Bob Dylan and Business Process Outsourcing, an obvious connection, right?
“If your time to you is worth savin', Then you better start swimmin', Or you'll sink like a stone, For the times they are a-changin'.”
Now more than ever, flexibility and agility are fundamental qualities for employee benefits. If an employer is not able to quickly adapt to the ever-changing needs of their team and extended families, they are not only failing the people that matter most but are also hurting the bottom line. So how do you help? You listen.
As a Canadian leader in the Business Process Outsourcing (BPO) industry, SEB has partnerships with over 50 clients and provides services to close to half a million Canadians and their families. What this degree of firsthand exposure provides, is a rare glimpse into what really matters to today’s workforce. And what matters today, is changing. At light speed.
At SEB, listening to our client partners put a spotlight on wasted time spent chasing and processing premiums for employees not actively at work. In response, we created the FlexPlus PAY solution to cost-effectively automate the process of premium payments.
Listening to employees that need ease of access to coverage or information, fueled the development of FlexPlus CONNECT; a total HR integration platform that eliminates the need for multiple passwords and bookmarked favourites.
“For the times they are a-changin’.” Gone are the days of administrative processes driving plan design decisions. Gone are the days of traditional, one-size-fits-all coverage and of paper administration. If your benefit solutions are a hurdle to clear rather than a helping hand, it might be time to re-evaluate. Or, if you’re enjoying the throughline, it’s time to stop “Blowin’ in the Wind”.
We’d love to start listening to you to find out how we can help you and your team today. Visit us at www.seb-admin.com.
Why is sleep critical to your workplace mental health and safety strategy?
Sleep is the underdog of the workplace. Often tossed aside, it is nonetheless one of the most powerful tools to protect mental health and support employees’ performance and safety.
Sleep deprivation is costly for everyone. Sleep disorders increase the risk of developing mood disorders, such as anxiety and depression and are associated with high rates of absenteeism and presenteeism at work. Epidemiological studies estimate that at least 40% of the population experience symptoms of insomnia. Meanwhile, the employer bears the cost burden: the direct and indirect costs associated with sleep deprivation in Canada total over $21 billion annually.
Physiological processes during sleep help potentiate attention and memory, better manage stressful situation and emotions, boost your immune system, and maintain better muscle reaction time. Prioritizing sleep hygiene therefore means mentally and physically healthier individuals, that show up for work, have more efficient work days, fewer accidents, and overall enhanced long-term performance.
Accessing effective care for sleep problems is a major obstacle for employees. HALEO’s national virtual care solution addresses this by providing access to licensed healthcare professionals with expertise in treating sleep disorders and optimizing sleep. Offered to employers on a subscription model, HALEO can be used as a standalone solution, or complementary to an Employee Assistance Program or telemedicine solution.
With mental illness and burnout increasing in all levels of the workforce amidst the current pandemic, helping your employees sleep better is your best insurance policy. Whether it’s treating a clinically significant sleep disorder or improving sleep hygiene, HALEO can help.
What benefit relief is being offered to plan sponsors, businesses, and their employees to aid in this pandemic?
Answer from George Grivogiannis, CEO, First Canadian Benefits
COVID-19 Health and Dental Relief Program
We all have overextended ourselves as we continue to navigate through these uncertain realities. Governments, institutions, individuals, etc., have sacrificed and endlessly continue to contribute aid during this pandemic. Health care costs have spiraled out of control. Our real GDP has plummeted at an annualized rate of 38.7%. There is currently no form of relief in health benefits. First Canadian Benefits (FCB) is putting forth a primary health network that provides benefit relief through contracted health and dental providers.
Thousands of health and dental providers have enrolled under the FCB delivery of care model to provide relief on fees for services being performed. This relief translates to savings for the plan sponsors and inevitably to Candian businesses and their employees.
FCB Health Network is away from common ownership, as it functions under governance with recommended program guidelines and Schedule of Services that are put forth and recognized by the health and dental provider’s professional associations. Procurements utilizing the FCB Health Network for benefit relief are established by the FCB executive team and approved, amended, and/or recommended by a governance board of the Ontario Managed Care Association (OMCA).
FCB pledges $1 billion in benefits relief to Payors of Health and Dental employee benefits. Savings being produced by plan sponsors range between 20-30% on all health and dental claims payable. FCB contributes a percentage of savings back to healthcare/charity.
We encourage all Payors, Funds, and Industry Affiliates to enroll by visiting our website www.Firstcanadianbenefits.ca. Once enrolled our procurement team will contact you with the terms and conditions.
Processors of health and dental benefits will be adopting, through their plan sponsors, the FCB Health Network, its guidelines, and schedules into their system as they enable FCB as a PPN (Preferred Provider Network) to payors of health and dental employee benefits. We will be rolling out the COVID-19 Health and Dental Relief Program for an effective date, Jan 01, 2021. Please join us in this non incentivized not for profit care model and contribute to FCB’s social contract through these unusual times. Enroll now!
