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Investments in EAPs Pay Off

February 1, 1993
Related Topics: Featured Article
McDonnell Douglas Corp. wouldn't sell you its employee assistance program (EAP) for a million dollars. That's because members of top management at the St. Louis-based organization know that its EAP is worth many times that amount—and that's just considering the cost savings related to absenteeism and health care costs. It's likely that there are additional savings that could be measured easily, such as litigation, damage and theft that never occurred because employees who were abusing drugs or alcohol have received treatment. Other likely savings can't be measured as easily, such as improved productivity.

Back in 1985, however, the CEO and the president of the company weren't so convinced of the value of their EAPs, which weren't available in all locations. During that year, they challenged the program to expand to provide services nationwide and to show a positive impact on the bottom line, according to Mardee Beckman, director of EAP for the firm.

The rest is history. The resulting study became—at least among EAP professionals—the best-known analysis of the cost-effectiveness of a program of this type. (See "How McDonnell Douglas Cost-justified Its EAP.")

This kind of success doesn't just happen, however. Many EAP programs are worth their weight in gold. Others could leave you with an EAP that's a financial drain on the organization and may not give your employees the services you want them to have. How you go about designing, developing, implementing and supporting the EAP can mean the difference between bust and bonanza.

Why have an EAP?
Probably the most important step in the process of setting up and implementing an EAP is articulating your reason for doing it. Do you want to save health care dollars? Are you doing it because it's nice to do?

In spite of the potential cost savings, many companies' only motivation to provide an EAP is to comply with the Drug Free Workplace Act of 1988, which states that federal employees and employees of firms under government contract must have access to EAP services. "The EAP industry went through an explosion after the passage of the Act," says Michael B. Garfield, VP of corporate services for ComPsych Employee Assistance, an EAP vendor based in Chicago.

If compliance with federal regulations is your only reason for providing an EAP, your program may be very different from a program motivated by the need to reduce costs. An EAP that's in place because management thought it was a nice thing to do may have different characteristics from a program that's under the gun to save money for the company, as was the case at McDonnell Douglas.

Whatever your reason starts out to be, sooner or later you should justify the cost of the program to the organization. Even if you're providing the EAP to comply with the law, it makes good business sense to have a cost-effective program.

"Most EAPs come about because of the need to control substance abuse or mental health costs," says Timothy E. Glaros, marketing manager for Minneapolis-based Ceridian Corp., the parent organization of Employee Advisory Resource, an EAP vendor. The tremendous impact of these two medical problems on the company's health care benefits makes them a logical target for cost-cutting efforts. These two areas also are easier to research. Their connection to savings in health care costs is clearer than is the connection to savings resulting from reduced theft, for example. The impact of the EAP on these costs also can be measured more easily than can savings related to productivity.

Quadion Corp. decided to develop an EAP because of concern about the number of accidents occurring in some of its plants. "Our level of mental-health and substance-abuse medical-plan usage was actually lower than average, so it wasn't a primary incentive," says Duane (Pete) Peterson, VP of HR for the Minneapolis-based manufacturer. About the same time, the company, which has a work force of 1,443, faced the incredible medical expenses of a premature baby. In spite of the expense, the baby died. "We wanted to avoid having anyone else covered by our medical plan give birth to a premature baby. After one large claim, we had some incentive to prevent premature births," he says. It wasn't a factor in this case, but drug or alcohol abuse by the mother increases the risk that a baby will be born prematurely. It became clear that the firm must address substance abuse.

An EAP can reduce medical costs by identifying substance abusers before anyone knows the problem exists. "If people are identified before the crisis stage, the prognosis is better and money is saved," says David Anderson, VP of operations for Eagan, Minnesota-based StayWell Management Systems. "Medical problems develop when chemical dependency goes untreated as the disease progresses."

The EAP also fits in with managed care. "The EAP will follow the case and make sure that the treatment is the appropriate level and intensity needed for that person," Garfield says. "You have to look at everything. If substance abuse is the presenting symptom, the person may go into a 21-day program, but the real problem might be the relationship with the spouse. After treatment, the problem still exists."

