SWSW Business Case for
Public Sector Investment
October 2010
Background
Minnesota was one of five states that participated in the Demonstration to Maintain Independence
and Employment funded by the Centers for Medicare and Medicaid Services. Under this research
Demonstration, the Minnesota Department of Human Services (DHS) developed an intervention –
Stay Well, Stay Working (SWSW) – that offered working persons with a serious mental illness (SMI)
a comprehensive set of health, behavioral health, and employment support services.
The goals of the research Demonstration were to:
1. Create a comprehensive and coordinated set of health care, behavioral health, and
employment based supports for employed individuals with SMI;
2. Determine how access to and utilization of these services and supports influences the
progression of potentially disabling conditions; and
3. Prevent or delay a person with SMI from becoming disabled and no longer able to work.
Stay Well, Stay Working Outcomes
The three-year SWSW evaluation used a randomized design and found the following participant
outcomes:
■ Fewer applications to Social Security Disability Insurance (SSDI)
■ Improved functioning, reductions in limitations in ADLs/IADLs
■ Improved mental health status
■ Higher earnings and greater job stability
■ Greater connection to a regular medical provider or clinic for routine care and preventative
services
■ Lower rates of medical debt
■ Less likely to delay or skip needed cared because of cost
■ Better quality of life
Introduction
Mental illnesses have a huge impact on disability
and healthcare costs, as well as on employee
productivity. According to the World Health
Organization, mental and behavioral disorders
affect more than 25 percent of people at some
time during their lives. They are present in
about 10 percent of the adult population at any
point in time and are a growing cause of years
lost to premature death or disability (Disability
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Adjusted Life Years (DALYS)). Mental and
neurological disorders accounted for 10 percent
of years lost to premature death or disability1
from all conditions in 1990, 12 percent in 2000
and are projected to increase to 15 percent by
2020.2 Depression accounted for the most years
living with a disability (11.9%), and ranks as
the fourth leading cause of burden among all
diseases, accounting for 4.4 percent of DALYS.3
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SWSW Business Case for Public Sector Investment - October 2010
Burden on Employers
Preventing Mental Health Disability
In the United States, workers who have mental
health problems are a significant and sometimes
hidden cost for employers. A 2008 survey of a
nationally representative sample of American
workers found that one third experienced signs
of clinical depression.4 A 2002 survey estimated
that major depression decreased productivity
by 8.4 hours per week, the most significant
single reason for reduced productivity.5 The cost
to employers is considerable; different studies
have estimated the cost of lost productivity
from clinical depression through absences and
productivity decreases at $44 billion. Based
on its 2003 short-term disability claims for
psychiatric conditions, Metlife estimated the
total cost to employers of lost productivity
plus medical fees at $344 billion annually.6
Increasingly, health insurance covers mental
health benefits and some employers offer
Employee Assistance Services, which are often
more acceptable to employees and their families
than seeking assistance from psychiatric or
mental health providers for emotional and
behavioral problems. These efforts are effective
in reducing the productivity and absentee
problems often created by untreated mental
health conditions. Multiple studies of company
Employee Assistance Programs (EAP’s)
find robust return on investment in lower
absenteeism and higher productivity.13 People
who get treatment for mental health problems
use less general medical care than those who
do not get mental health treatment.14 Two out of
three employees who seek care for workplace
issues or mental health problems were no longer
work impaired after 21 weeks of treatment.15
Depression and anxiety also interact with other
health conditions to increase productivity loss
or disability absences even more.7 Sixty-four
percent of individuals with physical concerns
(musculoskeletal, cardiac, etc.), or with extended
long term disability claims, have psychological
concerns that delay improvement in their
physical health.8 Anxiety or depression in
combination with a physical illness is a better
predictor of eventual functional impairment
than the severity of the physical illness.9
The Rising Incidence of Mental Health
Disability
Mental illness is also a rising cause of disability
and increased reliance on Social Security
Disability Insurance (SSDI). In 1999, a little
more than a quarter (27%) of beneficiaries
were diagnosed with a mental disorder,10 and
this number increased to approximately one
third in 2009.11 The federal government also
provides the Supplemental Security Income
(SSI) program and Medicaid coverage for
disabled individuals who do not have sufficient
work history to qualify for SSDI, and for those
SSDI recipients who fall below the program’s
income standards. In December 2008, a
full 60 percent of non-elderly SSI recipients
were diagnosed with a mental disorder.12
2
However, there have been few efforts to
prevent disability, and the current regulations
of the SSI and SSDI programs create strong
incentives to minimize employment in order
to ensure continued eligibility. This means that
once people become eligible for one of these
programs, they must find lucrative and stable
employment to consider leaving the program.