How can employers support employee financial wellbeing without incurring additional costs?
In a highly competitive talent market, Canadian companies are under more pressure than ever to become an employer of choice.
Research shows that a majority of employees believe their employer has a role to play in their financial health. Survey responses also show that financial stress impacts employees’ ability to focus on work: those who identify as financially stressed reportedly spend more than three hours per week dealing with financial issues*.
Addressing employee financial wellness is an ongoing need, but not just to solve for the negative impacts of financial stress. An excellent benefits package helps retain talent and the question that always comes up is how to provide more support and alternative compensation without the added expense to the employer.
One solution is innovation in benefits offerings. Looking beyond the traditional health and finance products and layering in additional group benefits can save employees thousands of dollars each year.
For example, Sonnet Insurance, a fully digital Canadian home and auto insurer, is leveraging its online platform and partner brands to provide group insurance participants a suite of services and information to improve and support members with car and home ownership. That’s in addition to turning a traditionally complex need into a 5-10 minute lunch break task.
With wage increases being outpaced by the cost of living, employers need to look for other ways to alleviate the financial stress of their workers. Digital brands like this enable employee engagement, retention and productivity with minimal effort.
How can employers offer employees better health benefits while managing costs?
Answer from Vigna Vivekanand, Chief Financial Officer, Express Scripts Canada
There is no doubt, high-cost medications have put a strain on drug plans across Canada. This trend is only expected to accelerate as the industry moves towards specialized and targeted drugs such as biologics. A robust benefits plan is an important part of overall compensation when recruiting and retaining top talent. Fortunately, you don’t have to choose between paying big premiums for a drug benefit and taking care of your employees.
Today’s drug insurance environment is more complex than ever, so you need to implement innovative solutions to optimize your benefit investment. A multifaceted or comprehensively managed plan should 1) control costs at the source, 2) optimize the use of the prescription drug benefit, 3) support plan members and 4) educate plan members.
If not controlled, drug plans can lose money due to poor patient decisions that lead to waste. For example, plan members should be encouraged to use less expensive pharmacy delivery channels and 90-day dispensing intervals. Further, they can be encouraged to use clinically-equivalent alternative medications, like generics, and prior authorization can be introduced to ensure plan members receive the most appropriate, safe and cost-effective treatments. Some pharmacy delivery channels also provide innovative solutions to manage high-cost specialty drugs while maintaining patient access and health outcomes.
To further support plan members who can become overwhelmed by a diagnosis or worry about whether they are taking their medications properly, employers should consider teaming up with a pharmacy that offers refill and renewal reminders and 24/7 access to highly qualified pharmacists to guide and support them.
As we look ahead, benefit plan sustainability hinges on solutions that translate into lower costs and improved health outcomes. Through better benefits management, employers can reduce benefits costs while still providing value to their employees.
How can telemedicine benefits support globally-mobile employees during the COVID-19 pandemic?
Answer from Nancy Brown, Sales Director, Canada, Voyageur Global Benefits
Working outside your home country can be exciting and rewarding. It can also make relatively simple things seem complicated—like seeing the doctor—especially in today’s climate of uncertainty with COVID-19. By eliminating travel time, time in the waiting room, and physical touch, telemedicine can provide safety and convenience.
To better support globally-mobile employees, Empire Life Voyageur Global Benefits, administered by MetLife, now includes telemedicine benefits. It’s all about easy virtual access to licensed healthcare providers who can offer medical advice, treatment options, prescription refill support, and more – globally.
Telemedicine benefits provide:
- 24/7/365 access from anywhere in the globally
- A trusted network of doctors – no matter where the employee is working
- Unlimited talk time with a doctor
- Consultations on a wide range of health care needs
- Access to doctor’s notes, referral recommendations, and prescriptions
Living in a new country can be challenging, especially today. This new addition to the Voyageur Global Benefits suite of products adds a new layer of support to globally-mobile employees as they navigate the challenges that come with being an expat during COVID-19. We’re doing our part to make it simple, fast and easy to access healthcare anywhere in the world.
For questions, please email Nancy at email@example.com
Teleconsultation is not an emergency medical response program. In the event of a medical emergency, you should contact your local emergency medical service. You can receive Teleconsultation services for limited, non-urgent, non-life threating medical conditions; this service is not appropriate for all conditions. Services, including assistance with prescriptions, will be provided if permitted under applicable law. Teleconsultation services are arranged through AXA Assistance USA and are provided by a third-party teleconsultation provider.
How can workforces become stronger and healthier in the midst of a pandemic?
Canadian organizations have been increasingly adapting best practices to ensure the sustainable health and safety of their workforces in this extended era of Covid-19. This must continue, especially now, as employees start to slowly return to the workplace after a prolonged absence during the height of the pandemic.
To this end, EQ Care, the Canadian pioneer in telemedicine, is uniquely equipped to mitigate the stress and anxiety of employees who are making this transition under the cloud and fear of this unprecedented time.