Garfield points out that an employee without access to an EAP must seek solutions without the knowledge and experience needed to make the best decisions. "Managed care doesn't come into play until after the decision has been made and the employee is in treatment," he explains. The employee may have checked the Yellow Pages or responded to a TV commercial for a hospital with a vested interest. "Hospitalization may not be appropriate. If there's no EAP, a review of the treatment comes too late to avoid hospitalization if it isn't indicated," he says.

Leaving it up to workers to find their own treatment options has other consequences as well. "Our primary reason for having an EAP was the impact of personal and work problems on the ability of employees to contribute to the company," says Diane Cushman, health and family program specialist at The St. Paul Companies based in St. Paul, Minnesota. "They don't shed their personal problems at the door in the morning. They may spend work time on the phone, researching options. If we provide the services of people with access to a wide range of resources, employees don't have to reinvent the wheel and can be more effective on the job. It's a bottom-line concern," she says.

In addition to reducing inappropriate health care utilization and time lost on the job seeking care, an EAP may prevent:

  • Reduced productivity
  • High turnover
  • Employee theft
  • Litigation
  • Lost business.

Helping workers manage their money can give payroll dollars more mileage, according to Peggy Roybal, retirement benefits supervisor for Quadion. Through an EAP, employees can get help making a budget and developing a plan to manage their money. Employees who have financial problems may seek to withdraw funds from their 401(k). If they have a good personal budget, this is less likely. There are benefits in addition to protecting retirement funds, however, according to Roybal. "With a good personal budget, employees get more value to their payroll dollars, and less financial stress means a better attitude," she says.

"The EAP can be a neutral, outside source to help managers solve performance problems."
Duane (Pete) Peterson,
Quadion Corp.

Companies seeking cost-cutting options often resort to reducing the benefits offered to employees. One advantage of adding an EAP is its perception as a benefit. "A lot of benefit changes are seen as takeaways, and we thought that the EAP would provide an added benefit to keep the value of the total package. We looked at it as a small investment for a large return," Peterson explains.

The cost of an EAP depends on the type and size of the program, the location and how it's provided. Garfield says that a rule of thumb would be $2 to $3 per employee monthly for a vendor-based program. Managed care could be added for $1 to $3 more per month. The savings vary according to the current situation in the organization and the effectiveness of the program. In a company that has a lot of waste in health care use, the impact can be significant.

"One company we worked with hospitalized for four weeks every person who had a substance-abuse problem. There was no outpatient treatment," Garfield says. The workers referred for treatment averaged seven to nine relapses. "These services were costing them $600 per employee annually," he says. The impact of the EAP was evident within a month.

Choose the right program for you.
Deciding why you want to have an EAP at your organization is only the first step. To get the greatest value from your EAP, you must make decisions about such issues as:

  • Which services to provide
  • Whether you want an in-house, a vendor-driven or a combination program
  • Which individuals in the organization should be involved
  • How to coordinate the program with your health care benefits to avoid duplication and conflict
  • How to promote the program to employees and management.

Beckman recommends forming a committee in the beginning to develop the program. "Bring all the right players—the people concerned with health, safety and security issues—on board. Discuss what needs to be done and how to do it," she says, adding that there are plenty of descriptions of different models that can be obtained through EAP professional organizations. "Even if you decide on a vendor-driven program, you'll still want all of those constituencies on board. That way people who have a vested interest in the program provide their input. This contributes to buy-in," she says.

The CEO is probably the first person to bring on board. Beckman says to show the supporting data on substance abuse and mental health. Then look at the social aspect. "Appeal to the CEO's moralistic sense. Ask, 'Do you think it's the right thing to do?'" she says.

Quadion conducted a needs assessment, beginning with discussions among members of management about problems they were having. They considered attendance data, personnel-action data, health care benefit utilization, industrial injury rates and management observations. They didn't use an employee survey, but employee input may be helpful. Any contact with employees about the need for an EAP, however, should cast the program in a positive light, to reduce any perceived stigma later on.

