Mental health is the third largest health spend in terms of benefits plan management, according to Derek Weir, manager of health benefit solutions at Medavie Blue Cross.
“Fifty-three per cent of Canadians consider anxiety and depression ‘epidemic’ in Canada and 85 per cent say mental-health services are among the most underfunded in health care,” he said during a session at Benefits Canada’s 2019 Toronto Mental Health Summit on Nov. 29.
Analytics in health plan management is collecting, aggregating and visualizing data in a way that’s useable, noted Weir, and data has to be presented so plan sponsors can use it to make decisions. This can allow actionable insights into what’s driving plan costs and help plan sponsors to drive priorities. Further, it can allow employers to coordinate their efforts, target hot spots and manage different risks. “Data is used to spend time more efficiently and allows organizations to enhance their portfolio of health plan products.”
When it comes to using data intelligently, according to Weir, the four main goals are: optimizing benefits utilization — the right treatment, the right person and the right time; improving population and personal health outcomes; lowering costs; and engaging members.
He showed a therapeutic dashboard detailing antidepressant drug spend by region. In Ontario, 13 per cent of people are covered for an antidepressant, while 8.6 per cent have also claimed counselling alongside that prescription. The average rate of medication change is 2.1 times. And 34 per cent of people claimed an antidepressant for the first time, but 17 per cent didn’t fill a second prescription.
It’s complicated, said Weir, noting employees aren’t taking just one pill. “They’re taking a lot of other things as well. People taking antidepressants are much more likely to claim other drugs. For example, they’re twice as likely to claim for gastrointestinal drugs.”
In addition, he said people taking antidepressants are much more likely to be also claiming for diabetes and vice versa. Further, looking at specific populations, data shows women comprise the bulk of claimants. Effectively, from the age of 25, twice as many females as males are claiming for antidepressants.
The prevalence of antidepressant use is very high and the prevalence of psychotherapy use is growing fast, said Weir. “In fact, psychotherapy is the fastest growing benefit we have in the top 10. The utilization trend on psychotherapy is high.”
When people are on disability leave for anxiety or depression, more than half (56.5 per cent) started taking their medication before their disability, and about half (28.4 per cent) of this group started more than a year before they went on disability, said Weir. Within this group, a quarter (25.7 per cent) started taking their medication in the same month as disability leave, he added, noting 17.9 started the medication after they’d opened their claim.
Today, plan sponsors have a lot of tools at their disposal and opportunity to get involved earlier, said Weir. “We’re trying to mitigate the chance that someone’s going to go on disability — that’s the million-dollar question. We’re trying to provide more solutions to people before they get to disability.”
On disability, the data shows that adding early psychiatry intervention on short-term claims can improve the number of people who return to work before going on long-term disability by 28 per cent, he said.
“Mental illness is the leading cause of disability. The optimizing of treatment selection — right person, right drug, right time — and adherence to the treatment is important. Solutions are being developed to try and improve drug adherence. We can’t ignore it. It’s so important and has such a pervasive impact on the benefits plan, that it can no longer be something we sit idly by and let happen. New supports like virtual cognitive behavioural therapy are important.”
Read more coverage of the 2019 Toronto Mental Health Summit.