As Canadians are understandably feeling anxious, as reported in Benefits Canada, there is a wave of forward-thinking employers who are providing flexible virtual healthcare services in their benefits plans.Even before the pandemic, more companies were adopting telemedicine as a valuable service to enhance their employees’ health and productivity.
Guided by over three decades of healthcare management expertise, EQ Care patients are able to speak face-to-face with Doctors, mental health professionals and a wide network for specialists. In fact, patients and their family members are just “Two Clicks to Care."
Our promise is to always provide simplicity, flexibility and empathy to best deliver the experience of EQ Care’s Human Touch.
In a national survey of 1,500 Canadians by the Angus Reid Institute for EQ Care, those polled across every demographic showed a clear preference for virtual healthcare delivered by human beings with compassion. That is why we are doubling down on the Human Touch while integrating cutting edge decision support technology for a better and more efficient patient experience.
Canadian businesses should also consider the broad implications of a looming mental health crisis that is emerging as a health issue for years to come. Impactful tools — like EQ Care’s Digital Cognitive Behavioural Therapy (dCBT) platform, which is supervised by dedicated therapists, can help fortify a more robust and comprehensive response to an unprecedented crisis.
When practiced optimally, EQ Care innovations like dCBT can help the public healthcare system, improve the mental and physical wellbeing of working populations and their families, and are valued as being among the best investments any business can make.
Tell us about Sun Life’s Group Retirement Services Environmental, Social and Governance (ESG) evaluation framework for your core investment platform and why it’s an important focus for you now?
Answer from Kate Nazar, VP, Strategy and Market Development, Group Retirement Services, Sun Life
Sustainable Investing is an integral pillar in Sun Life’s overall sustainability strategy. Not a day goes by when we don’t read about how COVID-19 has strengthened the case for incorporating ESG factors into investments. The current financial and health crisis has enhanced the importance of the Social and Governance factors, to a similar level that Environmental factors were, pre-pandemic.
Over the past three years, we’ve collected a robust body of knowledge about how each investment manager on our core investment platform integrates ESG factors into portfolio construction. With this, we’ve developed a proprietary ESG evaluation framework that we announced in July. Our framework covers funds available in every major asset category on the Group Retirement Services (GRS) platform. This framework is an extension of our industry-leading governance program managed by our Investment Solutions team.
The goal of our framework is to make it easy for plan sponsors to identify ESG leaders on our platform and help them understand ESG integration in their current line-ups.
We’re ready to start the conversation with plan sponsors about how they can align their corporate sustainable strategy to workplace savings plans. We can all contribute to a more sustainable future.
What strategies can we employ to ensure the sustainability of health benefits plans?
Answer from Shawn O’Brien, Principal, Data Enablement and Drug, Health, Dental Product Roadmap, Telus Health
As we consider our rapidly changing healthcare landscape, particularly in the face of a global pandemic, we can turn to drug data trends for guidance on how these changes might impact health benefits plans.
The 2020 TELUS Health Drug Data Trends and Benchmarks Report considers trends in private drug plan costs, utilization, and plan design feature adoption. It serves as a snapshot of the past year, giving insurers, administrators and employers a glimpse into the future as we navigate this COVID-19 world.
Over the past five years, 2019 saw the largest increase in average eligible costs for private drug plans. While a number of factors have contributed to this rise -- from the growing cost of specialty drugs to the increase in use of medications to treat chronic diseases such as mental health, diabetes and other metabolic disorders -- plan sponsors can also lean on a number of cost-containment strategies to curb spending, and support the development of more sustainable health benefits plans:
- Mandatory generic substitution -- Already a popular design tool, adoption of mandatory generic substitutions has grown over the last five years, helping to reduce overall costs. For plan sponsors not yet leveraging this design, it is encouraged to assess the potential cost savings this strategy could provide and prepare for any barriers to putting it in place.
- Managed formularies -- As drug prices continue to soar, including those for traditional drugs which saw a sudden price bump in 2019, plan sponsors should have a discussion with their benefits advisors to explore the merits of managed formularies. Advisors can be particularly helpful in navigating implementation and addressing any concerns from plan members.
- Next generation solutions -- Additional levers to contain costs, such as Product Listing Agreements, biosimilar strategies, high-cost claimant and chronic disease management, will begin to emerge which will further future proof private drug plans.
Health benefits plans serve as an important pillar within our healthcare landscape, and they must shift alongside major health issues and the evolving needs of our workforce. Insights into areas of need help all of us innovate and improve health experiences for all Canadians.
For more information, and to access the full report, please visit the TELUS Health Benefits Hub.
How has COVID-19 changed the landscape of healthcare in Canada, and what role can telemedicine play in employers’ return-to-worksite plans?
Answer from Dr. Tim Foggin, Canadian Medical Director, Teladoc Health
While COVID-19 has certainly accelerated the adoption of telemedicine in Canada, the need for expanded access to high-quality healthcare isn’t new.