Managers at Quadion looked at the attendance of the worst 10% in each location. "These employees had a lot of Monday and Friday absences. Some locations also had an increased rate of absences before and after the holidays," Peterson says. (Termination data also may be considered.)

The team at Quadion didn't wait for the EAP to solve the problem alone. They also reworded and updated the policy on chemical dependency and company expectations regarding job-related behavior, like drinking during lunch. "We asked, 'Should we allow it? If not, how do we state it?' We wanted to work toward providing a positive standard," Peterson says.

A broadbrush approach is best.
Even if substance abuse is the primary motivating factor in the development of the EAP, you should provide a wider range of services—a broadbrush approach—to bring them in. "Substance abusers tend to be in a state of denial," Roybal explains.

Joseph Des Plaines, COO of Family Enterprises in Milwaukee, agrees. "Six of every 10 people diagnosed as substance abusers have come to the counselor because of a different problem—marriage, family, financial, and so on," he says. A program that focuses only on substance abuse will miss these people. "The program should cover dependents. Sometimes the dependent is the person who has the problem or is the one motivated to do something about it," he adds. If the dependents know about the program and have access to it, utilization rates increase and substance abusers get treatment.

"Many problems are interrelated," says Cushman. "The counselors have a checklist. In one month there were 207 calls (263 personal problems and 48 work problems). Obviously, that's more than 207, so people are calling with more than one problem at a time," she explains.

In 1973, Control Data—now part of Ceridian—began a traditional EAP that focused only on alcohol and drug abuse. In the first year, only 13 of the company's 35,000 employees asked for help with alcohol or drug problems. Glaros says that 480 employees contacted the EAP with other problems and questions they considered just as serious. The next year the company expanded the program—now called the Employee Advisory Resource (EAR)—to address a wide range of employee concerns, including family and work problems, legal and financial difficulties and mental health, in addition to substance abuse. "During the first month of the broadbrush program, EAR identified more cases of alcoholism than had been addressed in the entire preceding year," Glaros says. (From 1980 to 1985, the company conducted a study of EAR to determine cost-effectiveness of the program. The savings indicated by the study are comparable to the savings reported in the McDonnell Douglas study.)

Just as people who abuse alcohol or drugs may not seek help, the substance abuse may reflect other problems that need to be solved if treatment is to be successful. "We felt that alcohol or substance abuse is a symptom, not a cause," Peterson says. "We didn't want substance abusers to think we were zeroing in on them. We wanted a broadbrush program and sold it that way. Anyone can identify with financial and child care problems," he says.

A survey of employees would show solid support for a full-service EAP, according to Glaros. "If people are asked to check the areas they think they'll use, they won't check mental health or substance abuse; they'll check relationships, financial problems, and so on. I would check work problems if my career needed refreshing. A program offering help only in mental health and substance abuse won't get used," he says.

A broadbrush program provides a more effective approach to substance abuse, but dealing with a wider variety of personal problems of employees has another advantage: Your chances of increasing productivity are better. "Workers aren't terribly unproductive only because of substance abuse," Glaros says. A person who isn't chemically dependent but has just been through a divorce, is up to the eyeballs in credit-card debt, is working a second job or has a sick child at home can't be as productive as he or she usually is.

Some problems that affect productivity may be very easy to solve. Glaros gives as an example a young man who moves to New York City from Minnesota and comes to work late because he has to get his car jump-started. "Because he comes from Minnesota, he thinks he has to have a car, but he can't afford a new one. All he really needs is an understanding of the alternative transportation available in the new location. The EAP can show him how to spend less money and get to work on time," Glaros says.

Cushman calls the EAP the Yellow Pages of personal and work problems. If an employee needs to know how to file for bankruptcy or create a will, there are attorneys on staff who give advice but don't represent clients in court. They refer them to other lawyers, if needed.

