Like most traditional behavioral health programs, Intuit's program had always worked well for employees who stood up and said, "I have a problem." But with depression, anxiety and stress among the nation's most under-diagnosed medical issues, the computer software company knew there were plenty of employees who weren't getting the treatment they needed, resulting in decreased productivity and increased medical costs.

 

"There still is a stigma associated with mental health," said Sarah Wilkins, a benefit analyst at Intuit. "Very often, people are in denial, and it takes someone else - a professional - to say, 'Hey, you know what? You might need some care. How about talking to a counselor or someone who can walk you through this?'"

 

In the past, the challenge has been identifying those individuals and connecting them with the professionals who can make a diagnosis. But in September 2006, Intuit decided to work with United Behavioral Health, a UnitedHealth Group company, to implement a new program called LifeSolutions, which is a proactive care-coordination program that integrates medical and behavioral care by bringing together all of Intuit's medical partners to identify and engage employees who suffer from unrecognized or undertreated behavioral health issues.

 

Through the program, nurses and others who are already in touch with employees with chronic health conditions through one of Intuit's health care vendors automatically screen those individuals for behavioral health issues, then, if needed, connect them with the resources that can help.

 

David Whitehouse, M.D., chief medical officer for strategy and innovation for United Behavioral Health, said this is especially important for high-risk employees with chronic medical conditions who also suffer from behavioral health conditions such as depression, anxiety, substance abuse or stress.

 

As many as 50 percent of individuals with chronic illnesses are estimated to have some sort of behavioral health issue, and the large majority of those cases go unidentified and undertreated. As a result, he said, it becomes harder for members to adhere to their medical treatment plans and can often lead to more medical problems down the road.

 

"When you're depressed, for instance, you lose energy, you lose focus, your concentration is off, and you don't care about yourself in the same way as you usually do; so you may not adhere to your medication or other prescribed treatments for your chronic condition," Dr. Whitehouse said.

 

With 8,000 employees and 38 offices across the country, Intuit has a strong reputation as a progressive employer that meets employees' health and well-being needs. For six years in a row, the company has been ranked on Fortune magazine's list of 100 Best Companies to Work For, and this year its ranking climbed to number 33.

 

"We really do believe that our employees are our biggest asset, and that's where our emphasis on this program and all of our wellness programs stems from," Wilkins said. "It's all part of what makes this company a great place to work."

 

For instance, through its "Choose Wellness For Life" initiative, Intuit has added on-site ballroom dancing, yoga and Pilates; as well as workout rooms and walking tracks at some locations. The idea is to support employees across the spectrum of their health needs.

 

"We've always said that we've got to look at each individual as a whole person," Wilkins said. "Health care really shouldn't be segmented, with an employee getting one kind of care from here and another from a totally different place and then trying to understand how it all pieces together on their own. Our employees aren't physicians - they can't self-diagnose - so if we're going to do it right, it needs to be a whole, rather than a piecemeal, approach."

 

That approach makes employees more confident about their health and their care, Wilkins noted. And integrating behavioral and medical health through a program such as LifeSolutions seemed a natural extension of that "whole person" philosophy. "It is essential that our employees' treating physicians have the full picture of their health - mental and physical - to provide better care and better diagnosis," Wilkins said.

 

LifeSolutions takes advantage of Intuit's existing nurseline types of programs that connect registered nurses with employees who have chronic or other medical
conditions that might be associated with comorbid behavioral health issues.

When employees call in, regardless of their health plan, the nurses are trained in behavioral techniques and automatically look for indicators of stress, anxiety or other behavioral health issues.

 

For instance, a mother of two with chronic back pain might be talking with a nurse about a treatment plan. The nurse might explain that many people in her situation feel overwhelmed, especially if her medical condition is limiting what she used to be able to do on the job or at home. If the employee says that's how she's feeling, the nurse can connect her with the appropriate resources.

 

Sometimes, that might mean transferring a caller to a behavioral health specialist who can find a doctor or clinician who treats depression. Other times, it might mean involving Intuit's work-life balance program, which offers programs aimed at relieving stress such as help with grocery shopping or finding child care.

 

At the same time, Wilkins said, Intuit realized that not all employees who need help will call. So, the company also implemented a health assessment and other measures to identify those who are at risk for having an undiagnosed behavioral health condition. In those cases, a nurse reaches out directly to offer assistance.

 

Wilkins said through these kinds of discussions, management hopes to get employees more engaged in their health care. "At Intuit, we approach all health and wellness as a partnership between employees and the company," she said.  

 

Dr. Whitehouse said: "The old method was all about waiting for people to come to us for help, but LifeSolutions is going 180 degrees from there. Now we're looking for ways to decrease people's stress, improve their focus and help them cope better with their health, then proactively reaching out to them to make them aware of those services. This helps improve outcomes for members and helps reduce overall medical costs for employers."

For instance, according to an analysis done for United Behavioral Health by the consulting firm Milliman, approximately 30 percent of individuals with cancer also have depression, and their medical costs run roughly twice as much as those of cancer patients without depression. Similarly, a quarter of asthma sufferers are estimated to have depression, and their medical costs approach three times as much as those of individuals with asthma who don't have depression.

 

Dr. Whitehouse said stress alone accounts for about 8 percent of an employer's medical spend on average, in large part because it often goes untreated. "When we get stressed and we aren't properly treated, we overeat, we don't exercise or keep appointments, we don't take our medications as prescribed," he said. "We're just too overwhelmed."

 

Better identification can lead to better treatment, he added, resulting in decreased medical costs, greater employee satisfaction and increased workplace productivity.

 

Wilkins said she realizes that when not addressed, behavioral health issues can interfere with a consumer's adherence to medication therapies and other treatments. And she expects to ultimately see a decrease in Intuit's medical costs and an increase in productivity as those needs are better met. "When employees are better educated about their illnesses and have help coordinating care and dealing with the stress of making behavior changes, they come to work and are more productive because they aren't as overwhelmed," she said.

However, to her, the primary measure of success will be the program's impact
on employees. "The employee experience isn't great when you're being pushed around from one doctor to another, and no one is piecing it together for you," she said. "This type of integration can really have a profound impact on employees' lives and well-being and - in turn - their engagement at work. Taking care of our employees and reaching out to them at the moment they most need it makes them feel valued and cared for. And if  you show your employees you care about them, they'll care about working for you."