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
E. Motorola
Company History / Profile
Motorola, an international communications company established in 1928, has undergone a significant transformation during the past 2 years. The 34th largest company in the United States, Motorola faced financial challenges in 1997-1998 that have had substantial effects on Motorola's employees. The company's financial losses led it to reduce U.S. operations by more than 20,000 employees; the Schaumburg, Illinois-based company now has 133,000 employees worldwide and 65,000 in the United States.
Factors Influencing Company's Decision to Provide Comprehensive Benefits
In the late 1980s, the Federal Government introduced legislation supporting drug testing in the workforce. As a result of this Drug Free Workforce (DFWF) legislation, Motorola embraced random drug testing before and during employment. Drug testing encouraged early identification of problems; therefore, Motorola recognized that providing benefit coverage for a wide range of diagnoses and treatment alternatives was a critical next step.
During the same period, Motorola's EAP sought to improve the quality and cost management of the behavioral health benefits plan design. Developed in 1979, the EAP had a profound influence on the company's philosophy of behavioral health care. The EAP examined quality of care, utilization, and cost data. In response to the DFWF policy, opportunities identified by the EAP, escalating health care costs, and decreasing employee satisfaction with health benefits, Motorola developed a comprehensive plan to foster employee well-being and productivity, thereby generating long-term cost savings.
The company's progress in the area of health benefits is evidenced in part by the national attention Motorola has received from its corporate peers and the Federal Government. In 1997, the company was invited to present its health plan to employers at a meeting of the National Managed Health Care Congress (Ceniceros, 1997). In 1998, The Health Project, a nonprofit health consortium, presented Motorola with a C. Everett Koop National Health Award, honorable mention.8
Mental Health Benefits
Description of Benefits Options
Motorola currently provides three types of physical health benefit options for its employees:
1) Health Advantage Plan: a customized network of approximately 100,000 doctors, 900 hospitals, and 4,000 mental health care providers nationwide brought together by Motorola to form a PPO;
2) Basic Medical Plan: an indemnity plan with an open provider network; and
3) Several HMO plans.
The company provides uniform behavioral health benefits to all PPO and indemnity plan enrollees through a Mental Health and Chemical Dependency (MHCD) program.
Before 1995, approximately 33 percent of Motorola's employees enrolled in the company's HMO option and 66 percent in its indemnity plan. Employees received behavioral health benefits through these plans. Motorola embarked on a partnership with Private Healthcare Systems (PHCS) to create the PPO and the MHCD program. Consultants estimated that between 25 and 50 percent of Motorola's employee would enroll in the PPO during its first year. In fact, 58 percent of employees switched. In 1999, 70 percent of Motorola's employees chose the PPO, 17 percent chose an HMO, 6 percent chose the indemnity plan, and 7 percent waived coverage. Tables 13, 14, 15 present the specific benefits Motorola offers under the PPO and the indemnity option.9
Motorola provides coverage for full- and part-time employees and their dependents. PPO monthly premiums range from $24 for a single employee to $55 for a family, and indemnity plan premiums range from $45 for a single employee to $76 for a family. Although Motorola contributes the same amount for HMO coverage as it does for PPO coverage, most employees who select an HMO pay higher premiums than under the PPO.
Motorola contracts with an external network and medical manager to provide CallCARE, a utilization review program offering assistance and case management to Motorola employees. Employees must receive precertification from CallCARE for full coverage of inpatient physical and behavioral health care for employees.
Motorola also operates a prescription drug program for its PPO and indemnity plan enrollees. The program enables employees and their dependents to receive medications through either a retail network pharmacy or a mail-order service. Motorola encourages employees to use generic drugs unless the doctor or pharmacist recommends a name-brand medication. The plan requires an $8 copayment for generic drugs and a $16 copayment for name-brand pharmaceuticals. This copayment covers a 30-day prescription in a network pharmacy or a 90-day supply from the mail-order service. Motorola contracts with PHCS to administer pharmaceutical benefits.
