Bridging Gaps in Substance Use Care with Dedicated Substance Use Management

The latest research on substance use in the U.S. workforce highlights one of the biggest challenges facing benefits leaders today. Substance Abuse and Mental Health Services Administration (SAMHSA) data finds that 4 out of 10 U.S. workers misuse substances or have substance use disorder (SUD).* Pelago’s own 2024 Pelago Annual State of Substance Use Management Trend Report mirrors this stark reality, finding that 42% of employees have missed work due to personal or family substance use issues. And although more than half of workers in our survey believe employer support for substance and alcohol issues is crucial, only 14% report having access to such a benefit.

Without an integrated substance use management solution to address these gaps in SUD care, U.S. employers face dramatically increased medical spend, chronic health issues, regulatory and compliance liabilities, workplace safety issues and lost productivity. 

As healthcare costs continue to rise, it’s crucial for organizations to navigate the complex terrain of benefits and make informed decisions that prioritize employee health, both mental and physical, while also driving cost savings. Among the many considerations, the rising prevalence of substance use disorders (SUDs) and their associated costs have made choosing the right level of substance use care a critical organizational decision.

The Benefits Mix: Substance Use Care, Mental Health, and EAPs

Within today’s mix of employee benefits that can address gaps in care, three essential components stand out: substance use care, mental health care, and employee assistance programs (EAPs). While most companies have robust mental health programs, a glaring gap exists when it comes to dedicated substance use management. This deficiency in addressing substance use leaves significant costs and productivity issues unaddressed, as attempts to tackle SUDs and related mental health problems through EAPs or mental health care often fall short.

The boundaries between mental health care and substance use care have blurred, while the gap between the care needed and the care accessed has widened. A substance use disorder is not simply another mental health disorder. SUDs have unique characteristics and implications that require specialized care. 

Despite the prevalence of co-occurring mental health disorders, many individuals with SUDs go undetected or receive inadequate treatment in mental health settings. Research indicates that detection rates for alcohol and drug use disorders among adult populations range from 11% to 37%, meaning that as many as 63% to 89% of adults with SUDs go undetected. 

The annual minimum cost of substance use disorders, estimated at over $35 billion, represents just the tip of the iceberg. It doesn’t account for hidden, yet very real, costs related to absenteeism, presenteeism, job retention, or the severe health consequences and complications of underlying, undiagnosed SUDs such as pancreatitis, liver disease, cardiovascular issues, obesity, depression, and anxiety.

Unfortunately, even “next-gen” EAPs are ill-equipped to provide the specialized care necessary to effectively treat substance use disorders and deliver validated outcomes supported by clinical expertise and guaranteed performance outcomes. Furthermore, based on their own studies, EAPs do not have the capabilities to detect proper levels of SUDs amongst their population.1,2

Solving the Gap in SUD Care Challenge

Undetected and untreated SUDs lead to escalating costs via medical claims across all sub-populations, including those with chronic conditions, due to negative health impacts increasing over time. By treating SUD effectively, Pelago’s dedicated substance use management reduces overall healthcare costs and improves population health over time. This is achieved by lowering the incidence of high-cost claims associated with untreated SUD such as cancer, heart and liver disease, inpatient treatment, and dialysis. The savings are significant across all chronic condition populations.

Furthermore, new Mental Health Parity and Addiction Equity Act (MHPAEA) regulations require that employers and health plans offering SUD and mental health benefits enable plan members access to mental health and substance use benefits in a manner that is no more restrictive than medical and surgical benefits. Many employers struggle to meet these regulatory requirements, leading to gaps in care and increased costs.

Pelago ensures compliance with MHPAEA by offering SUD and mental health services without additional restrictions compared to other medical care. Our nationwide coverage and comprehensive approach ensure that SUD treatment is on equal footing with physical health care, reducing stigma and barriers to access.

The Pelago Approach: Clinician-Directed Care Pathway

Closing the gap in SUD care requires a dedicated, integrated and personalized approach to early SUD treatment. Members receive immediate, in-person (virtual) access to qualified professionals who guide them through the care evaluation process. Pelago’s care model is in line with integrated treatment principles, ensuring clinically validated, cost-effective care. In addition to addressing SUDs, Pelago offers care coordination for certain mental health conditions and has demonstrated its effectiveness through peer-reviewed studies and a randomized controlled trial. This approach has resulted in impressive outcomes, including a 52% verified tobacco quit rate at four weeks, a 62% abstinence rate or drinking below safe limits after three months for alcohol, and a 67% opioid abstinence rate at 90 days. 

The advantages of Pelago’s approach include performance guarantees, validated outcomes, cost savings, and return on investment. This includes our recently demonstrated healthcare cost savings of $9,367 with 3x ROI in the first-ever ROI study conducted on the impact of a substance use management program in an employer population across multiple clients with a large sample size. These benefits surpass what EAPs and mental health plans can offer, making Pelago an essential component of a holistic behavioral health strategy.

Untreated SUDs lead to annually compounding health costs, absenteeism, lower productivity, and increased turnover. As the leader in Substance Use Management, Pelago is uniquely positioned to bridge critical, costly gaps in SUD care. Our complete spectrum of SUD care, from prevention to treatment and recovery support, ensures that no one falls through the cracks. This comprehensive, multi-year approach delivers significant cost savings, improves overall population health, and supports compliance with new Mental Health Parity regulations. 

With nationwide virtual coverage supported by our inpatient Centers of Excellence Network, Pelago is the only provider that can fully address gaps in SUD care, ensuring that everyone has access to the treatment they need. If your benefits team or health plan is looking for ways to significantly decrease the direct and hidden costs of employee substance use, contact us for a free claims or geographic vulnerability analysis.

 

* Calculated from SAMHSA 2022 detailed tables and U.S. Census Bureau data: 63 million out of 155 million U.S. adult workers 18+ misuse substances or have an SUD.

1. Validation Institute. (2023). Spring Health ROI Validation Report. Validation Institute.
2. Aon. (2024). Lyra Health: Claims Cost Impact of Behavioral Health Services 2018-2021. Aon.