and unfortunately, we're not an incredibly healthy world. So we need to be able to support that better. But then I can't remember, it was Kirsten or Lisa when we were preparing for this, you brought up suggestions that employers need to keep in mind if they're going to help support people. If someone is great enough to raise their hand and go through the right treatments and, and be successful, or at least continue to attempt to be successful, because I don't know that you're ever sober – you're in a process of becoming sober, or, I don't know…I don't have that language quite right, so you can correct me on that. But the whole idea is then create an environment that's supportive. And the one thing you guys talked about was happy hour, which, how many employers do that, or giving wine or whatever for, as a gift. So kind of talk about some of those pitfalls that employers need to consider, if you don't mind.

KIRSTEN

Sure. I'm happy to share about this because we've actually seen some culture changes with companies that we work with directly. It's really interesting when you start to think about, from the perspective of somebody who's in recovery, and the things that you might be doing culturally as a company, because society is lean that way, or it's always been done that way. But, you know, for example, you said happy hours, right? That's a thing people have done. You know, let's get together after work, let's meet up for a drink. Let's, you know, even within work environments, you know, alcohol is provided. And we're not saying that that's bad. We're saying what is the alternative that you're offering for those who may be in recovery or may not use, you know, alcohol. And so we've seen companies actually seeing culture shifts of doing hikes or taking classes or doing other types of activities that are more inclusive for those who may be in recovery or sober. So that's one area. Yes, it's gift…you know, what is your gifting policy? When you're having gatherings, are you offering, you know, mocktails or non-alcoholic beverages? You know, just thinking about some simple things to be more inclusive of how you're making sure that those who may be in recovery are comfortable and want to participate and don't feel excluded or isolated because they're not participating. And that's also just as simple as, you know, don't ask someone why they're not drinking. There's a variety of reasons why people don't drink and a lot of people will comment. And, you know, it's just important to remember that that's personal and it's really none of your business to know why somebody may or may not be drinking that day.

HOST

Lisa.

LISA

Part of the inclusiveness is it would encourage, as these discussions start to occur, it's amazing how many people may be in recovery that have not disclosed it previously. As they feel more comfortable, there's more and more people that are able and willing to disclose that. And you may find that it's actually really enlightening to have someone who is on that recovery journey on the committee that is designating what are some of the culture and what are some of those get-togethers. We're finding more and more as this is getting out into the open that they are having sober designated areas. There are concerts that have sober seating areas, and we're starting to see that more and more. So have someone and elevate their voice, allow them to be a seat at the table and to be able to help make decisions and be comfortable sharing with what helps make them comfortable, what helps support their recovery. And how can the culture overall become more inclusive around all recovery, not just substance use, but substance use in my health as well.

HOST

You know, I'll be honest with you, as you're talking about this, we're also talking, you know, of course the world is talking about weight loss now because the GLP-1 – same thing. There's the shame. We do this to each other in so many different ways. And if we could just be comfortable speaking up. I still keep thinking about how do we allow it to feel okay? Because it is. There's so much shame in substance use disorders. And I laugh when you guys bring up alcohol because I'm sure that's much more overused than it should be. But who would ever, you know, we don't criticize those people as much as we do people who may be using hard drugs. So how can an employer make it feel comfortable? Is it more than just talking to them or having policies that say, you know, if you speak up first, then, you know, there's, I guess Danielle brought up maybe a strategy, if you test positive, you don't automatically lose your job. Like that is, I’m sure everyone's fear is they don't want to lose their job. Kirsten?

KIRSTEN

I was just going to say a lot of this is tone at…the tone from the top, right? When a CEO embraces this culture, when your senior leadership embraces this culture, is really when it starts to make it okay. And I think that's one thing that companies can do. And we've seen that, as I said with companies that we work with, when the CEO is a champion for those in recovery or even shares their own experience, whether it's themselves, a loved one or a friend, that's what kind of opens that door. And as Lisa had mentioned, you know, there is that sharing, there is that elevation of the topic, but I think a lot of that comes from tone at the top. But then, yes, policies. And I think, Danielle, you have some recommendations I'd love to hear on policies that could be more inclusive or more helpful to guide people to recovery versus just exclude them right away.

HOST

Danielle, please.