Long wait times, geographic limitations and a shortage of licensed physicians have all contributed to a shortage of access to timely healthcare. And with a growing number of Canadians reporting existing health conditions combined with an aging population, that shortage is only getting bigger. According to The Sanofi Canada Healthcare Survey, more than half of plan members (54%) report having at least one existing condition, and that number jumps to 69% among those 55 to 64.
Telemedicine, when delivered with the unsurpassed scalability and clinical quality of Teladoc Health, solves these challenges by giving patients across Canada 24/7 access to Canadian board-certified physicians by phone or video within one hour of a visit request, relieving the burden on emergency rooms and urgent care clinics.
Perhaps the most significant unexpected benefit of the COVID-19 pandemic is that it has opened up many Canadians to the idea of using more technology in their health management. According to Sanofi, 71% of plan members are now willing to use telemedicine—up from 45% only a year ago.
Now, as businesses start looking at how to safely welcome employees back to the office, Teladoc Health provides the additional benefit of giving employees a sense of confidence in their employers’ return-to-worksite plans while continuing to close the gaps in access to high-quality care.
Has the COVID-19 crisis affected the use of mental health medications?
Answer from Mike Roszak, Vice President and Chief Operating Officer, Express Scripts Canada
The COVID-19 pandemic has had a profound impact on Canada and the world, and there are numerous reports that Canadians feel it has affected their mental health. Our research reveals a significant uptick in the number of prescriptions being filled for antidepressants in the first five months of 2020.
Between January and the end of May 2020, we noted a 11% increase in plan members making claims for antidepressants compared to the same period in 2019 and claims volumes and costs in this category rose proportionately. This analysis confirms the serious impact that COVID-19 may be having on Canadians’ mental health and employers have a role to play in ensuring their employees stay mentally healthy.
Employers need concrete plans to assist employees with rising mental health concerns. As well, plan sponsors must ensure employees who are experiencing mental health conditions have access to doctors, pharmacists, therapists and prescription medications.
It is important that people suffering from mental health and other medical issues receive the support they need from their benefit plans. While we can’t predict what the coming weeks and months will bring as the pandemic evolves and Canada re-opens, we do know that members need additional care and support.
How can HR Leaders and Consultants support the remote workforce and their families during the COVID-19 pandemic?
Answer from Nancy Brown, Sales Director Canada, Voyageur Global Benefits
As the COVID-19 pandemic evolves, HR Leaders and Consultants are grappling with how to effectively support the workforce — especially the vulnerable working parent population. Voyageur Global Benefits is providing access to a recording of a recent webinar, provided by MetLife, with Cleo, the support system for working families that combines proactive, expert guidance with an intuitive engagement hub to help working parents confidently manage every stage of their family’s journey. The webinar is titled, “Supporting Your Workforce and Their Families in the Time of COVID-19”.
Here are some recommended tips from Cleo on how to better manage, engage, and support remote workforces and their families during this time:
- Let it go: Send a questionnaire/poll at the top of the week for suggestions of what can be moved off of the schedule this week or this month. Discuss them and agree to move on (for now).
- Buddy up: Communicate the top 3 musts for the week, record them, and create partnerships/tag teams for team members to share responsibility, even if that goes against the norm.
- Be realistic with yourself: Be transparent with colleagues & your manager. Take non-essential tasks off your to-do list & communicate what is/isn’t possible. Be forgiving of your imperfect parenting.
For more insights on how to support the remote workforce, watch the webinar recording here.
Group insurance policies issued by The Empire Life Insurance Company, 259 King Street East, Kingston, Ontario, K7L 3A8, Canada
Toll free: (877) 548-1881 | Visit empire.ca/
How can you uncover and resolve hidden health risks in your Plan Member population, including challenging issues such as mental health?
Despite the best efforts of healthcare providers, issues related to medication safety, adherence, and less than optimal care all contribute to poor health outcomes for plan members, and disability and absence costs for plan sponsors. Such issues are avoidable. But only with professional intervention.
There is a solution…MedMonitor.
MedMonitor identifies health risks in large populations and helps prevent and resolve those risks. Using proprietary RxCompanion™ software, sophisticated clinical algorithms are applied to drug claim data to identify medication and health risks. HumanisRx pharmacists then resolve those risks by consulting virtually with employees or their prescribers.
In a recent study, HumanisRx, with partners Munich Re Canada, GroupHEALTH Benefit Solutions and Disability Management Institute, found one in every four members using medication had at least one medication problem, with 60% of those related to safety. A valuation model developed by Munich Re estimated long-term disability savings from MedMonitor at $2.7 million for a population of 200,000 plan members. A similar model developed by HumanisRx predicted annual short-term disability savings of $3 million for 200,000 members, for a total annual disability savings of $5.7 million. Additional savings from lower presenteeism and absenteeism also accrue.