Though the Social Security Administration is
experimenting with reducing disincentives to
work and developing programs that support
employment, SWSW is one of the few programs
for people with mental illness in the workforce
that is designed to prevent disability. It is
also notable as one of few formally evaluated
Demonstrations of combining health care,
navigation and employment supports to prevent
disability. This Demonstration is highly relevant
because the SWSW population is similar in
many ways to currently uninsured people who
will soon get coverage under the provisions of
the Affordable Care Act. One third of SWSW
participants had incomes under 133 percent of
the federal poverty level, which is the future
eligibility standard for Medicaid. The remainder
would become eligible for other subsidized or
employer provided health insurance options.
As health care becomes available to this
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SWSW Business Case for Public Sector Investment - October 2010
group, navigation and employment support,
the other components of the SWSW program,
will become an affordable alternative for
preventing or postponing disability claims.
income support programs, program participants
and their employers derived from the program.
It estimates the costs of implementing this
program for a hypothetical cohort of 3,000,
and shows that the potential savings in
reduced dependence on public programs and
increased taxes paid into the Social Security
system repay the investment in the third
year following program participation.
About This Brief
This brief describes the costs of the SWSW
program, and the benefits that government
Table 1: SWSW Costs
Cost for Federal Grant Period
(Sept 06 through Sept 09)
Cost Category
Provider
Total Project Cost
PMPM
Cost of Full Operations
(June 08 through Sept 09)
Total Project Cost
PMPM
Program Management and
Oversight
Department of
Disability Services
$1,100,211.24
$43.80
$304,825.65
$15.06
Enrollment and Eligibility
Determination
Department of
Disability Services
$1,292,676.13
$51.46
$616,865.27
$30.47
SWSW Administration
Medica
$785,018.45
$31.25
$253,631.56
$12.53
Health and Behavioral
Health Care Coverage
Medica
$20,678,621.67
$823.16
$17,074,420.28
$843.43
Reinsurance Stop Loss
Secondary Insurer
$221,726.96
$8.83
$172,570.16
$8.52
Navigation and
Employment Counseling
Minnesota
Resource Center
$1,835,228.52
$73.06
$1,122,468.20
$55.45
Employment Services
Minnesota
Resource Center
$246,510.00
$9.81
$200,376.50
$9.90
Employee Assistance
Optum
$23,813.00
$0.95
$18,536.00
$0.92
WRAP
Consumer Survivor
Network
$7,312.10
$0.29
$2,802.10
$0.14
$26,191,118.07
$1,042.60
$19,766,495.72
$976.41
$5,290,769.44
$210.61
$2,519,505.28
$124.46
Total Cost
Total Cost of Navigation and Related Services
(less health care and reinsurance)
Source: Dept. of Disability Services Contract Expenditures Report and Special Reports, PMPMs from Medica data
Costs of SWSW
The SWSW program cost a total of $26.2 million
over the federal grant period, September 2006
through September 2009 (evaluation costs
are excluded from this total.)16 Table 1 shows
how these costs were divided between the
Minnesota Department of Human Services,
Disability Services Division (DHS), Medica,
the prime contractor, and other subcontractors,
and the key functions each provided. A total
of 25,121 member months of service were
delivered at an average cost of $1,042.60 By
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far the costliest element of the program was
health care coverage, which amounted to $20.7
million, or approximately $823 per member
per month (PMPM). The cost of all other
navigation and employment related elements
totaled $5.3 million or $210.61 PMPM.
As a Demonstration program, SWSW
experienced a slow initial enrollment period.