DANIELLE

I also think you can take a look at some of the more regulated industries who have drug and alcohol policies for safety reasons, such as the airlines, and see, you know, what are they doing right? Because as I mentioned before, it's of utmost importance that anyone who's moving people around this country is doing so as safely as possible. And many airlines have 24-hour drug and alcohol teams that are available that employees can reach out to and they can proactively get help before there is an issue that endangers safety or anything like that. And so those are things that employers might want to look into, you know, and it's probably not something that the employer has to staff themselves. There are resources and hotlines and services out there that employers can partner with to create opportunities for employees to reach out and get help proactively. Robust EAP programs, you know, can provide assistance along those lines as well. But again, giving people an opportunity to get help proactively I think is incredibly important, and making those resources easy to find. If it's buried 17 clicks within your internal intranet site and a spouse or family member can't get to it, maybe in a time of crisis, that's not going to be as useful as something that is easily accessible, has an easy phone number, a fridge magnet, whatever it might be, so folks can get access to those resources in a timely manner.

HOST

That's a really great point, Danielle, thank you. Go ahead, Lisa.

LISA

I was just going to add a little bit more going off of what Kirsten said from the tone at the top. I'll never forget a previous organization that I worked with. A CEO had an off-site senior leadership retreat and started sharing some of his own personal experience with family members, suicidal ideation, etc., and then asked the senior leadership team how many of us had had direct contact, either ourselves or a direct family member, with significant mental health or substance use concerns. Over 70% of the senior leadership team raised their hand. So I think that making it first of all okay, and then really embracing that peer support and understanding that when employees are going through these challenges and oftentimes having that shame, it takes a lot of effort and they really want to talk to somebody. So creating that safe space, whether it is an employee resource group, etc. I think we talked previously that one of the recent meetings that I facilitated was within an employee resource group providing some information around substance use disorder. And all of a sudden, as soon as one person began actually asking some hard questions about, you know, a family member is struggling, where do I get treatment or what does this mean, etc., the whole group erupted with, oh my gosh, I've had that same problem. I've been afraid to ask, what is the answer to that? How do we find that information? Where do we go from here? So sometimes it just takes that one brave person after the tone from the top is set.

HOST

That's great. And that is, appears to be so true in everything, is once someone mentions that they're dealing with it everyone else can be honest and open, and then we realize we don't have to hide things. So this is really great. Anyone else have anything you want to share there before I switch? Yeah, go ahead, Kirsten.

KIRSTEN

Yeah, you know, it's funny. Lisa just reminded me of a conversation I had. I was with a panel of different, of pretty big companies, and it was an internal discussion around, you know, the challenges that they were having in navigating how to support employees with substance use disorder. And one of the companies at the table said, said, you know, “I walked into this meeting, I thought I didn't have…we didn't have a problem because a lot of people don't access our, our benefits for substance use disorder. And what I'm hearing and learning is that we probably have a bigger problem because nobody wants to come to us to get the help that they need. And that we really have to address this because people are probably struggling and don't feel like they can get the support from us that they need.” And so I thought that was a really interesting perspective. And as employers listen to this, I hope that they think about, you know, that whether, you know, people are accessing your benefits for substance use disorder or not, the “not” may be a problem as well. And so something to look at as a company.

HOST

That's a good point. The other thing, I hope that people with substance use disorders are dealing with it also realize many times what we experience at Vital Incite is the employer comes to us and says, “This is a great person, a great employee. I don't want to lose them. What on earth can I do?” And the sad thing is, it's just like all other conditions. If we let it go on and we ID it later, identify it later, we don't appropriately care for them, then it's become so critical that it is really catastrophic. And the goal would be how do we support people early, get them to the right resources. I love that Lisa said that some of those can be even outpatient. So you're not telling people, move away from your entire life and give everything up in order to improve. That really does help quite a bit in this. And employers really want to keep people there. There's not a lot of employers that have too many employees. People are looking for good people, and just because they have a condition does not mean they're not a good employee or a good person, as you guys mentioned. Okay, so the trick with this is it is a condition that the mental health parity laws, you know, help protect, and the mind-numbingly complex and, and the fear tactics. Quite honestly, in our last conversation, I felt like it was…Tim was like, “Oh, well don't worry. That's really not what the, the Department of Labor, they're not going to go after the employer.” But the reality is the employers are filling out difficult documents and sometimes don't have all the information to fill them out. They want to be compliant. Danielle, can you give advice on kind of what employers need to think about or how they should go about this?

