St. Luke’s University Health Network (SLUHN) is a nonprofit health system with more than 16,000 employees providing care and services at 12 hospitals and more than 300 outpatient locations.
The leadership team at St. Luke’s identified a need to expand mental health services to employees for the following reasons:
The healthcare profession has higher rates of anxiety, depression, and stress among employees than in many other industries, and SLUHN is committed to supporting employees through a variety of ongoing wellness programs.
Based on the results of employee surveys, wellness program participation, and medications prescribed to employees, demand for mental health services for employees was high.
Finding the Right Solution
With these learnings, SLUHN began exploring cost-effective mental health solutions that would provide additional coverage to employees.
While the effectiveness of in-person Cognitive Behavioral Therapy (CBT) is well established for many mental illnesses, the delivery of these services is difficult, due to cost, stigma, provider shortages, scheduling issues, and the lack of ability to reach the appropriate patients.
As SLUHN researched other options, it found peer-reviewed literature showing that internet-delivered CBT is an effective alternative to face-to-face treatment. This led SLUHN to consider online CBT programs. After evaluating options from multiple vendors, SLUHN selected SilverCloud for a two-year pilot program, beginning on June 1, 2017. SilverCloud would provide online clinical-level, evidence-based programs, based on CBT, to all SLUHN employees and their spouses, free of charge. The pilot specifically targeted stress, anxiety, and depression.
SilverCloud had previously achieved successful clinical outcomes by providing companies with a self-guided approach. However, SLUHN wanted to deepen its employee offerings, by supplementing SilverCloud’s self-guided program with coaching. SLUHN hired a full-time coach with a master’s degree in social work to help guide employees through the online SilverCould system. The aim of coaching alongside SilverCloud’s programs is to support engagement, personalize the experience, and to escalate to additional care when necessary.
SLUHN then developed goals in four areas: participation, clinical effectiveness, cost avoidance, and participant satisfaction rates:
Achieve 1,000 participant activated sign-ups in year 1
Gain clinically-significant improvement in each category of baseline severity
Provide mental health services to more employees at a lower overall cost
Reduce stigma of mental health services through network member use of the SilverCloud program and determine participant satisfaction with the platform
The results were overwhelmingly positive.
Participation and Satisfaction Rates
SLUHN reported these outcomes after implementing SilverCloud’s online CBT program:
- In the first year, 1,161 SLUHN employees and spouses signed up -- a 16.1% increase over goal.
- Participants gave a 97% satisfaction rate to the program.
Participant outcomes were measured using the industry-standard tools, Patient Health
Questionnaire (PHQ9), for depression, and Generalized Anxiety Disorder-7 (GAD7), for
anxiety. Participants in every category of depression and anxiety severity reported
clinically-significant improvement, meaning a reduction in GAD7 or PHQ9 scores of 3 points or more. Highlights include:
- PHQ9 (Depression) - In the Moderate to Severe category, 71% of SilverCloud users reported clinically-significant improvement.
- GAD7 (Anxiety) - In the Severe category, 62% of SilverCloud users reported clinically- significant improvement.
Return on Investment (ROI)
SLUHN achieved its goal of providing cost-effective mental health services that would provide additional coverage to employees:
During the first 21 months of SilverCloud implementation, for every dollar spent on SilverCloud, SLUHN saved $17. SLUHN achieved 17X Direct Return on Investment (ROI).
Expansion of Mental Health Services
“Based on these results, SLUHN extended the use of the SilverCloud platform beyond the initial pilot project. Employees and spouses continue to have use of the program, and we have made it available in several specialty care settings for participants, including behavioral health and cardiopulmonary rehab clinics. We continue to see favorable results among participating employees", says Amy E. Previato, MPH, CHES, DipACLM, St. Luke’s Network Director, Employee Wellness.