“Through on-going analysis of plan members’ medication patterns, MedMonitor has the potential to prevent health risks, and offer plan sponsors dramatic cost savings. We help keep your employees well so you can focus on running your business.” says Sayeh Radpay, President at HumanisRx.
To help employers in these challenging times, HumanisRx is offering to find the hidden risks in your member population through a FREE analysis of your plan – contact Sayeh Radpay at firstname.lastname@example.org, for information.
How can telemedicine balance humanity with technology as Canadians head back to work during the COVID-19 pandemic?
As Canada’s pioneer in telemedicine with over three decades of healthcare leadership, EQ Care is continually innovating to help employers create healthy and resilient environments for their employees, and to address dramatic shifts as a result of the pandemic.
Going back to our workplaces will not be back to “normal.” Layered on top of this is the feeling that as we lean on technology more, the world is crossing a historic bridge to a model where interactions that used to be human-centric are now with an AI.
In the midst of this crisis, we built a customized care management and navigation capability to ensure that EQ Care’s virtual care services are delivered with compassion, empathy and good judgment, face-to-face by experienced medical professionals. This approach is leading to better outcomes for employees and their employers, and alleviating pressure on the overburdened healthcare system by providing tailored resources related to COVID-19.
A soon-to-be-released EQ Care poll by the Angus Reid Institute suggests thatfour in five Canadians prefer face-to-face virtual careover automated systems like chatbots; a triage system preferred by only 4% of Canadians polled.
EQ Careis the only provider in Canada with live Care Managers at first contactwith patients, creating conditions for optimal care.
Activating the untapped potential of Canada’s healthcare system requires balancing resources and connecting knowledge centers to deliver the most effective care possible. As the system modernizes, compassion and the human touch is what Canadians need and deserve in these most stressful times.
What are some of the most important considerations when implementing a mental healthcare benefit?
Answer from Karen Grant, Vice President, International Solutions, Teladoc Health
When employers think about mental health, they need to consider what their employees are not saying.
The Mental Health Commission of Canada estimates that 1 in 5 Canadians will personally experience a mental health problem or illness in any given year, and approximately 8% of adults will experience major depression at some time in their lives.
In 2019, Teladoc Health commissioned a global research firm to survey nearly 4,000 employed adults across the U.S., U.K., Australia, and Canada to better understand the impact of mental health in the workplace. Of all workers, 39% said they would not tell their manager if they were experiencing a mental health challenge, and 55% of Canadians feared being open about an existing mental health diagnosis at work.
We also learned one of the most effective solutions for those who have experienced poor mental health in the past was having access to professional support through their workplace (71%). And of respondents who selected stigma as a reason for not confiding in someone at work, nearly half wanted remote forms of mental healthcare.
Virtual mental healthcare can break through stigma and expand access to available resources regardless of physical location. It provides members a convenient and discreet way to get the help they need from wherever they feel most comfortable. For help, contact Teladoc Health, the leader in virtual care that has helped Canadians facing healthcare challenges for over 20 years.
It’s time we break with what’s not working in mental health andconnect withwhat is.
What options are available for Life and LTD insurance coverage for employees working temporarily outside Canada?
Answer from Nancy Brown, Sales Director Canada, Voyageur Global Benefits
Group Life and Disability coverages are an essential part of most expatriate benefit packages. That’s where Empire Life’s suite of products for globally-mobile employees, Voyageur Global Benefits, comes in. Whether in conjunction with a global group medical program or on a standalone basis, we offer you the flexibility to craft custom policies at competitive prices so that your clients’ employees remain covered — at home and abroad. *
We are here to help with:
- Customized benefits that match domestic benefit offerings for easy parity
- Standalone coverage options for as few as two employees
- Eligibility flexibility for plans that are designed specifically for globally-mobile travelers
- Global support to provide timely and accurate reimbursements
- Rate Guarantees: 24-month for Life and 12-month for LTD
- High Guarantee Issue and aggregate limits on Life insurance
- Option to convertto a personal Life Insurance policy upon termination of employment to continue coverage.
Contact me today to learn more about how I can help you better serve your clients’ globally mobile employees.
Group insurance policies issued by The Empire Life Insurance Company, 259 King Street East, Kingston, Ontario, K7L 3A8, Canada
Toll free: (877) 548-1881 | Visit empire.ca/
* Subject to applicable legal and regulatory restrictions
What health and wellness approach are you taking as a Benefits Consultancy and Third Party Administrator?
Answer from Brendan Hickey, Director, Health Solutions at People Corporation.
