Member Assistance Programs (MAPs) help local health and welfare funds manage their benefits and control their costs while also helping Laborers and their family members get the kind of assistance most needed for a variety of personal problems and work-related issues.

Yet, only about one in three LIUNA health and welfare funds have MAPs.

“Many funds view the MAP as an additional expense,” say LHSFNA Health Promotion Director Mary Jane MacArthur, “so they leave treatment decisions to the patient and the family physician. Generally, these doctors do not specialize in diagnosing and treating behavioral health issues, and they do not always direct the patient to a more appropriate care provider. Yet, the care and monitoring of a mental health condition – which can include counseling and medication – can be very expensive. Inappropriate or unnecessary care can far exceed the cost of a MAP.”

Typical Areas of MAP Concern

Job performance problems
Worksite fatalities or critical incidents
Interpersonal problems
Jobsite conflicts

Substance Abuse
Drinking or using drugs on the job
Positive drug tests
Prescription drug abuse
Quitting smoking

Illness or death of family member
Aging parents
Childcare concerns
Single parenting
Parent-child conflicts

Communication with spouse
Separation or divorce
Domistic violence

Child custody
Child support

Overextended family budget
Spending or credit problems

Emotional and Mental Health
Grief or depression
Anxiety, stress or anger
Life transitions

“This is an absolutely wonderful program,” says Sue Harkness, an administrator with TIC International, which provides administrative services under contract to the Laborers’ Metro Detroit Health Care Fund. Under her direction, the Fund contracts with Health Management Systems of America (HMSA) to manage its MAP, known as the Laborers’ Assistance Program (LAP).

As is typical in most MAPs, Detroit clients who want help call a toll-free number to arrange an assessment with a professional counselor to clarify their problems and then plan a course of action. Depending on the benefit plan, a client may meet up to five times with the counselor, or the counselor may refer them to other agencies or a health care provider for further assistance or treatment. The MAP is completely confidential.

A variety of problems fall within the realm of MAP services. Self-referrals commonly trigger the MAP process, but in certain work-related situations a supervisor or a union steward might start the process. Commonly, the service is used as much by family members as by Laborers, themselves.

For example, among those who utilized the MAP services of the Massachusetts Laborers’ Health and Welfare Fund in 2002, 49 percent were Laborers; the rest were spouses or children. Sixty-four percent accessed the program for emotional or mental health reasons; 11 percent for marital problems; 10.5 percent for drug use and 7.6 percent for alcohol. “Overall, the utilization rate was ten percent of eligibles,” says Fund Administrator Tom Masiello, “not uncommon relative to the industry as a whole.”

“Often,” says Harkness, “a number of problems are mixed up together. The counseling helps the client sort out the causes and make a sound decision about how best to utilize benefits under the overall health care plan.”

For instance, a member might be “feeling depressed” and want to go on mental health medications – medications like Zoloft or Prozac, known as psychotropics – but a session with the counselor might reveal that the source of the depression is financial problems that can be best addressed by a financial advisor. Another member might feel the need to be hospitalized for psychiatric services, but the MAP counselor might recommend that the member could best be helped on an out-patient basis, allowing him or her to stay in familiar surroundings and continue work.

“The MAP gives the small fund administrator someone she can consult when unusual problems arise,” says Dora Crenshaw, Administrator of the Railroad Maintenance and Industrial Health and Welfare Fund. “A member called needing an immediate referral for psychiatric care because his teenage daughter was at the emergency room after a drug overdose. I called the MAP and got a referral right away.”

Managing costs is another important role of a MAP. Psychotropic medicines provide a good example.

“Over the last decade,” says LHSFNA Behavioral Health Care Coordinator Jamie Becker, “the use of these drugs in the United States has climbed to unimagined levels.” Of the top 100 drugs prescribed today, eight are psychotropics.  “Many people are relying heavily on medication to ‘fix’ their problems when all it really does is alleviate symptoms. Meeting with a counselor will help get to the root of what is causing the feelings. With therapy, a member may not need medication at all or may need it for less time. Members would do well to consider all alternatives before committing themselves to these medications.”

“A MAP program is particularly valuable to a smaller health and welfare fund,“ says Crenshaw. “We don’t have the staff to properly assess mental health problems. Too often, family physicians and gynecologists aren’t expert either. How long should a patient be on a psychotropic? At what dosage?  When is it appropriate to try a different drug? The system is subject to fraud, too, because patients are vulnerable, and some doctors may unnecessarily prolong treatment. The MAP has the expertise to assess these situations.”

According to Betty Smith, Administrator of the Southern Illinois Laborers’ and Employers Health and Welfare Fund, after participation in the MAP was mandated, psychotropic prescriptions dropped from first to seventh among the medications filled by the plan.

“We’d had the MAP for four years,” says Smith, “but didn’t require its use. Though few clients used the MAP, more and more were using prescription medications. Due to rising costs, we considered dropping the MAP program, but, after consideration, we decided instead to mandate its use. Now, we do not pay for mental health medication unless it is prescribed through the MAP.”

Smith acknowledges that there have been some problems in making this adjustment. “The system is more cumbersome, especially for small town clients who do not have as ready access to MAP offices and mental health providers. Communication is the big thing. We’ve devoted a lot of time to getting out and talking to the membership about our benefit programs.”

“Our MAP, launched 13 years ago, is one of the better programs we have,” says Masiello. “The greatest advantage is to have a gatekeeper so that the individual gets treatment at providers with whom we’ve contracted to ensure top quality care at prices affordable for our Funds.”

Of course, the MAP program has its own costs. These, however, must be compared both to the improvement in services for members and the savings in other costs to the fund.

In Detroit, first-quarter 2003 data indicate that the LAP saves the fund about $175,000 annually over the likely cost of service to members if no MAP existed. In Southern Illinois, drug expenditures for the first two quarters since MAP usage was mandated are running more than 50 percent below the previous year’s average. In Massachusetts, since the MAP was established in 1991, the Fund has saved about $8.8 million in average length of service and per diem costs for in-patient care.

“No way is there a downside to a MAP program,” says Masiello. “Any interested administrator should ask the fund consultant to recommend four or five service providers for bids and consideration.” The LHSFNA Health Promotion staff also is available for consultation, advice and assistance with developing RFPs and evaluating responses.

[Steve Clark]