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Comprehensive Mental Health Insurance Benefits:
Case Studies
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
Office of Managed Care
VIII. Appendix C: Employer Case Studies
C. Eli Lilly and Company
Company History / Profile
Based in Indianapolis, Indiana, Eli Lilly and Company conducts drug research and sells pharmaceuticals, medical instruments, diagnostic tools, and animal health products throughout the world. Founded in 1876, Eli Lilly has experienced its most significant growth in the past 20 years. The company's nearly 30,000 worldwide employees include more than 14,000 in the United States, primarily in the Indiana area.
Factors Influencing Company's Decision to Provide Comprehensive Benefits
As a company with considerable psychotropic pharmaceutical sales, Eli Lilly has a significant investment in neuroscience and mental health. Recognizing that comprehensive mental health benefits foster productivity and help recruit and retain employees, the company is also dedicated to providing such care to its employees. Data from a 1998 report suggest that Lilly has profited as a corporation because of its benefits plan decisions. Lilly ranks among top pharmaceutical employers in terms of the employer-paid value of its health care benefits. This value coincides with average employee copayments and deductibles lower than those offered by comparable organizations (Hewitt Associates, 1998).
Mental Health Benefits
Description of Benefit Options
Unless they have waived it, all employees receive mental health coverage through the company's Uniform Mental Health Benefit, an internally managed indemnity plan. Since 1995, employees have had a choice between an indemnity plan, referred to as Lilly Health, and various HMOs for physical health care. In 1999, approximately 60 percent of employees enrolled in the indemnity plan, and 40 percent enrolled in managed care. Tables 6, 7, and 8 give details about the health care plans.
Eli Lilly's health benefits have been transformed as the company, responding to a growing workforce, has begun to develop managed care options for its employees. Before 1992, Lilly offered only the Lilly Health indemnity plan, which included mental health coverage. In 1992, the company contracted with United Behavioral Health (UBH) to institute an EAP to provide worksite counseling and to manage the mental health component of the Lilly Health Plan. Physical health benefits remained under the Lilly Health Plan. The EAP served as a gatekeeper to mental health services. After 1 year, however, as a result of employee dissatisfaction with referrals through the EAP, the company reintegrated the mental health benefit into the indemnity plan. UBH continues to operate the EAP.
Eli Lilly first ventured into managed care in 1995, offering employees a choice of the Lilly Health Plan or various HMO options. In Indiana, the company has maintained full-risk contracts with the same four HMOs (Arnett, CIGNA Healthcare/Healthsource, M Plan, and Prudential) since 1995. Prudential also serves employees outside Indiana. Each HMO plan provides identical physical health benefits negotiated specifically for Lilly employees, with monthly premiums of $5 for a single employee or $10 for family coverage. The Lilly Health Plan requires monthly premiums of $15 for an employee or $35 for a family (Eli Lilly & Company, 1999).
When Lilly began the transition to managed care, the company's benefits administrators were concerned about the vendors' ability to provide quality mental health care. As a result, the company decided to retain responsibility for mental health coverage by establishing and managing a uniform benefit under which all Lilly employees could receive services. The plan offers the same coverage level as the indemnity plan but waives the indemnity plan's deductible, making the mental health benefit richer than any physical health benefits under either the managed care or Lilly Health Plan option.
A carve-out pharmacy coverage offers a uniform benefit for both managed care and indemnity plan enrollees. Administered by PCS, the pharmacy plan includes an open formulary with a 20 percent copayment for both generic and name-brand drugs. Further, all Eli Lilly pharmaceuticals are free of charge. These benefits are available at any pharmacy. PCS also operates a mail-order pharmaceutical service requiring a $20 copayment for name-brand drugs, a $5 copayment for generic drugs, and no copayment for Lilly drugs. The company places no restrictions or caps on drugs for the treatment of physical or mental conditions.
Employee Assistance Program
The EAP, managed by UBH, offers a 24-hour toll-free telephone line for confidential psychological counseling and three free visits with community-based psychologists. As an indemnity plan, the Uniform Mental Health Benefit ensures continuity of care, enabling patients to see a provider of their choice for EAP visits or for mental health benefit services. Mental health benefits are available without precertification or an EAP referral.
Benefit Management
Eli Lilly's Corporate Health Services Division operates the Lilly Health Plan and Uniform Mental Health Benefit and oversees the EAP, the pharmacy, and the contracted HMOs. By centralizing benefits administration in one division, Lilly has been better able to manage its own health plan, to respond more effectively to employee dissatisfaction, and to increase on-site services. The company's mental health coverage reflects the corporate philosophy to help employees balance professional life and personal life.