At People Corporation®, we are making a difference in the lives of more than one million Canadian employees and their families by providing employee group benefits, group retirement, health, and human resource solutions. We have an incredible opportunity to impact the health of Canadians every day. Canadians spend one third of their time at work; it’s no wonder work can influence their health, and the health of employees can impact an organization’s success and business goals. This is why People Corporation has gone beyond administration of benefits and consulting to actually providing strategic input and health solutions. People Corporation provides an end to end approach for the sponsor and also the plan member. We tie our health programs to specific claims cost drivers, helping employers get out in front of critical health issues
At People Corporation we always encourage a multi-layered approach. For example, in 2019 we focused on mental health, providing an industry leading solution with (pcpeopleconnect.com) People Connect: mental health assessments, virtual therapy and psychiatric consultation. We also encourage programs that examine the health of the work place and the intrinsic support for a psychologically safe workplace. This included supporting organizations in their journey to be compliant with the Canadian Standard for Mental Health and Safety. We also look at organizations’ health policies to ensure parity in their support for mental and physical health and safety. Finally, we challenge organizations to obtain senior management buy in, top level support and a champion for a mentally safe and healthy workplace. Our commitment is to a three pronged approach that impacts the member, the organizations’ practices, and the very culture that leads the group. This is the critical way in which People Corporation is integrating health solutions with our group benefits, group retirement and human resource solutions.
What can employers do about their short-term travelers who may lose or have a gap in coverage through their current group benefits plans due to changes in the OHIP law effective 1/1/20?
Answer from Nancy Brown, Sales Director Canada, Voyageur Global Benefits
Empire Life’s Voyageur Global Benefits is a solution for employers in Ontario who may now find themselves with a gap for protecting employees who need to travel outside of Canada on a short-term basis. Our International Business Travel Medical (IBTM) plan provides emergency and emergent medical care around the world to employees and their dependents who are traveling outside of Canada on business travel.
Key features include:
- Urgent and emergent care around the world* for business travelers outside their home country
- 24/7 assistance services
- Standard and flexible plans available to provide the best option for your employees, and your business
- Your choice of plan design options and coverage levels
Optional features include:
- $100,000 Accidental Death and Dismemberment (AD&D) coverage
- Dependent medical coverage for traveling spouse or children accompanying an employee
- Sojourn coverage for leisure travel associated with a business trip
If you find that your clients may need this coverage, getting a quote with Voyageur Global Benefits is simple, quick, and cost-effective:
- Simply provide travel information – no census is needed.
- We can return a proposal in about one business day.
- Standard rates are very competitive – annual premium for 240 travel days is about $1,500 USD.
The Empire Life Insurance Company, 259 King Street East, Kingston, Ontario, K7L 3A8, Canada
Toll free: (877) 548-1881 | Visit empire.ca/
* Subject to applicable legal and regulatory restrictions
Is it possible to put the brakes on the national opioid epidemic?
Answer from Jeff Boutilier, General Manager, Pharmacy and Chief Clinical Officer - Express Scripts Canada
The short answer? Yes. While the opioid crisis is a national emergency, it’s the personal toll – in 2018 alone, 4,614 Canadians died from opioid-related overdoses – that drives our mission to make the use of opioids safer.
We know that many opioid users aren’t aware of the risks that come with taking opioids and need specific types of care. This begins with the understanding that curtailing opioid abuse requires a clinically-driven solution. With this as our driving force, Express Scripts Canada launched the industry’s most complete and effective approach to drive change in our nation’s opioid epidemic.
Our solution – the only one on the market – proactively manages every user of opioids: new and acute users, short-term and intermittent users, as well as chronic users. In fact, the program realizes a nearly 32% reduction in the average days’ supply for the new opioid-prescribed patients.
How? By minimizing early exposure and preventing progression to overuse and misuse through enhanced care, which includes:
- Providing influence and safety interventions at point of sale to opioid-naïve patients (those who have never used an opioid or have not used one in the last 180 days).
- Minimizing early exposure by limiting the first fill to a seven-day supply. This solution prevents excess opioid dispensing at the first fill.
- Ensuring safe starts of long-acting opioids by encouraging the patient to use a short-acting opioid first.
The opioid crisis does not discriminate. Anyone is vulnerable and everyone is affected.
While we still have a lot of work to do, together, with our clients, we remain committed to making a meaningful difference in the lives of plan members and their families.
What service options are available in the Canadian market to employees that protect and promote their positive mental wellbeing?
Answer from Chrissy Piraino, Director, Business Development - Health Solutions by Shoppers
The digital marketplace for wellness and wellbeing solutions has exploded. There are a wealth of options available for multiple conditions at varying price points. With societal trends breaking down barriers and removing the stigma related to mental health there is now more of an appetite to offer solutions at the employer sponsored level. It goes without saying that healthier and less stressed employees have a profoundly positive impact on an employer’s bottom line. Supporting an employees mental wellbeing should be high on every employer’s priority list now and in the future.
Solutions available can range from self-guided, supported (using asynchronis health supporters), to connecting members with virtual counsellors. When reviewing options, some key things to consider include the following:
- Striking a balance between accessibility and affordability
- Evidence of clinically significant improvement
- Ability to help employees with a variety of mental health conditions
Health Solutions by Shoppers has partnered with SilverCloud Health to bring Canadian employers an award-winning digital platform for cognitive behavourial therapy (CBT). This proven, evidence based platform has been shown to help employees struggling with a variety of mental health conditions by getting them the tools that they need to feel better and more importantly, stay better. Learn more @morewaystobenefit.ca/silvercloud
How does your expat employee benefits provider show that they are committed to providing you and your employees an exceptional service experience while abroad?