Therefore, we identified the period when the
program was at full operation (total enrollment
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SWSW Business Case for Public Sector Investment - October 2010
at 1,000 or greater) and calculated the costs for
this period. The second set of columns shows
the estimated cost of the full operations period.
At full operations, the $17.1 million of health
coverage is an even larger share of total costs
at 86 percent of the total $19.8 million. The
cost of all other navigation and employment
related elements totals $2.5 million, or $124.46
PMPM, substantially less (40%) than the
PMPM cost of the full Demonstration period.
We will use the $124.46 PMPM costs for
navigation and employment services to
calculate the costs of the program. The costs
of reinsurance are not included, as it was
purchased because the insured group was
small and its cost history not well understood;
reinsurance would not be needed for a larger
group. We exclude the cost of health care
services because most low income working
adults will have some form of mandated
coverage beginning in 2014. States or employers
and participants will be incurring the costs of
providing health care coverage for virtually
all potential participants. At that time, the
only consideration for states and the federal
government will be the value of providing
navigation and related services to supplement
and foster optimal use of health care coverage.
Considering the Costs of Comprehensive
Medical Benefits
It is important to note that Minnesota’s
Medicaid program is quite comprehensive, as
its state plan includes most optional Medicaid
services. Comprehensive medical and mental
health benefits were a critical element of the
SWSW program; individuals needed access
to affordable psychotropic medications, as
well as treatment for co-occurring conditions
such as substance abuse, back problems,
surgeries, and dental care. This medical care
was critical in allowing them to address health
problems that otherwise limited their ability
to work. States with more limited Medicaid
benefits will need to consider the value of
offering navigation and employment, and
will also have to calculate the costs of offering
a more comprehensive Medicaid benefit.
4
Benefits of SWSW
SWSW has produced significant value to
state and federal funders. Many of these
benefits accrued over a period of years. This
section describes the value of the benefits
and calculates the total benefits to the
public that can be reasonably estimated.
Increased Independence
The purpose of navigation services for SWSW
participants was to increase independence
through the improved use of health care
benefits and other community resources, and
an increased focus on attaining employment
goals using needed employment supports.
The intervention did reduce dependency on
government income support programs.
Reduced applications for disability benefits.
According to participant self report, the
intervention group applied for disability at a
rate 9.5 percent lower than the control group,
which was statistically significant. This means
that 170 of the 1,794 SWSW participants who
would have applied for disability did not do so.
Federal disability benefits consist of Social
Security Disability Insurance (SSDI), which
is available to people who have contributed
enough in Social Security withholding
taxes. Those with lower earnings may also
qualify for Supplemental Security Income
(SSI). Minnesota also provides Supplemental
Aid (MSA) for some SSI recipients. On a
yearly basis, an SSDI recipient would receive
approximately $13,500, and an SSDI/SSI
recipient also getting Minnesota MSA would
receive close to $10,000 annually. Disability
status also provides eligibility for health
coverage. SSDI participants qualify for
Medicare coverage after 2 years on SSDI. SSI
recipients qualify immediately for Medicaid.
Clearly, the cost savings from preventing
people from applying for disability are
considerable. However, not all of those who
apply for disability are determined eligible. In
Minnesota, approximately half of applicants
apply for SSDI and the other half apply for
both SSDI and SSI. But only half of those
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SWSW Business Case for Public Sector Investment - October 2010
applying for SSDI are determined eligible,
and only about a quarter of those applying
for both SSDI and SSI are determined
eligible. Just over a third of those determined
eligible for SSDI and SSI also get MSA.
People who successfully apply for SSDI or
SSDI/SSI are likely not to be working or to
cease working when their income support and
health care coverage begin. This means that
they are no longer paying payroll taxes and
federal and state income tax payments are likely
to decrease. We can estimate the payroll tax
payments that would be made by individuals
who did not apply for SSDI because of SWSW
services and supports. SWSW participants
had an average monthly income of $1,574,
amounting to $18,888 annually. Employees and
employers each pay 7.65 percent in payroll taxes
for Social Security and Medicare, amounting
to a combined annual total of $2,890.
