Current Update
Over the last twelve months, the work of the Taskforce has been focused on implementing an initial pilot as recommended in the Taskforce report, which stated "The recommendations of the Clinical Committee and the Employer Practices Committee need to be tested to determine whether they are acceptable to and feasible for employees/patients, providers, and employers."
Costco Wholesale Company agreed to test the Taskforce's tools and recommendations through a pilot project, which is being conducted for employees at their headquarters in Issaquah, Washington. The Harvard Medical School's Health Care Policy Department will conduct the pilot evaluation. After a great deal of preparatory work, the pilot officially began on May 1, 2008.
The Costco pilot activities include the following:
- Revising and improving the set of new clinical tools used in the assessment of function which focus treatment
planning by psychiatrists on preserving and enhancing function during treatment. Improvements included
making forms interactive and streamlining text to make forms more concise.
- Managing the pilot implementation, including coordination of all pilot participants: Costco;
WellPoint for behavioral health services; Unum for disability; Aetna for medical and payment data.
- Identifying and recruiting experienced local psychiatrists willing to set aside time and respond quickly to perform the assessments.
We selected psychiatrists who have an active, general clinical practice and do not specialize in an area of practice such as the
treatment of substance use disorders. We did not limit our candidate list to psychiatrists participating in the WellPoint managed
care network (nor did we exclude them).
- Developing and delivering a training package to the assessor physicians, the treating providers, and all of the employer and
vendor support staff. The training of assessor physicians took place on April 12, 2008. Five psychiatrists from the
Seattle/Issaquah area were trained.
- Evaluating and revising employer policies and procedures to facilitate the clinical intervention. For example, Costco agreed to a
revised call intake process to allow for the early identification of employees going through the intervention. Costco also agreed
that the new intervention would be a standard part of their disability process for psychiatric cases.
- Assessing and devising/revising/customizing disability and behavioral health intake, process, and coordination
for the employees who will receive the intervention. For example, a new "soft transfer" phone process was
developed from the disability carrier to the behavioral health vendor, and we worked to develop scripts for
each of the vendor personnel to ensure a seamless coordination through the new disability management process.
- Working with the vendor legal teams to ensure sure that the data from the pilot conforms to federal,
state and company laws and/or policies and can be shared safely in a de-identified format for evaluation purposes.
- The Harvard Medical School's Health Care Policy Department will conduct the pilot evaluation. Ron Kessler, Ph.D.
is the lead investigator for Harvard in this project. Data from the employees going out on psychiatric disability
under the pilot will be compared with data from historical disability incidents as well as with disability data from
other Costco sites that are not participating in the project.
Last 12 Months
The pilot outcomes will be used to refine the tools. Our plan is to have a formal review of the process and instruments after
the first 6-9 months of the pilot and make any appropriate adjustments to the process or tools. We will continue the pilot
with the revisions.
Once the tools have been refined and tested, the second stage of the initiative will focus on testing both the instruments
and the new protocol in a larger setting to more broadly assess return-to-work outcomes and cost effectiveness. We have
not determined all of the details of this stage yet. We would like to have three to five sites with at least 10,000 employees
per site. Part of the study design will have half of the employees who have a behavioral health disability go through the
intervention and the remaining half receive standard care. This stage will last 18 - 24 months and will continue to gather
data for up to 24 months after the last subject employee has returned to work.
We invite you to check back with us as more updates become available. For more information on the project, please contact us.