Answer from Nancy Brown, Sales Director Canada, Voyageur Global Benefits
We know your globally-mobile employees, or employees traveling for business outside of Canada, are talented VIPs. So, we make sure that they have the service they expect. In addition to giving you confidence in the service excellence that's baked into Voyageur Global Benefits, our Service Guarantee provides us with the opportunity to hear from you if we’re not meeting your needs. Policyholders can request a Service Guarantee Payment at any time during the policy period for services performed during that year, and the Service Guarantee Payment (if any) will be made within 60 days following the next policy renewal date.
To help provide this top talent with a personalized experience while they are on assignment, Empire Life offers a suite of health and wellness solutions for globally-mobile employees through Voyageur Global Benefits. Voyageur Global Benefits offers comprehensive, high quality expatriate benefits, insured by Empire Life. We stand behind our Voyageur Global Benefits Service Guarantee because we value your business and are committed to providing you and your employees with an exceptional experience.
Contact Nancy Brown or visit our website to learn more about Voyageur Global Benefits and how we can help you better serve your global ambassadors. Please visit our website for full details of the Service Guarantee.
How can you combine drug plan sustainability and employee health and wellness? Deliver benefits beyond cost control?
Answer from Stéphanie Myner-Nham, Chief Human Resources Officer, Express Scripts Canada
Prescription drug coverage is one of the most important features of a benefits plan, but striking a balance between plan costs and employees’ health is increasingly complex. Express Scripts Canada’s 2018 Drug Trend Report highlighted an issue that should be of particular interest to employers - nonadherence. To maintain a suitable balance between cost containment and employee health, employers need to keep in mind the impact of nonadherence on the cost of benefit plans. Medication nonadherence may cause increases in disability costs, absenteeism, additional drug therapy as well as productivity losses. Many members with chronic conditions are found to be nonadherent to at least one of their medications. For example, 42% of patients with diabetes were found to be nonadherent to at least one of their therapies, increasing their risk of cardiovascular, kidney or visual complications. Patients taking high cholesterol medications is another condition with high levels of nonadherence, increasing the difficulty of containing costs for benefit plans.
To deliver a comprehensive, well-managed drug benefit plan it’s essential that you work with your insurance provider so you can offer the right balance of cost containment and health for your employees. After all, an attractive benefit plan makes an attractive company and maintaining employees in a state of good health benefits the entire organization. Being able to attract and retain talent while keeping employees healthy, engaged and productive means your job as an HR professional will be easier and more rewarding.
How can you reduce disability and absence costs by improving medication therapy?
Answer from Jeff May, President, HumanisRx
Medication therapy problems are common, clinically harmful, and largely preventable. Approximately 1 in 50 people have had a preventable adverse drug event leading to emergency room visits and increased costs to the health care system.1
HumanisRx recently set out to study how proactively managing plan member’s medications would lead to disability cost savings for plan sponsors. This retrospective study evaluated HumanisRx’s MedMonitor program, which identifies and resolves medication related problems before they occur.
MedMonitor uses state-of-the-art software, RxCompanion™, applying hundreds of clinical algorithms to analyze drug claims data. Health risks and drug related problems are identified. HumanisRx’s licensed pharmacists then intervene with plan members or prescribers to resolve these problems.
A valuation model was developed to estimate disability savings from the interventions in the retrospective study. The model predicted the MedMonitor program could provide up to $2.7 million in annual savings on long-term disability (LTD) costs in a population of 200,000 plan members, similar to that of the study. Using similar parameters to the LTD model, HumanisRx quantified $3.0 million in short-term disability savings in this population. Therefore, improving medication therapy through the MedMonitor program provided at least $5.7 million in total annual disability savings.
This study demonstrates that improving medication management can provide significant savings to insurance and plan sponsors on disability costs. Plan sponsors can also expect reductions in related costs such as workplace absence, presenteeism, and plan member replacement.
1. Excerpt: “Enhancing the impact of the profession of pharmacy on people’s lives in the context of health care trends, evidence and policies”; CPJ/RPC. January/February 2019. VOL152, NO15. Dolovich, L et al.
Patient exceptions in Quebec. What do plan sponsors need to know?
Answer from Pierre-Étienne Tremblay, General Manager Québec & Chief Privacy Officer, Express Scripts Canada
When evaluating the current and future financial risks for national plan sponsors, it’s important to consider the effect of the “patient exception measure” in Quebec. This measure mandates that if a private plan patient meets the Quebec government (RAMQ) criteria, the private plan is required to cover the total drug claim cost.