Decreased use of other income support services.
Approximately 20 percent of the intervention
and control groups participated in Minnesota
General Assistance and in SNAP (the Food
Stamp program) at the time of the baseline
survey (Table 2). Smaller percentages used
housing subsidies, vocational rehabilitation, or
other public programs. Both groups showed
decreases in their use of Food Stamps and
General Assistance between the first and
second year surveys. The intervention group
experienced significantly larger decreases.
However, the differences between intervention
and control were relatively small particularly
for Food Stamps. Therefore, relatively few of
the intervention group members who ceased to
participate in General Assistance (27 individuals
or 1.2%) or Food Stamps (2 individuals or 0.1%)
could attribute the change to their participation
in SWSW. The value of General Assistance for
a year is approximately $2,300 and the value
of 9 months of Food Stamps (the average for
individual adults) is $760. Because of the effect
size, the monetary benefits of reduced General
Assistance and Food Stamps are relatively small.
Table 2: Estimated Reduction in Public Program Participation
N^
Formula
Baseline
12 month
B. %
C. #
D. %
E. %
F. Percent Change
Between Baseline
& 12 month
Participation
(C-E)/C
G. Difference
Between
Intervention &
Control
F. Intervention –
F. Control
H. Percent
Decrease Due
to SWSW
FxB
Intervention
Food Stamps
Intervention
1,112
21.00%
234
16.50%
183
21.80%*
Control
251
26.30%
66
20.70%
52
21.21%
0.59%
0.12%
General Assistance
Intervention
1,102
20.10%
221
8.20%
90
59.30%*
Control
247
24.30%
60
11.30%
28
53.30%*
6.00%
1.20%
* difference between baseline and 12 month is statistically significant at the 5 percent level (Sign Test);
^excludes missing responses;
Source: Minnesota Demonstration to Maintain Independence and Employment: Evaluation Report – Phase 1.
Estimating the Return on Investment
To provide an estimate of the return on
investment of SWSW’s navigation and
employment related services, we estimated
the costs and benefits of serving a cohort of
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3,000 participants, the approximate number
that would be eligible and interested if the
program was offered statewide in Minnesota.
The first year costs are recouped (in present
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SWSW Business Case for Public Sector Investment - October 2010
dollars) during the third year post program
enrollment, and a savings equivalent to 45
percent of the initial investment is generated
in the fourth year (net public costs).17
As shown in Table 3, provision of navigation and
employment supports in conjunction with health
care coverage to a cohort of 3,000 participants
would prevent 285 applications for disability, of
which 69 would have been accepted for SSDI,
38 would have been accepted for SSDI/SSI, and
3 would have ended their participation in Food
Stamps. An additional 13.5 of those on SSDI/SSI
would have received Minnesota Supplemental
Aid. In addition, 36 participants would have
ended their participation in General Assistance.
Table 3: Reduction in Dependence in a
SWSW Cohort of 3,000
Total enrollment
3,000
Prevented SSDI/SSI applications
285
Prevented SSDI enrollments
69
Prevented SSDI/SSI enrollments
38
Decrease in Food Stamp
participation
3
Prevented MSA enrollments
Decrease in GA participation
13.5
36
Source: Minnesota Demonstration to Maintain Independence
and Employment: Evaluation Report – Phase 1 and SSA special
report on Minnesota applications for SSDI and SSI 9/29/2010
To project net savings, we estimated total
annual operating costs of $4.5 million to provide
navigation and related employment services for
a cohort of 3,000 for 12 months in 2008 dollars,
assuming the program is at full operations
(Table 4). Most of the monetary benefits accrue
to the Social Security trust fund, which supports
SSDI and Medicare. Other savings accrue to
SSI and smaller support programs. Unlike
6
SSDI and SSI, eligibility for Food Stamps and
General Assistance changes frequently, and
average tenure is limited. We therefore cannot
assume that the savings achieved in one year
will continue at the same rate in following
years. Total savings are discounted using the
Social Security Administrations intermediate
assumptions for the real rate of return on trust
fund dollars (investment rate less inflation rate).