Employee Assistance Program
Staffed by internal professional employees, Motorola's EAP has operations throughout the world. The EAP is part of the Global Employee Consultation Systems (GECS), an organization with responsibility for the DFWF program, workplace violence strategy and policy, and systemic problem-solving structures. The GECS director and the director of global rewards and benefits report to the same supervisor, a system that encourages discussions and collaboration between the corporate benefits and EAP leadership.
In 1988, the EAP leadership team developed the strategy and vision for a global EAP organization. The team proposed to consult with and provide effective solutions to Motorola management, Human Resources, and employees to achieve maximum performance. A significant aspect of the new strategy involved the team influencing the design and delivery mechanism of the behavioral health benefits. This strategy represented a departure from standard EAP practice of the time as the EAP did not want to act as the "gatekeeper" to benefits.
During the past decade, the EAP leadership has focused on remaining an internally staffed organization. The EAP staff serves groups, teams, and individual associates within the company. In addition to direct interaction with employees, the company's EAP helps ensure the quality of behavioral health service through various management roles: helping develop the provider network, providing case management to referred patients, and coordinating worksite activities for services that are administered by both the behavioral health benefit and the EAP.
Benefit Management
Motorola actively manages much of its benefits program through the Benefits Administration Office. This office and the EAP take an active but nonrestrictive role in managing the PPO. Providers who have won the confidence of Motorola and PHCS must discuss patient progress with utilization review medical managers only after 20 visits (the average number of visits is eight).
Motorola also has become involved in monitoring its HMOs. The company has reduced the number of HMOs from 35 to 23 during the past 6 years and has frozen enrollment for HMOs that do not meet Motorola's standards of care. The company is concerned about HMO and provider compliance with its demands for increased access to behavioral health services and improved quality of care.
Key Program Components / Best Practices
- Motorola uses employee feedback to help design its customized PPO.
As part of its ongoing review of benefits programs in the early 1990s, Motorola conducted 150 focus groups with workers across the country to gain a better understanding of employee priorities and concerns regarding their health benefits. The company also reviewed data on benchmark programs and evaluated information from employee satisfaction surveys. Mirroring national trends, the company's employees reported dissatisfaction with 1) excessive paperwork burdens, 2) gatekeeper restrictions to services within HMO plans, 3) unexpected out-of-pocket costs, and 4) lack of preventive and well-baby care.
Employee feedback served as a driving force behind the company's decision to create its PPO option, which is unique because the company's Corporate Benefits and EAP management set the vision and strategy for network development and management and worked closely with PHCS to create the customized network. A key driver in network development was the desire to minimize micromanagement by screening providers with an extensive set of quality measurements; Motorola gave providers who met the standards flexibility in delivery of care through less restrictive utilization review.
Motorola identified potential providers through a variety of mechanisms, including claims data, recommendations from EAP staff and Motorola employees, and the network manager's provider preferences. Because the EAP had operated with Motorola since 1979, it had extensive knowledge of the behavioral health providers in various Motorola locations. The company also reviewed existing EAP providers and expanded the mental health network to include psychiatrists, psychologists, and licensed social workers.
Even after the establishment of the network, Motorola employees continue to have the opportunity to recommend specific providers (both medical/surgical and behavioral health) for inclusion. Inclusion is based on whether the provider meets the screening requirements.
- Work/life initiatives improve overall employee well-being.
Motorola believes it can improve the productivity and health of its workforce significantly by encouraging a supportive work environment for all employees. As a result, it has sponsored several initiatives designed to reduce stress in employees' lives.
In partnership with PHCS, Motorola operates disease management programs (called "Essential Quality of Life Programs") for employees and dependents facing chronic conditions, such as depression. These programs educate patients about their conditions and methods of treatment, foster a healthy lifestyle, and encourage them to coordinate with physicians to follow the treatment and prescription regimens designed by clinical experts.