This employee-centered philosophy also is visible in the company's relationships with vendors. The company strives to guarantee that plans offer high-quality health care. For example, when dissatisfied with UBH's mental health services, Eli Lilly reintegrated the benefit into the indemnity plan. At each worksite, the company employs full-time patient advocates who help employees navigate the claims process.
Key Program Components / Best Practices
- Graduated alternatives to outpatient care ensure appropriate levels of service.
Eli Lilly provides three graduated levels of outpatient care. Nonintensive outpatient treatment includes provider evaluation, diagnosis, and preliminary care. Intensive outpatient treatment with a focus on rehabilitation involves care to individuals with chemical and alcohol dependency problems. The program, operating 3 days per week, 3 hours per day, provides group therapy, psychoeducation, and family therapy. This model, occasionally used as a transitional phase from partial inpatient services for acute emotional problems, offers services through a multidisciplinary provider team. Partial inpatient care provides an intermediate level of outpatient treatment to assist patients with problems too acute for conventional outpatient therapy. With 5 day per week, 6 hour per day services, the program includes individual, group, and family therapy and uses a multidisciplinary provider team. Employees must have precertification for inpatient and partial inpatient care.
- Worksite services offer additional
outlets for care.
Eli Lilly is committed to expanding its worksite services for mental health counseling. Each Lilly office has two full-time, on-site clinical psychologists who provide free, unlimited evaluation, treatment, and education. Services include individual or group consultations, group educational therapy sessions (usually related to enhancing group working dynamics, managing stress, or responding to traumatic personal events), and on-site educational seminars (usually surrounding mental health concerns like depression awareness, work/life challenges, and teenage mental health).
According to Lilly, on-site staff have averaged 52,000 visits per year. Utilization has risen both as availability has expanded and as employees find on-site providers to be a more efficient use of their own time.
- Work/life initiatives attempt to strike balance between work and home life.
Consistent with Eli Lilly's holistic approach to mental health care, the company has implemented an evolving set of "work/life initiatives" to create a corporate culture that values a balance between home and workplace responsibilities, according to CEO Sidney Taurel (Lilly CEO, 1999). Services include two child care centers; adoption assistance; flexible work arrangements; paid leaves for maternity, paternity, and adoptive and foster parents; elder care consultation and referral services, including support and information-sharing groups; and financial planning and investment services.
- Residential schools benefit helps children with severe emotional problems.
As part of its mental health benefit, Lilly provides coverage for intensive, 24-hour structured residential care for dependent children ages 6 to 22 with a significant history of emotional problems. The program offers mental health care and an on-site educational curriculum coordinated with the local public school system. The benefit has no deductible and is exempt from the company's out-of-pocket maximum; coverage is limited to $50,000 lifetime.
- Global Incident Team coordinates
crisis response.
Lilly maintains a Global Incident Team to coordinate company-wide response to critical incidents that could affect the safety of the workforce or the surrounding community. This team works to expedite access to health providers and other resources. One key component of the team is mental health staff and psychological crisis counselors who provide timely mental health services for employees operating under crisis conditions.
Employee Satisfaction / Performance Data
Eli Lilly surveys 3,000 of its plan enrollees each year to get their feedback regarding health benefits. The survey asks employees to rate the quality and accessibility of care, administrative response, and customer service. The Corporate Health Services Division collects results, which, along with claims and clinical data, inform internal benefit structure and management decision making. Recent findings suggest that enrollees are generally satisfied with the HMOs and the Lilly Health Plan. The company does not collect data specific to satisfaction with mental health benefits.
In January 1999, Eli Lilly established an Absence Coordinator position to track employee absenteeism. Eli Lilly hopes to understand the duration and causes of absenteeism to help create better employee services. Currently, if an employee misses more than 1 week of work or receives complicated medical treatment, a worksite physician or psychologist reviews the treatment plan and monitors the employee's progress. Although complete data are not yet available, initial findings suggest that adequate mental health care has reduced absenteeism.
Lessons Learned and Challenges Remaining
Eli Lilly has identified several key lessons learned to date and recognized specific areas in which challenges remain.
Lessons Learned
- Design benefits to help employees balance their home and professional lives.
- Recognize that employee benefits play a role in employee recruitment and retention in a changing corporate environment. Flexibility and responsiveness in benefit design and redesign permit a corporation to react to the mental and physical health needs of a growing workforce.
- Recognize the advantages of a uniform mental health benefit; realize that a company can successfully retain control of its benefits.
- Ensure that contractors understand the corporate philosophy underlying the mental health benefits being offered. Without a clear perspective, contractors may try to reduce costs by denying or reducing mental health services. Clarifying the scope of work for vendors is key.
Challenges Remaining
- Eli Lilly continues to encourage utilization of work/life initiatives, on-site care, and EAP services among employees and to increase awareness about benefits among dependents and retirees.
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