Garfield calls the EAP the family doctor for mental health. "A family doctor can resolve some problems or can make a tentative diagnosis and refer the patient to a specialist," he says. "Few people grow up with a family psychologist. They need to feel comfortable enough with the EAP to be able to call and come in and talk. Then the EAP will resolve the problem or determine the proper referral," he says.

The EAP can be a management tool as well, according to Peterson. "We felt that the managers weren't including enough improvement areas in the performance appraisals, perhaps because they would be the ones needed to solve the problems. An EAP is a neutral outside source to help managers solve performance problems. Managers aren't afraid to hand out cards and make referrals to the EAP," he says.

Some companies prefer a vendor-driven EAP.
Quadion chose to use a vendor for its EAP. Roybal says that the vendor-provided EAP was less expensive, considering the size of the work force, and Quadion's nationwide locations would have made an in-house program more difficult to maintain.

Generally, a company that has 3,000 to 4,000 workers or more in one location can consider the possibility of hiring an EAP professional to head up the program. "If those employees are spread throughout 180 locations, there's no way you can provide it in-house," Garfield says.

Some companies having 20,000 employees or more in one location still may choose to use a vendor. McDonnell Douglas, for example, had to have the entire operation running within six months, according to Beckman. The company began with vendor-provided counselors on-site and eventually converted the program to in-house. "At the time our study began, the program was managed internally," Beckman explains. "The people who provided the service were external. They were on-site and managed by me, but provided by a vendor." Usually the client goes to the vendor's office. McDonnell Douglas wanted a program that was vendor-driven but with people of its own. It provided equipment, facilities and management. The counselors had to follow the policies and procedures of the client as well as their own. "We worked out the inconsistencies beforehand. Then, during the first three months, we worked out the issues we hadn't considered," she says.

Other companies prefer a vendor on a permanent basis. Access is one reason. "If you have an in-house program with a couple of counselors who work from 8:00 to 5:00 and see you by appointment, you have no coverage during the night. Employees may have to wait two to three days," says Glaros. Vendor programs typically provide access 24 hours a day and have more counselors and affiliates. "It's also a fixed expense, usually based on a head count," he adds.

Glaros also points out that confidentiality can be a significant barrier to access. This often gives vendor-driven programs an advantage. "The in-house EAP counselor may be a friend, but you don't want to be seen sitting in the waiting room," he says. Employees can phone a vendor-provided EAP from the privacy of home.

"By using a vendor-driven EAP rather than an in-house service, employees feel more secure that their discussions will be kept confidential," Roybal says.

Glaros agrees. "If you're concerned about the company's knowing something about you, are you going to bare your soul to a company employee?" he asks.

Unless your company has many employees in one location, it's difficult to provide the wide array of services your workers really need. No one person can guide troubled workers through financial, personal and work-related problems. If the in-house EAP representative's expertise is in mental health, for example, he or she might ask a victim of sexual harassment, "How do you feel about being sexually harassed?" according to Glaros. The employee may be seeking information about ways to get the behavior to stop, so that may not be the best approach. On the other hand, he says that it's useful to have an HR person on staff to work with the vendor. "An on-staff person may have intimate knowledge of people in the work force, as well as knowledge of company policy," he says.

Cushman advises talking with employees before deciding on a program. "Know your work force. Would they walk down the hall to an office with EAP on the door and talk with a company employee, or would they be concerned about confidentiality?" she asks.

Find the vendor that's best for your company.
The most important issue in choosing a vendor is the fit with the company. A program that's perfect for one company might not work so well for another. Some factors to consider about the work force are:

  • Size
  • Disbursement
  • Composition
  • Culture

Although some small companies have government contracts and need an EAP, many vendors limit their services to companies that have 500 employees or more. According to Glaros, whose company can provide a cost-effective program for a work force of as few as 100 employees, this is changing. "The Fortune 500 companies are pretty well saturated now. Vendors have to move to smaller companies. That's where the growth will be in the industry," he says.

