Why claims data underestimates mental health risk

Mental health is often the most prevalent condition among white-collar workforces and second only to musculoskeletal issues in blue-collar settings. Yet, many senior leaders still can't answer a fundamental question: how many of their employees are living with a behavioral health condition? 

That knowledge gap creates a strategic blind spot with direct implications for performance, safety, retention and cost. Closing it requires employers to look differently at data from health plans, TPAs, PBMs and EAPs with the help of their advisers and insist on reporting that reflects a population health perspective rather than fragmented benefit utilization.

Many organizations start by asking the wrong question. They treat "mental health data" as a count of EAP calls or isolated claims rather than a window into the overall health and resiliency of their people. A better approach is to step back and consider the prevalence of behavioral health conditions across all covered lives, their impact on both acute and chronic health and how effectively available programs work together across the continuum of need. Answering these questions depends on integrating data across sources and grouping diagnoses in a way that mirrors how people actually experience mental health challenges.

When related conditions such as depression, anxiety, substance use disorders and attention disorders are viewed together, the true scale of mental health's effect on workforce performance becomes visible. However, traditional reporting often splits these conditions into silos, minimizing the aggregate impact. 

Read more: Modern Health's new FlexEAP aims to meet employees' mental health needs

Employers can address this by working with their health plan, TPA and PBM to request behavioral health reporting that integrates medical and pharmacy claims. This step helps capture both prevalence and cost, since many individuals receive treatment solely through medication and might not appear in medical claims at all. These reports should also highlight comorbidities, given that roughly two-thirds of those managing a mental health condition are also dealing with another chronic medical issue.

Granularity matters, too. Differentiating between low-intensity services such as brief counseling or general medication and higher levels of care provides valuable perspective on where resources are most needed. That clarity allows employers to invest strategically and helps shift executive discussions from "should we invest in mental health?" to "how quickly can we strengthen this support?"

Employee assistance programs often serve as the front door for mental health, but high-level utilization numbers can be deceptive. Many employers see only 2% to 5% of covered lives using the EAP each year, even when actual need is much higher. Organizations that actively promote their programs and cultivate a stigma-free environment often reach utilization rates closer to 10% to 12%. To make EAP data meaningful, reporting should go beyond call volume to show unique users, the primary reasons people seek help, such as anxiety, stress, or relationship challenges and user satisfaction with access and follow-up support. Some EAP partners also can provide estimates of how their services affect absenteeism and presenteeism, offering a more direct link to business performance. 

Another often overlooked source is EAP website analytics. Search terms and content usage patterns can act as an early warning system, revealing pressure points such as caregiving strain or financial stress months before they surface in claims. Reviewing these insights alongside claims helps benefit leaders spot emerging trends and take proactive steps.

Putting all of this into practice takes coordination across partners. Benefit leaders should request grouped behavioral health prevalence and cost reports, ensure EAP metrics reflect meaningful indicators of reach and satisfaction, and benchmark utilization against that 10% to 12% aspiration. 

Read more: 5 considerations when supporting employee mental health needs and comorbid conditions

They also can review cases requiring higher-level referrals to understand how effectively employees are being guided toward ongoing care. Regular data reviews with wellness committees and senior leaders can keep mental health visible as a core performance driver. Equally important, managers need training to recognize early signs of behavioral distress and to know how to connect employees to the right resources. 

Ultimately, the goal isn't another standalone report or point solution — it's a cohesive, population-level view of behavioral health that draws from every relevant data source. Once employers see mental health for what it is, one of the top chronic conditions affecting their workforce, a comprehensive, coordinated strategy becomes essential. 

Read more: How to effectively communicate EAP benefits to employees

By integrating data intelligently and acting on what it reveals, organizations can move beyond fragmented efforts toward a sustained, high-value approach to emotional well-being. Benchmark employers already recognize that strong behavioral health is inseparable from total workforce health and rely on clinical expertise to continuously refine their strategies. The organizations that follow their lead will be the best equipped to sustain performance, resilience and growth in the years ahead.