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SWSW Business Case for Public Sector Investment - October 2010
Table 4: Estimated Return on Investment of Navigation and Related Services for a
Cohort of 3,000 at Full Operations
2008
Total Annual Operating Costs
2009
2010
2011
2012
$4,480,448
SSDI Savings
$931,914
$931,914
$943,097
$965,731
SSDI/SSI Savings (2009)
$332,305
$332,305
$336,293
$344,364
Payroll Tax Payments
$309,215
$309,215
$309,215
$309,215
$1,573,434
$1,588,605
$1,619,310
$16,196
$17,161
Food Stamp Savings
$327
Total Federal Savings
$1,573,761
MSA Savings
$15,254
$15,722
GA Savings
$85,199
$24,365
Total State
$100,453
$40,087
$16,196
$17,161
$1,674,214
$1,613,521
$1,604,801
$1,636,471
$1,599,129
$1,577,975
$1,632,879
$1,207,105
+$370,870
+$2,003,749
Total Overall Savings
Present Value
Net Public Cost
$4,480,448
$2,806,234
Source: Social Security Administration, Disabled Beneficiaries and Dependents Master Beneficiary Record file and Supplemental Security
Record file, 100 percent data, 2008; Minnesota Department of Human Services, Reports and Forecasts Division, Family Self-Sufficiency and
Health Care Program Statistics, June 2010; Special Report on Minnesota Food Stamp tenure, 10/14.2010; 2010 OASDI Trustees Report.
Limitations. Analyses are based on selfreported rates of SSI/SSDI applications. In
addition, analyses assume that the individuals
whose SSDI applications were prevented
continue to be able to maintain employment
and independence for at least the four years
of the analysis. If some only postpone their
application for a year or two, savings estimates
would be reduced. The limited length of the
Demonstration did not provide the information
necessary to understand the durability of the
positive effects generated by the program. Given
the time required to generate a return on the
investment, it is important to better understand
longer term impacts of the intervention.
By design, this return on investment model
is conservative and does not include certain
potential savings, nor does it assume the
additional state or federal income taxes that
people would pay when they continue to
work rather than depend on SSDI or SSI.
In addition, we have not attempted to
determine whether there would be savings
in health care coverage. However, the
following section discusses the possibility
that SWSW services may desirably affect
health care costs over the long run.
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Costs of SWSW Participants’
Health Care
SWSW participants, all of whom had an
identified mental health problem, had lower
health care costs on average than estimated for
their member per month rate. This was true
even though SWSW participants, as described
below, increased their utilization of dental,
pharmacy, and medical services in comparison
to the year before SWSW enrollment and in
comparison to the control group. In addition to
demonstrating increased access to medical care,
SWSW participants also reported participation
in preventive care and behavior changes, like
quitting smoking that could generate longer
term savings in use of high cost services.
Utilization. Intervention group members
increased their utilization of health care
services in all categories compared to the 12
months before enrollment in SWSW. Control
group participants reduced their health care
utilization in comparison to the prior year.
The intervention group’s pattern of increased
utilization continued in the second year
for those who remained in the program.
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SWSW Business Case for Public Sector Investment - October 2010
Preventive care. The intervention group had a
statistically significant higher rate of reporting a
wide variety of health screens. The most widely
used screens were for Well Woman exams,
dental exams, eye exams and mammograms.
Continuity of prescription. The control
group was more likely to use strategies for
managing the cost of prescriptions such
as participating in a pharmacy assistance
program or not filling some prescriptions.
Most prescriptions were prescribed by
participants’ primary care providers.
Healthy behaviors. Thirteen percent
of the intervention group reported
that they had quit smoking.
employees, increased their value, or resulted
in a better job. The evaluation measured
participants’ self-reported employment and
income changes. Many of these changes
would have also benefitted their employers
in concrete and measurable ways, though
we do not have data to quantify it.
SWSW participants successfully met
employment goals: Participants who completed
an annual review with their navigator and
set employment related goals reported
meeting almost half (49%) of those goals.
Nearly three-quarters of those who wanted
to maintain their current job met their goal
and 33 percent of participants who made a
goal to find a better job were successful.