A widely disbursed work force that travels often may need a national vendor. "Be aware of how extensive the network is that the vendors can provide," Cushman says. "Are they all over the country? Can they provide face-to-face counseling in all of your locations? That's particularly helpful for someone having financial problems, who needs to show the counselor the bills, for example. It's much easier than on the phone. The employee can go in, show the bills and complete everything in a two-hour meeting," she says.

Even if workers stay put, often dependents don't. "You may have disbursement anyway, if their kids are away at college, for example," Glaros points out.

In addition to size and disbursement of the work force, other aspects of the population influence decisions about the kinds of services to offer. "A population in its 40s can count on elder care issues," says Glaros. This can be a major distraction in the workplace. If the work force is predominantly young male, an employer can expect more alcohol abuse. In a work force that's predominantly female, however, single-parent issues will become more important. Take a close look at your demographics before choosing a vendor.

Take the culture of the work force into account. Although much can be done to bring about positive changes in attitudes through education and promotion, the program will be more effective if you consider your culture from the beginning, according to Beckman. It was awareness of company culture that made management at McDonnell Douglas realize that an in-house EAP would work. "The company's primary customer is the federal government, so we deal with high-security issues. Our workers are accustomed to confidentiality and are comfortable with it, so they feel comfortable with an in-house EAP, which is the opposite from most companies," Beckman explains.

While you're taking a look at the work force, take a look at your current benefits package. Coordinate the two programs so that you aren't duplicating coverage or leaving gaps to create problems later.

The program should provide support for managers as well as employees, according to RenŽ Coult-Calendine, EAP product consultant for Eden Prairie, Minnesota-based MCC Behavioral Care. "Employees who aren't performing well may not come to the supervisor with a problem. It's really important for managers to feel comfortable about going to talk to the EAP about the employee or to refer the employee to the EAP," she says.

Just as your employees need help finding the right resources to help with their problems, HR professionals need help finding the right vendor. Garfield says that the explosion in EAPs brought about by the Drug Free Workplace Act brought unqualified vendors into the field. "Companies had to scramble to get programs," he says. "Some companies bought programs called EAPs that were terrible. Others thought the programs were great. There was a lot of inconsistency in the quality of EAPs—and there still is," he points out. "Ask the people with whom you network," he says.

Cushman recommends getting a full client list from the vendor and contacting long-term clients. "Meet with the account manager. Check references. Find out how long they've been in business," she says.

"Look for a vendor that meets the licensing standards for mental-health work and that has a good reputation," recommends Des Plaines, whose organization provides the EAP services for Xerox Corp., based in Stamford, Connecticut.

The Employee Assistance Professionals Association can provide guidelines to follow when you're choosing a vendor. "People should know that there's information out there available to help them," Garfield points out.

The first thing a vendor representative should do in response to a phone call requesting information about EAP services is offer to do a needs assessment. "If they just offer to send a proposal and then hang up, they aren't doing an adequate job. They should find out what's the driving force behind the call," Garfield explains.

Find out what the vendor will do to promote the program. If people don't use it, you're just wasting money. Many vendors handle the training of the managers and the work force, provide a newsletter and posters and report on use of the program to show where further promotion or other action might be needed.

"Ask each prospective vendor what will be included in its utilization report," Roybal says. "The report we receive, for instance, compares our data with the vendor's entire customer base. It also provides a detailing of services rendered and referrals made to other resources. This gives us an indication of areas that may require more attention," she says.

Garfield agrees that these reports are important. "In the case of one client of ours, several employees from the same unit were complaining to the EAP of sexual harassment. Because of confidentiality, we couldn't give the employer the name of the supervisor who was involved, nor reveal the names of the employees. We went to the organization and asked them whether they had a policy on sexual misconduct. They didn't, so we asked if we could help them write one," Garfield says.

After the policy was written and implemented, the behavior stopped. "It didn't cost the company anything extra to allow us to help write the policy," Garfield says. A good vendor should be able to pick up on problem areas and provide guidance in finding solutions.

