ABSTRACT

As EAPs evolved, they were viewed as a benefit to the employee. During the past five years contracting organizations have been increasingly concerned with the effect that health care costs have on the "bottom line" profitability of the organization. As a method of addressing these concerns, they have turned to Utilization Review, Programs (URPs) to address the rising health care costs. To date, URPs have operated separately from the EAP. URPs characteristically utilize telephone consultations' and second opinions as the primary methodology for generating cost savings. Typically, URPs have either excluded or have not effectively addressed psychiatric problems and/or substance abuse. This is primarily a result of the medical model philosophy underlying the URP's process and the lack of accepted standards for treatment modalities directly and expense similar to Diagnostic Related Groups (DRGs) for psychiatric and/or substance abuse treatment. Medical service providers and provider networks have marketed the medical model approach, by offering discounts for exclusive use of their facilities and networks. In the pressure for cost containment, traditional and sacred EAP tenets, i.e., provider care quality, appropriateness of treatment, and effectiveness, have been ignored or minimized.