Reduced medical debt. There is a considerable
and statistically significant difference in
the percentage of intervention and control
group members that carry medical debt.
At the end of the second year, 17 percent of
the intervention group reported carrying
medical debt, while almost half (48%) of the
control group did so. Worry about incurring
or increasing medical debt can cause people
to postpone or forego needed medical care.
Participants set a variety of other goals, including:
Good preventive and primary care practices,
such as those described above, can reduce
the use of high cost emergency room and
inpatient services by maintaining good health
and managing chronic health conditions.18
However, the savings from reduced use of high
cost services may be realized over a period of
years. While Minnesota’s cost did not change
because they paid a capitated monthly fee to
Medica, states should be able to realize longterm savings from reduced utilization of high
cost services. These savings can be immediately
captured in state fee for service Medicaid, and
will eventually affect capitation payments.
SWSW participants with greater functional
impairments demonstrated a significant
increase in earnings. In the first year, both
the intervention and control group members
maintained or improved their income. However,
some members of the intervention group showed
statistically significant increases in income in
comparison to their control group counterparts.
Benefits to Participants and
Employers
SWSW participants set and reached a number
of goals that maintained their value as
8
• Maintain current job;
• Improve work/professional skills;
• Improve attendance at work;
• Meet productivity goals;
• Improve salary/increase hours; and
• Improve attitude at work and co-worker
relations.
Individuals in the intervention group with
lower Global Assessment of Functioning (GAF
<50)19 reported higher earnings at 12 months,
while control group participants with lower
GAF scores reported a significant decrease of
nearly $5,000 in their earnings after a year.
This placed them well below the poverty line
and at greater risk of losing independence,
offering a strong rationale for targeting this
group for navigation and employment supports.
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SWSW Business Case for Public Sector Investment - October 2010
Participants more engaged in the program
experienced greater gains in earnings.
Within the intervention group, more engaged
participants experienced greater increases in
earnings one year after enrollment compared to
participants who were less engaged (7% v. 2%).
They also showed significant improvements in
mental health status and overall functioning.
Participants with higher engagement were those
who had ten or more navigator contacts annually
and completed an annual review of their goals.
Earnings increased with greater time in
SWSW. While both groups reported increased
earnings over time, the increase at 24
months was only statistically significant for
the intervention group. Intervention group
participants enrolled in SWSW for at least 24
months reported an average earnings increase
of 14 percent compared to an increase of 8
percent for control group participants.
Personal Benefits for SWSW
Participants
Improvements in financial status and quality
of life. Intervention group participants reported
statistically significant improvements in their
ability to afford food, housing, clothing, travel
around the city and social activities which
the control group did not experience. The
intervention group also reported statistically
significant increases in positive feelings about
seven aspects of quality of life, including
financial situation, work and salary, social life,
living arrangements, free time, health, and
life in general, while control group members
experienced increases in only two aspects.
Conclusion
Analyses presented in this brief show that the
Stay Well, Stay Working program could yield a
significant return on public investment in less
than four years based on an estimated potential
savings from reduced dependence on public
programs. Most of the return is realized by the
Social Security system, demonstrating a strong
incentive for the Social Security Administration
to invest in this kind of program. While this
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analysis shows relatively small effects on other
public programs such as General Assistance and
Food Stamps, targeting services on the lower
functioning individuals in this group is likely
to show a larger impact. Many participants
generated increased earnings, especially those
with more severe problems and those who
were more engaged in the program. This would
have generated greater income tax revenue.
Almost all participants set employment
related goals, and met many of them, even in a
challenging economy. Their accomplishments
often benefitted their employers in the form of
higher productivity, more consistent attendance
and better employee relations. Depression and
anxiety were the most common problems for
the individuals in the SWSW program, and are
also the conditions of highest prevalence among
employees overall. The SWSW navigation model
could become an important addition to employer
options for addressing problems of workers
with more serious mental health conditions.
Additional benefits that participants received
include greater independence and ability to
use community resources, greater health and
job satisfaction, reduction in medical debt, and
greater satisfaction in multiple life dimensions.
Author Information
This research brief was a joint collaboration of
The Lewin Group and DMA Health Strategies.
