Between 2010 and 2014, the Alberta School Employee Benefit Plan’s spending on specialty drugs increased by 71 per cent. When it came to those members taking specialty drugs, 90 per cent of the spend was for chronic therapies.
The findings led the organization to rethink and redesign its benefits offerings.
Shandy Reed, division manager for health strategies and stakeholder engagement at the plan, spoke at the 2016 Face-to-Face Drug Plan Management Conference in Vancouver, about how the plan create a health and benefits charter.
“What we really realized was that things are changing around us,” she said. “So we don’t have a lot of control over some of those factors and we needed to have a charter to help us make some plan design changes now and into the future.”
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In 2014, the plan also created a health benefits advisory panel to support future efforts to redesign and develop current offerings. Numerous stakeholders contributed, including physicians, pharmacists, a dentist and a dental hygienist, as well as people with expertise in analytics, plan design and strategic planning.
“We said to them, ‘Here’s our plan. Tell us where we’re off. Where are we paying for things that we’re not having good health outcomes? Where can we do better? What’s not aligned to clinical guidelines? Where are we missing the boat?’” said Reed.
She noted the panel’s experience from relevant sectors has helped the plan avoid major problems it wouldn’t have otherwise known about.
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Reed also spoke about how the plan shifted its plan philosophy to make it more strategic. “We’ve looked to see [whether there] are short-term investments that will have longer-term gain for us.” For example, the plan now pays for travel vaccinations because doing so can prevent people from getting sick and missing work.
The plan is also finding new ways to interact with members, such as social media, which it hadn’t been using in the past. It’s using mobile apps and online claims and, in the future, will have a new website that could include live chat and other tools like gamification. “We’re really in a state of growth and there’s a lot of work to be done,” said Reed.
Read more from the Face-to-Face Drug Plan Management conference