You also may want the vendor to have a substantial data base, according to Cushman. "The counselors at EAR have complete benefit information and everything else considered important for them to know about our company. They can refer an employee back to a child care resource or to one of our benefits specialists," she says.

Get the most out of your EAP.
A good vendor or a good in-house EAP still can fail to save money for the company if it isn't implemented properly, promoted and supported. The primary concern is getting employees to use the program. After all, it's there to help them and to save the company money. If they don't use it, it can't do what it's supposed to do.

Quadion has been very successful in promoting its program. "We promote the EAP as one of the means of empowering our employees to accept greater individual responsibility for solving their work and personal problems," Roybal explains.

To accomplish this, the company has ensured the support of management in developing and maintaining the program. The vendor provided all staff members, from the president and vice presidents down to all the members of middle management, with training and education. The training program stressed that the EAP can help resolve:

  • Management conflicts
  • Workers' personal or work problems
  • The managers' personal concerns.

The St. Paul Companies also promotes its program to supervisors. "If a supervisor is having problems with performance issues, the specialist can explain how to document performance; if employees turn to the supervisor with a problem, it's more comfortable to refer them to EAR," Cushman explains.

After the management training, Quadion's vendor provided training and education to all of the employees, which included an introduction of the program and how it worked, giving examples of the EAP's services. It stressed the confidentiality of the program. Although some companies provide their own training, having the vendor do it has some advantages. "We felt that the employees would be more accepting of the program and its confidentiality if they received the initial training from the outside vendor," Roybal explains. The company followed up these training sessions with posters and mailings. Brochures covering several different topics were placed in display cases at all company locations.

When complaints from employees about the EAP occur, Roybal and the HR representatives immediately contact the EAP contract manager to work to resolve the problem to the satisfaction of the employee, always working within the confidentiality standards set by the EAP vendor and Quadion, according to Roybal. "We expect—and get—high-quality service from our EAP vendor, to ensure that our employees feel that the EAP is a positive, worthwhile experience," she explains.

"We see our EAP as one means of empowering our employees to accept greater responsibility."
Peggy Roybal,
Quadion Corp.

The feedback provided by the vendor is a useful tool for locating problem areas early and should be used to ensure effectiveness of the program. Quadion looks carefully at the report it receives quarterly from the vendor. "It gives us an indication of particularly troublesome areas we need to address," Roybal says. For instance, if employees are calling the EAP because of child care or elder care issues in greater numbers than the average for the client base, that may indicate a need for programs or literature in those areas.

"Constant visibility is important for continued success," Roybal points out. "We continuously display EAP posters and brochures, send out quarterly mailings with EAP brochures on various topics to all employees, provide follow-up training to management every two to three years and provide new-employee education and training as a part of the orientation process," she says.

Glaros recommends that promotions of the EAP bury the high-stigma concerns—substance abuse and mental health—in a list of less-threatening problems. "Put up front the things that catch people's eye: legal problems, family law, child support, consumer concerns, and so on," he says.

Anderson agrees that visibility is important. "In one case in which work-site visibility wasn't high, one mailing to employees quadrupled the utilization rate," he says.

There are other real advantages to a mailing. "The service is for the whole family. If the mailing goes to the employee's home, the information gets to other family members," he says.

Cushman also agrees with this approach. In addition to the quarterly mailings of brochures, The St. Paul Companies has an internal newsletter that goes out to all employees. "In December there was an article on holidays, which are a fun, happy time for many people, but aren't much fun for many other people. The January issue was about change. There are a lot of changes going on in the company. We're doing some rightsizing, retirement windows, and so on," she says. People may need help from the EAP during these changes.

"EAR is fully integrated into our culture," Cushman says. For example, The St. Paul Companies writes insurance in Florida. The organization had tremendous losses after the hurricane, but its independent agents in Florida also lost their places of business. Their employees suffered losses as well. "Our employees asked that EAR assistance be provided to these people, even though they aren't normally covered by the program, so the vendor provided it," Cushman says.