Motorola also offers a variety of additional programs designed to address employee concerns. The company's Milestones program, developed in response to employee focus groups, offers financial assistance for major life events. Motorola's Special Delivery program provides case management during pregnancy and free use of pagers for expectant parents. Motorola also helps parents with child care, reimbursing expenses incurred during in-home care for mildly ill children and offering on-site and near-site child care development centers.
- Consolidation of behavioral health benefits ensures coverage.
Motorola decided to consolidate its behavioral health benefits because of a corporate desire to offer uniform coverage guided by a consistent treatment philosophy across the covered employee population. Because employees generally do not anticipate the need for behavioral health benefits at the point of enrollment, they could neglect to select coverage. Consolidation offers the benefits without requiring employees to make a specific selection and permits the use of the benefit in a stigma-free environment if the need arises. All employees are automatically covered, no matter which plan they choose.
- Motorola offers three paths of entry to the mental health benefit.
The company's dedication to ensuring access to mental health care has resulted in three points of entry to the mental health network: the EAP, family physicians, and self-referrals.
Employee Satisfaction / Performance Data
Motorola has developed an extensive system to evaluate its benefits plan options. Since 1993, the company has used an assessment conducted by Towers Perrin to rate HMO performance. Motorola integrates these results to evaluate its HMOs based on the following criteria: clinical quality of care (35 percent), customer satisfaction (30 percent), financial management (20 percent), and accessibility (15 percent). Due to poor performance, specifically a decline in customer satisfaction and increased barriers to access, Motorola froze enrollment for two plans in 1998. Furthermore, the company distributes an HMO Report Card detailing plan ratings for each of the criteria to all employees.
Motorola has also evaluated its PPO as part of its annual Report Card. The results from the 1998 analysis show that the PPO received a score of 67.25, compared with the average HMO score of 49.03 (on a scale of 100). The PPO performs particularly well in the employee satisfaction component of this score. Ninety-four percent of enrollees reported overall satisfaction with the PPO, compared with 86 percent for the HMOs and 79 percent for the indemnity plan.
Motorola is also working with MEDSTAT, a health data consulting firm, to develop an information system for performance data. The system will include analysis of
- direct costs (medical claims, pharmacy benefit management costs, and other vendor costs);
- people-specific issues (quality of care, customer satisfaction, self-management, quality of life); and
- indirect costs (employee absence, productivity).
Lessons Learned and Challenges Remaining
Motorola has identified several key lessons learned from its experience providing comprehensive mental health benefits and recognizes specific areas in which the company must strive to meet challenges.
Lessons Learned
- Respond to employee concerns about the quality of behavioral health care. Using focus groups enabled Motorola to customize its provider network and behavioral health benefits plan to employee needs. Additional employee feedback led to quality-of-life programs.
- Encourage the "least intensive locus of care" approach by investing in alternatives to inpatient care, such as disease management, worksite programs, and outpatient options. Worksite programs capitalize on the convenience of on-site services for employees, while outreach and education increase understanding of appropriate care. Such programs result in greater access to and use of services and reductions in expensive inpatient costs.
- Partner with the EAP to take a key role in developing a high-quality behavioral health benefit and helping to coordinate care. The EAP is a unique resource for developing a behavioral health network of providers and facilities. It also has the expertise to partner with senior corporate management in designing the behavioral health benefit and in developing a myriad of employee programs.
Challenges Remaining
- Motorola faces continuing challenges in profiling providers and in precertification for inpatient care. Motorola also hopes to improve its overall health benefits by enhancing its Essential Quality of Life Programs and broadening the scope of company-sponsored health risk assessment screenings.
- In developing its PPO plan, Motorola found its greatest challenge to be convincing medical providers and vendors that quality care is paramount. The company must clearly define its expectations and work with providers and vendors to meet them. Turnover within vendor organizations (because of mergers and other market changes) remains another barrier to quality care.
- The company believes the flexibility and sensitivity of an organization to respond to its employees' needs with its own approach might be compromised if government regulates employers.
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