DANIELLE

Yeah, I think my biggest warning would be to be cautious of categorical exclusions. Right. A categorical exclusion is going to throw up a red flag. And that's when a plan says we don't cover any outpatient mental health services out of the state that our, you know, employees are in or something. It's very unlikely you have a categorical exclusion like that on your medical surgical side of your plan. And so that's, that is going to cause some problems. But you can work with counsel and come up with thoughtful ways to put boundaries in place to ensure that your employees, if they are seeking out-of-network care, are doing so in a thoughtful manner, are going to reputable facilities and are not being taken advantage of by the bad actors that are out there in the system. I think we need to be cautious. We don't want to demonize residential services. They can be life-changing in the best of ways for many people. But we do want to make sure that people are going to reputable facilities. I think the recent news coverage on wilderness therapy and the bad actors out there has raised awareness to this. We've seen quite a few wilderness therapy centers shut down in the past 2 years to 18 months. A lot of news about one in North Carolina, a few in Utah that were shut down as well. We also know that, you know, Paris Hilton has been very vocal out there in Washington, D.C. trying to raise awareness for the facilities that are preying on families in crisis, you know, and putting children into facilities that are not providing the services that they're supposed to be and are simply taking money, you know, and that's what everyone wants to avoid. Parents, family members and employers all want to avoid facilities like that. And so working with council, working with partners and identifying, you know, can you put ratings in place and say you're going to cover outpatient facilities that have certain accreditations or certain ratings is a way to go about that. Just keep in mind you're going to have to balance that on your medical surgical side as well. And make sure that you're kind of putting similar parameters in place as well. Just like you don't want someone going to a bad mental health facility, you don't want people going to a bad facility for a hip replacement either. So being thoughtful in this is kind of go slowly to go fast.

HOST

Wonderful advice. Thank you. And I'm hoping that as employers listen to this, they're going to feel more confident that they can do more and, you know, get rid of the bad apples because I…those do…or bad actors I guess is what you called them, because they do cause damage to everyone – financially and mentally. So one of the values that we found with the mental health parity laws is that they do hold health plans accountable, that they do need to have access, that employers need to have access to their data. And there are lawsuits now supporting that. And those efforts are really helping create transparency. And why I bring this up is that we just had a carrier actually that masked 30% of their data of a self-insured employer. And what that meant is the employer couldn't look at, you know, is the issue with dependents, are they even accessing our EAP program? Maybe we need to communicate it differently. Is this impacting more people who don't speak English as a primary language? And we need to communicate differently our resources. So that data is really powerful. What I would say to employers is make sure you have the right team supporting you in signing the appropriate contract language with your carriers. Because I do think that employers and maybe some benefit advisors haven't paid enough attention to that. And some of the language that we've been really concerned about is the amount that a carrier will be reimbursed because of shared savings because they're doing such a wonderful job in helping pay the out-of-network people correctly. When we talked last in our last podcast that there's some pretty big cases out there where the carriers have been paid threefold more than the providers. And we see this in the data all the time. But employer has to have access to that information. The carriers will also put language in that states things such as they will put in payment integrity or shared savings opportunities and base that off of their proprietary and confidential procedures. And to that I just say, blah, blah, blah. That means that they will not explain to you how it's done. It's not clearly defined. You have no idea if you're paying a carrier more than the provider, which is terrible if you think about how badly we need providers to be paid appropriately so we have provider access. So that's really critical. And then in this, there's also a lot of language around whose fiduciary responsibility that is. So I would just tell you that, you know, in order to create a really solid program, you will need your data and you will need access to the appropriate information. And now you do have the authority to push for that. 

So just I wanted to make sure, and if you aren't sure exactly what I'm talking about, we did have a long discussion in this, in our previous podcast with Marilyn Bartlett, Stacey Barrow and Brenda Moffat in May of 2024. And that podcast was titled the Benefit of Tight Contract Management. And if you missed that one, I would really highly recommend that you take some time and listen to that also.