Just as it's important for the vendor to alert management if trends indicate a need for action, management also must be aware of problems that come up within the organization and require assistance from the EAP. Cushman considers vigilance to be one of her jobs. "After the San Francisco earthquake, we called the EAR in that location to make sure that people had everything they needed," she says. In another location, an employee died suddenly. Cushman called the EAR representatives in that location to alert them to be ready to provide individual or group counseling.

Watch for a utilization rate that's unusually low or high, Coult-Calendine recommends. "If only 2% to 3% of the work force is using the EAP, the program may be of little value. If it's 25%, it may reflect a problem in the organization, such as high stress," she says. The EAP may be viewed as an extension of HR and may be fulfilling a management function, however, according to Coult-Calendine, which could account for high utilization rates.

If you don't think your company is getting the best use out of its EAP, what can you do? "If you think you aren't being serviced well by the vendor, look at the expectations," Coult-Calendine recommends. "What agreement was communicated to the vendor? Know what you purchased," she says.

If the company culture attaches a stigma to using the EAP, employees won't use it. "Get to top management and find out where the reservations are. Break down barriers," Coult-Calendine says. "Bring the EAP into it."

If employees think that there's a breach of confidentiality, they won't use the EAP. "It isn't the breach of confidentiality—or lack of it—that's important. What's important is the perceived breach of confidentiality. You can do something about perception," Cushman says.

The EAP proves its value.
Few studies have been conducted to test the value of the EAP because such studies can be very expensive. Many companies prefer to trust the results of research like the McDonnell Douglas study, rather than pay for a study of their own. "We have such a strong belief that the program has value that our executives don't require a cost analysis," Cushman says. "We're content to use the models for programs that the vendor provides in its cost-effectiveness report," she says. The report provides the number of people using the program and the number of troubled employees the company can expect based on an industry average.

"We have data for the cost of troubled employees, based on productivity, health care use, disability and workers' compensation costs, and we have data on their impact on the bottom line. We factor in the cost of the program and the cost of treatment. We subtract the cost savings revealed by people who have used EAR. We've tracked the cost of the program and we know that we've saved money," Cushman says.

Coult-Calendine would like to see a study to determine the effect of the EAP on productivity. "Most issues that are impacted by the EAP are softer. Manufacturing companies are pretty good at putting together how much they can expect from an employee in terms of productivity," she says.

"An internal EAP has access to the data needed, such as how and why employees are absent, or whether there's a link to chemical dependency or personal problems," says Coult-Calendine. She recommends that vendors have access to the data so they can do cost analyses and other studies of the effectiveness of the program.

Although Quadion hasn't conducted a study of its EAP either, improvement is evident. "We're doing many things along with the EAP—such as implementing a safety-improvement process and a new managed-care medical-benefit program—so we can't determine which benefits come from which program," Peterson explains.

"We're in a good trend that started two years ago. Our medical costs are increasing at a rate lower than average. They're stabilizing now, and we even may see a slight decrease in medical costs. The absence rates are decreasing. The EAP is part of the solution. Things that are tough to do can be made easier if you have a positive process like an EAP in place," Peterson points out.

"A well-run EAP will return three dollars for every dollar spent on the program, at a minimum," Des Plaines says, "but it can't happen without the commitment of the employer. This commitment means promotion of the program, education of the employees and managers, and elimination of stigma from the environment."

There was a time when companies didn't want to have an EAP because they were afraid the news would get out and the public would think that they had a problem, according to Garfield. "The walls are coming down now," he says.

EAPs are becoming more involved with managed care. "The EAP is the front end of a managed-care delivery system. You can build a lot of efficiencies into the combination," Coult-Calendine explains.

The EAP won the numbers game at McDonnell Douglas, as it undoubtedly has at many other companies, but there are times management would like to be able to look beyond the bottom line. A well-designed EAP provides that opportunity. "The greatest impact of the EAP has been to show that you can care about people and still save money," Beckman says. "It's the caring way. It's the face-to-face, hands-on service that has made the difference."

Personnel Journal, February 1993, Vol. 72, No. 2, pp. 42-54.

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