PPG Forges Ahead in Tackling Depression
Dealing with depression among its employees became a top priority for Pittsburgh Plate Glass Industries (PPG) when it learned three years ago that mental illness was one of the top 10 reasons for hospitalization in Pennsylvania. PPG decided to educate employees about depression and to improve coordination of their employees’ mental healthcare.
PPG’s approach to reducing the cost of depression in the workplace was to first contact all the stakeholders — employees, providers, health plans, pharmacy benefit managers (PBMs), employee assistance program (EAP) providers, behavioral health carve-out program providers, and wellness teams. Working together they wrote a business plan to create both intervention partnerships and an integrated business model to sustain those partnerships.
“Our plan was far from perfect and still is,” Alberto M. Colombi, M.D., M.P.H., Corporate Medical Director of PPG, said. “But this effort to address depression is absolutely necessary,” he emphasized. “The important thing is to get started.”
Within three years PPG’s program “Depression in Primary Care: Work-Site Interventions and Coordination of Care” has won awards and — most important — is reaping positive results. Employees are accessing EAP services in increasing numbers to receive treatment.
PPG Philosophy
Dr. Colombi explains PPG’s overall philosophy this way: “The company believes one of its responsibilities is to help shape a different kind of ‘healthy company’ culture that could counteract the stigma associated with depression and empower employees to take an active role in their own care.” Here’s how they put that philosophy to work.
The Depression in Primary Care Program
The Depression in Primary Care program intervenes in two ways: 1) to help improve the diagnosis and management of depression for its employees and their families, and 2) to increase the productivity of employees who have depression.
Key Components of the PPG Project on Depression
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Education
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Awareness
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Early recognition
Target Audience
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Employees
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Supervisors
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Management
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Healthcare providers, especially primary care physicians
The program was conceived as a component of a collaborative effort led by the Pittsburgh Regional Healthcare Initiative.
PPG’s Depression Primary Care program has two components:
Worksite Intervention Phase
Occupational nurses, wellness teams, and health promotion volunteers create opportunities, bring in experts, and set up awareness forums to provide depression education to employees, supervisors, managers, and company healthcare providers, including nurses, contracting physicians, and EAP agents. Tactics include wellness programs and on-site seminars. PPG also developed a depressionspecific section on its employee Web site, as well as links to EAP resources. The site features selfmanagement techniques and information about depression and treatment options.
Coordination of Care Phase
By working closely with the health plans, PPG fosters the coordination of services provided by the EAP, PBMs, and behavioral health specialty program partners, as well as primary care physicians (PCPs) and the medical practices that serve PPG employees.
To reduce the variability in the treatment of depression, PPG partnered with major health plans, such as Highmark-Blue Cross Blue Shield. Their goal is to provide clinicians with consistent training about depression screening, treatment, and rehabilitation using PHQ9, an instrument that helps screen for and diagnose mental disorders.
PPG also partnered with Highmark to promote the use of practice guidelines and protocols to ensure that healthcare providers are uniformly diagnosing and treating depression. These guidelines and protocols outline standard procedures for recognizing depression, stratifying patient risk, treating depression, following up with patients, and assessing whether a referral to a mental health specialist should be given.
“Integrated treatment is key,” said Alan A. Axelson, M.D., Highmark’s Behavioral Health Medical Director. “It’s important to understand that the primary care physician is part of the behavioral healthcare team,” he said. “We’re asking all practitioners to enhance their care of patients with depression and all consumers to expect that level of care.”
To do that, he emphasized that the employer and the health plan must communicate the same message to the patient about what to expect in treatment and to the physician about how to provide an accurate assessment with timely and consistent follow-up.
Dr. Axelson noted that when health plans and employers work in concert they can make a change and improve care. “Employers,” he said, “can provide the necessary vehicle for educating consumers.”
Evaluation of Program
The Depression in Primary Care project has been applied with different intensity to employees at five of PPG’s ten sites in Pennsylvania; the remaining sites are control sites.
Some of the measurement tools used are health risk assessments, depression surveys, and medicationuse indicators. PPG is looking at the impact of employee health on productivity by analyzing medical, pharmacy, and mental health claims data, as well as absenteeism, workers’ compensation, short-term disability, and turn-over data.
Norman A. Clemens, M.D., chair of APA’s business initiative, said that PPG’s analysis of the results of this program will be highly informative, noting that protecting individual employee privacy is, of course, crucial.
Program Impact So Far
The following data show the kind of impact the Depression in Primary Care program is having thus far.
| Internet Traffic for Information About Depression | ||
|---|---|---|
| 2002 | 2003 | |
| Number of Users | 57 | 169 |
| Number of Pages Viewed per session | 4.81 | 8.4 |
Note: In the first six months of 2004, 130 people accessed the site for information; on average each user viewed nearly 40 pages.
| EAP Program Access and Case Utilization for Depression | ||
|---|---|---|
| 2003 (First 6 m) | 2004 (First 6 m) | |
| Number of cases opened | 63 | 82 |
| Number of cases closed | 44 | 82 |
| Number of workplace support cases (management consults and referrals) | 11 | 25 |
In self reports, 62% of employees said that their work was much improved or improved as a result of receiving counseling. At the same time, 87% of employees said that their functionality at home was improved or much improved as a result of the counseling sessions. When asked how many days of work they would have missed had they not received counseling, 14% said four days and 12% said five or more days.
These results conform to the scope of impact of depression on job performance: A study of more than 6,000 employees at three corporations found that decreased job performance was seven times higher for employees who are depressed than for those who are not (B.G. Druss et al., American Journal of Psychiatry, May 2001, pp 731–734).
According to Clemens, “PPG’s Depression Primary Care program resonates with many goals of APA’s Business Initiative—to increase employer awareness of the value of helping employees overcome depression; to build a partnership of many stakeholders; to help primary care physicians provide effective, first-line care; and to increase knowledge about when to refer a patient to a psychiatrist for more extensive treatment with psychotherapy and/or medications.”
Making the Business Case
Looking back on the depression program, Dr. Colombi thought that it was crucial to build a solid business case from the beginning. “The business plan helps you educate your own people,” he noted, “and then, as the program unfolds, it can serve as a road map for everyone.” Of course, it took time to build the partnerships. PPG even collected signed letters from each of the stakeholders.
Dr. Colombi emphasized that the plan must be synchronized with the outside world. He explained that it was relatively easy to begin the program with PPG’s employees, but key to the program’s success was the involvement of clinicians in the “outside world.” “Without synchronizing our work with the outside world,” he said, “we could not be successful.”
He encourages others to get started on their own programs. “The more you do,” Dr. Colombi said, “the more you learn.” It’s just that simple.
About Pittsburgh Plate Glass Industries
PPG Industries is a global supplier of coatings, glass, fiberglass, and chemicals. The company has more than 34,000 employees in about 50 production sites in the U.S. and 120 sites worldwide.
Last Updated: October 2004