Four months ago, my daughter woke up with a stye in one eye.
While my 10-year-old was handling her infection like a champ, I wasn’t. All I could think was, “I need to get her to a doctor as fast as humanly possible.” But it had been almost two years since we visited her physician’s office and I was still tepid about sitting in a waiting room with other people.
I said a silent prayer, called her doctor’s office and left a message, hoping everything could be sorted by a phone call. After all, we were still in the midst of the coronavirus pandemic. When the doctor called me back a couple of hours later, he asked me a running checklist of questions about her symptoms and the stye’s location. About 15 minutes later, I had a prescription waiting at my local pharmacy.
Typically, in such a situation, I would’ve missed work and spent hours in a medical centre’s waiting room. But all of that was simplified with a single phone call. In addition, my employer has since introduced a virtual platform that’s made it even easier to access a medical practitioner.
Over the last two years, virtual health care has solidified its place in both the public and private health-care systems, with employers across the country investing in these digital solutions to support their employees.
But as Canada starts to return to some semblance of normalcy, will our health-care system revert back to primarily in-person care? Or will provincial governments continue to invest in these support tools, rendering employer-sponsored health apps moot?
Case in point
Almost a year before the pandemic, IGM Financial Inc. enrolled in a pilot program for a mobile health and wellness app.
Then, in April 2020, the company — which already provided its 4,000 Canadian workers and 4,000 advisors with an employee assistance program — expanded its support by launching an internet-based cognitive behavioural therapy program at no cost to employees.
Felicia Blackburn, the organization’s director of pension, benefits and wellness, doesn’t see virtual
health care disappearing or changing, particularly now that people are used to receiving timely and personalized services.
Indeed, in the first year of the pandemic, 43 per cent of plan members received care virtually from a health-care provider, a number that increased among those in poor health (57 per cent), with caregiver responsibilities (52 per cent) and those with a chronic condition and/or chronic pain (51 per cent), according to the 2021 Benefits Canada Healthcare Survey.
While some of Blackburn’s industry colleagues view virtual health solutions as a temporary measure that won’t be required when the pandemic subsides, she believes these platforms will continue to be a critical part of the employee value proposition. “Just because the government is offering it, it doesn’t mean that’s the level of coverage that we want our employees to have.”
Paula Allen, global leader and senior vice-president of research and total well-being at LifeWorks Inc., likens these offerings to the additional health benefits provided by employers despite the public health-care system. And she believes these apps will evolve even further to meet the needs of the post-pandemic workforce.
An equitable system
When IGM Financial rolled out its iCBT offering, the service was already available through Manitoba
and Ontario’s public health-care systems.
But the organization has offices across the country, so it provided the benefit for free to all employees to ensure they have access to the care they need without waiting in a queue, says Blackburn. She notes this also ensured IGM Financial is providing equity in delivering the service.
Allen believes the next frontier of virtual health solutions involves ensuring employers are providing equitable services. “If you’re a single parent who works full time, there’s a lot of things that prevent people from getting care — there’s inequities for those who live in remote areas or challenges such as parking in urban areas.”
Virtual health care will continue to level the playing field by embedding service options — such as video and telephone counselling, iCBT and chat-based interventions — into the health-care system, she says.
However, Aude Motulsky, assistant professor at the University of Montreal’s school of public health, says virtual health care could also unintentionally increase inequities. “It’s the responsibility of our universal health-care system to ensure that everybody has the same accessibility. Regulators should make sure everybody is going to have the same improvement and that distribution isn’t based on your income, employment or insurance type.
“The status of the providers rely on provincial health-care law outlining what is insured or what is not. Virtual care is unclear. Is it a universal service or not? I think we need regulation for quality and safety
of these services, but also for universal access.”
While virtual care became the entry point for care for acute medical conditions at the beginning of the pandemic, it’s now viewed as an extension of many other services in the continuum of care — from prevention to full treatment and recovery, says Andrée-Anne Bourgeois, director of products, communications and marketing for group benefits and retirement solutions at iA Financial Group. “Virtual care is reshaping our view of health care, from curative to preventative.”
Daniel Martz, vice-president of virtual care at Telus Health, believes employer-sponsored virtual health-care solutions will increasingly become the front door into the entire continuum of care for employees. These virtual experiences cover the entire wellness journey for plan members, he adds, and plan sponsors are seeking to deliver that journey through one unified platform.
Indeed, at IGM Financial, feedback from employees has highlighted that those looking to use the organization’s virtual care services often don’t know where to start. “We’re looking for more of a one-stop shop that can provide us with the most bang for our buck, so we’re not taking away any services, just enhancing that employee experience,” says Blackburn.
Suresh Moorthy, national product leader at Mercer Canada, agrees more choice can be overwhelming for employees because it may mean a change in habit. But he also notes this is part of the evolution of how people consume their health-care services. “There’s always a change management process. What we’ve seen is once a person uses these services, the satisfaction rate goes through the roof.”
And from an attraction and retention perspective, Moorthy says the more services employers provide, the more likely employees are to stay with the company.
Considerations around privacy
With specialty vendors from a range of disciplines breaking down barriers to digital care, employees can find the right help, no matter where they live and work, whether it’s digital health counselling or support for musculoskeletal health issues, sleep therapy or alcoholism, says Moorthy.
He believes the next phase of virtual care will see more communication between physicians in the public health system and physicians accessible through employer-sponsored health-care apps. “If I’m an individual looking to take care of my health, it would be great if the health-care provider I choose is able to see my circle of care — which pharmacist am I using? Am I also seeing a specialist for a condition?”
Telus Health has launched a collaborative health records platform that facilitates secure communication between health professionals and plan members in order to maintain continuity of care. Through the app, data derived from plan members’ interactions with health professionals are sent, with members’ consent, to their family doctors.
Martz believes opening up those portals of communication so plan members’ interactions within employer-sponsored health and wellness experiences can be captured in electronic medical records will power continuity of care.
However, Moorthy notes patients are already providing this information through a number of self-reporting tools. “If we could elect to make that self-reporting available in a record of truth that’s accessible to all of our health-care providers, it would . . . allow me to go between the public and private sectors and have all my health-care providers know what I’m doing with my health.”
But navigating privacy laws when it comes to patients’ health-care records can be a minefield, particularly when health information is collected through a mobile app, says Robin Gould-Soil, a data privacy consultant at KPMG in Canada.
Privacy laws clearly define that employers don’t have the right to individuals’ medical information, she says, cautioning employers to tread carefully because many of these platforms may be collecting medical information through questionnaires administered through artificial intelligence. Since these chatbots aren’t regulatory professionals — such as psychologists, doctors or other specialists — there are no real laws governing these tools and that’s a worry spot, she says.
Gould-Soil advises employers to add an extra layer of due diligence when including mobile health-care apps in their benefits offerings to ensure they know how and where that information is being stored, as well as how it’s used. This is highly sensitive medical information, she adds, so they should understand what needs to be protected and what type of information they have the right to access.
This aggregate data is a game-changer for employers, as they can see trends within their entire population and gauge whether they want to use other strategies to minimize risks that could affect their workforce, says Moorthy.
IGM Financial has used aggregate data as a guide to know when and where to pivot, what the organization is seeing with disability numbers and to gauge the competitive landscape, says Blackburn, and it intends to harness the data to proactively target its employee support tools and strategy.
Lauren Bailey is an associate editor at Benefits Canada.