Author collaborators included Karen W. Linkins,
PhD, Jennifer J. Brya, MA, MPP, Wendy Holt,
MA, and Richard Dougherty, PhD.
The sum of years of potential life lost due to premature
mortality and the years of productive life lost due to
disability.
2
Chisholm, D., Saxena, S. and van Ommeren, M. (2006)
Economic Aspects of Mental Health: Key messages to health
planners and policy-makers, Chapter 2: Burden of Mental
and Behavioral Disorders, World Health Organization.
3
Ibid.
4
Aumann, K. and Galinsky, E., (2008) The State of Health
in the American Workforce: Does Having an Effective
Workplace Matter?, National Study of the Changing
Workforce. Families and Work Institute, 2009.
1
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SWSW Business Case for Public Sector Investment - October 2010
Stewart, W.F., Ricci, J.A., Chee, E., Hahn, S.R., and
Morganstein, D. (2003) Cost of Lost Productive Work
Time Among US Workers with Depression, JAMA,
289:23.
6
Toran, M. Making Mental Connections, Risk & Insurance
Magazine, LRP Publications, May 2005.
7
Kessler, R., White, L., Birnbaum, H., Qiu, Y., Kidolezi,
Y., Mallett, D., Swindle, R. (July 2008) Comparative
and Interactive Effects of Depression Relative to
Other Health Problems on Work Performance in the
Workforce of a Large Employer, JOEM, 60:7.
8
Warren, P.A. (2005) The Management of Workplace
Mental Health Issues and Appropriate Disability
Prevention Strategies,Work Loss Data Institute, pp. 6-7.
9
Langlieb, A.M., Kahn, J.P. “How Much Does Quality
mental Health Care Profit Employers?”, JOEM, Vol. 47,
No. 11, Nov. 2005.
10
Drake, R.E., Skinner, J.S., Bond, G.R., and Goldman, H.H.,
(2009) Social Security and Mental Illness: Reducing
Disability with Supported Employment. Health Affairs,
28, no.3:761-770.
11
Annual Statistical Report on the Social Security
Disability Insurance Program, Social Security
Administration, 2009.
12
SSI Annual Statistical Report, 2008, Social Security
Administration.
13
Richard Csiernik, David Hannah, and James Pender.
2006, “A Review of the University of Saskatchewan
Employee Assistance Program.” Report to the
University of Saskatchewan. Saskatoon, Saskatchewan.
14
Campbell, TL; Franks, P; Fiscella, K; McDaniel, SH;
Zwanziger, J; Mooney, C; Sorbero, M; Do Physicians
5
10
Who Diagnose More Mental Health Disorders Generate
Lower Health Care Costs? Journal of Family Practice,
Vol. 49, No. 4, April 2000.
15
American Psychiatric Association, Early Treatment for
Employees Increases Productivity, Mental Health Works,
Third Quarter 2003.
16
For additional detail on cost components, see the
Appendix to the SWSW Manual.
17
For the purposes of this estimation, we have assumed
that the cohort was served in 2008 and benefits were
accrued beginning in 2009. This allows us to use actual
SWSW cost data and results, and actual data on costs
of public benefits for 2008 and 2009. Official Social
Security and State of Minnesota projections are used
for public program costs in the years 2010 and 2011.
However, our analysis is done in the context of the 2014
provisions of health reform, and therefore assumes that
SWSW services are provided as a supplement to health
care coverage which is not an optional expense.
18
The Partnership for Medicaid, Reducing Inappropriate
Emergency Room Use among Medicaid Recipients By
Linking Them to a Regular Source of Care. Available online
<http://www.thepartnershipformedicaid.org/images/
upload/ER_Use.pdf>, Accessed 10/29/2010.
19
Functioning was measured using the Global Assessment
of Functioning (GAF) scale in the Diagnostic Statistical
Manual IV (DSM IV), which was administered as part
of the eligibility determination process for the SWSW
program. Individuals with a GAF score lower than 50 are
classified in the DSM-IV as having “serious impairment
in social, occupational and school functioning
(e.g., limited social supports, unable to keep a job).
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