So final thoughts. I think we've covered a lot. Let me just kind of summarize what we've talked about so far. We started off talking about how to set up your benefits related to substance use disorders. And keeping in mind the ERISA rulings, Lisa talked about the creativity and the emerging treatments, and how important it is for us to consider that there will be new treatment options. And some of those may be wonderful in the long run. We may find out that that's exactly what we need to be more successful. But we have to get rid of that predatory marketing. We have to take into account the bad actors, the wilderness, and you know, even I think it was Lisa that brought up even the psychedelics. That may be a treatment option over time, but we've got to understand how to, how to give people access to that without causing harm to the plan or the individuals. And one suggestion and great resource is the Treatment Atlas. And again, that's not in all the states around the country, but at www.treatmentatlas.org, for the states that they do have, it gives you the ability to look at not only which providers are available, but how strong are they in the treatment that your individual would need. And then we have SAMHSA at findtreatment.gov that does provide a laundry list of different providers, but again, that doesn't have quite the quality metrics involved in there. But then, you know, the reality is we had, I believe that Kirsten said 49 million people impacted by substance use disorder. This is a public health crisis. And then along with that, Kirsten really hit the nail on the head, I think, in saying it's our job, all of our roles, to make sure we educate people that this is a medical condition and not a moral failing. We have to stop this shame or people aren't going to be able to reach out. We're not going to be able to support them. And I think one of the examples that was really good is to have a town hall. Educate employees. And the more we educate people, the more they understand it, the more they understand that it's not a moral failing. And I really loved, I think it was Lisa who's shared to elevate the voice of the people in recovery. So if we're going to create an environment that is more conducive to improve health, which, whatever that is, let people speak up. So that could be someone with obesity, that could be someone with a substance use disorder, but let them play a role in improving our environments. And I think that'll be really critical. And then Danielle finished it off by work with your counsel. Create thoughtful ways, go slow, make sure you put in the appropriate boundaries, but really be thoughtful about what you do. So that was a ton. What else did I miss that you want to make sure people leave here with. Yeah, go ahead, Kirsten.

KIRSTEN

I just want to share that, you know, this is not a one size fits all for every company, right. I mean, every company has a different culture, work style. Some people come to an office and sit behind a computer. Some people are working hourly. Some have various languages. As Danielle talked about, there's transportation and safety. So I think it's really important that people realize that there's not a, you know, handy toolkit that's going to give you the step by step. I think there's a lot of really good guidance out there to help you through this, but it's really important that you're thinking specifically for the culture of your company, your workforce, and the people that you're trying to support. So that I think it's really important to remember that. And it does take time. It does take consultation with your counsel. It does take your leadership to really come behind us to put the right education programs and support system in place.

HOST

Perfect. And also remind me, what Danielle spoke of is look to those industries that have to have really good procedures in place. I thought that was brilliant, that, look at the airline. What do they do? I'm sure it's posted out there. And go to those industries for examples of how you could structure something better. Anyone else? Lisa, please.

LISA

I'd also just like to say, first of all, Mary, thank you so much for elevating this topic and bringing this up. I think this is so important. And to all of the employers that are listening, please recognize this isn't a one and done. People have been suffering in silence for a very, very long time. So if you do one town hall and nobody speaks up, please do not think it's a failure. This is a recovery process for the employers as well. And this is a journey as well. So a recovery friendly workplace does not happen after one town hall, after one education event. It is infusing it in the culture. It is feeling that change come over time and as it occurs and as you get over some of the adolescence and the bumps and the struggles, it's beautiful thing on the other side, but it takes time to get there. I mean, you know, Danielle gave such a great example of the airlines industry. If we think back 15, 20 years, how punitive it was and how much that has changed as well over time.

HOST

Awesome. That's great. And I appreciate you saying that because I think that probably would have been my thought process if I tried to create a town hall and no one spoke up. Well, then I failed. So that's really great. Well certainly I feel like I've learned a lot today, and employers should feel empowered after this conversation.

I'd like to thank our panelists for a truly insightful and inspiring discussion. To our audience, I hope you feel more equipped to demand more from your carriers, create a more progressive approach to provide for earlier identification, acceptance and therefore more cost efficient and effective treatment strategies.

Now in our next episode we're going to tackle another big one and dive into maternal health. At Vital Incite, we've seen an increase in pregnancy and delivery with complications ever since COVID. We thought that was due to just the complexity of taking care of people during COVID, but that did not decline after. We will explore why we have seen that increase and what employers can do to help bend that curve.

And I just want to thank our panelists again. You were absolutely incredible. I appreciate you being here so much and sharing your knowledge.

Thanks for listening to this episode of The Pulse. If you enjoyed it as much as we did, please be sure to subscribe so you can always stay up-to-date on the most recent conversations. Share the link with others, let others learn from this so we can all start to demand and create something new, and Follow us on LinkedIn. The Pulse is produced by Vital Incite and the Alera Group company. Vital Incite is on a mission to help organizations identify medical spending waste through data driven strategies while helping to improve the health of their employees. If you want to make healthcare easier to understand and manage, and improve your organization's bottom line, reach out to us at vitalincite.com. I'm Mary Delaney. Thanks for listening.