Since its introduction, patients have increasingly used this measure and the trend should concern plan sponsors and insurers alike. There were 5,130 approved applications in 2006. This number skyrocketed to 50,621 in 2017 – an almost tenfold increase over eleven years. Overall costs increased by an even larger factor, from $19M to $280M over the same period.
We anticipate that this trend will accelerate in the future, creating additional risks for plans. The drug development pipeline is filled with medications targeting rare diseases and cancer therapies, many of which will incur high costs for drug plans. The projected costs for gene therapies are also a cause for concern.
Insurers and plan administrators should ensure they have a mechanism to manage patient exception requests, and it’s recommended that they contact their pharmacy benefit managers to understand the terms, criteria and financial risks concerning this measure in Quebec.
What is the relationship between mental disorders and comorbid diabetes?
Answer from Dr. Sam Ozersky, Senior Consultant, University Health Network Mood Disorders Clinic and, CEO, Mensante Corporation
Research has shown an increasingly clear relationship between diabetes and a variety of mental health issues (2018 Diabetes Canada Clinical Practice Guidelines, Can J Diabetes 42 (2018) S130–S141).
With more than 6.7 million Canadians affected by Mental Illness and 2.2 million affected by Diabetes, the economic impacts to health systems and to the workplace are well established.
There are multiple reciprocal relationships in Diabetes & Mental Health Disorder Comorbidity:
- Hypoglycemia (low blood sugar) can severely impair cognitive functioning.
- Diabetes is a risk factor for dementia.
- Having PTSD, Bipolar Disorder or Depression increases the risk of diabetes by 50%.
- Having Depression alone increases both the morbidity and mortality from diabetes.
Any workplace program aimed at supporting those with a Diabetes and a Mental Illness may want to take into consideration this bidirectional relationship.
From an assessment perspective, the 2018 Diabetes Canada Clinical Practice Guidelines recommend that all individuals with diabetes should be regularly screened for the presence of diabetes distress, as well as symptoms of common psychiatric disorders.
Workplace Chronic Disease Programs focused on Mental illness/Diabetes comorbidity should also facilitate Self-management since persons with diabetes are directly responsible for 95% of their diabetes management.
Physical disease and mood management need to be integrated.
FeelingBetterNow (feelingbetternow.com) provides a unique, medically differentiated solution to workplace mental health that takes into consideration Chronic Disease Comorbidities.
The integrated Personalized Action Plan for “Self-care” is based on medically approved Clinical Practice Guidelines and grounded in a trinity of early detection, treatment and prevention.
What more can employers do to help the more than 50% of their employees who are struggling to cope with chronic disease?
Answer from Jonathan Tafler, Senior Director, Product Development & Experience, Health Solutions by Shoppers Drug Mart
In today’s workplace, over half (58%) of employees are dealing with with one or more chronic conditions (such as diabetes, mental illness and cardiovascular disease), up dramatically from 37% just 10 years ago.
What’s more, 57% of these employees agree that it’s hard to change lifestyle habits necessary to improve their health condition, and 84% would like to know more about their conditions and how to treat them.
This gap means chronic conditions often progress, negatively impacting employee productivity and plan sponsor benefits costs.
Countless studies demonstrate that successful behavior change occurs in small, incremental steps.
The traditional “teach-and-tell” approach to chronic disease management, delivered during short healthcare appointments that can be months apart, does not encourage or sustain healthy behaviours for the long term. Instead, behaviour change experts are proving that lasting change comes through patient empowerment, which can be nurtured through coaching services delivered between medical appointments.
These services are typically provided virtually or over the phone by non-physician health professionals. They are targeted to the individual’s personal goals and needs and use evidence-based behaviour change models, such as motivational interviewing and single-concept learning theory. And they are often far more affordable than employers expect.
And perhaps most importantly, they have been proven in many cases to lead to improvements in blood pressure, cholesterol, blood sugar, physical activity and weight loss – the key “silent” metrics often responsible for rising benefit plan costs.
By providing additional day-to-day supports such as health coaching, employers can help address the growing impact of chronic disease in the workplace – an increasingly important component of any long-term focused workplace productivity and benefits strategy.
How can plan sponsors add virtual care to their health benefit plan without an increase in costs?
Answer from Laura Mensch, Vice-president, Health Benefits Management, TELUS Health
A number of approaches allow for the integration of virtual care without a net increase in cost:
- Health spending accounts: Virtual care is an eligible medical expense for health spending accounts, so employers can promote to employees that they can use their account to pay for virtual care consultations or the employer could automatically allocate specific dollars for this within the spending account
- Long-term disability premium: Employers with an employer-paid model for long-term disability premiums can consider moving to a premium-sharing or employee-paid model. Employees will receive tax advantages, and employers will free up funds to invest in virtual care.
- Reduced days of absence: Virtual care provides convenient, timely access to medical services, without long wait times in a doctor’s office or hospital emergency room. Employers can consider reducing the number of allotted absence days as a result of less time off needed for medical appointments.
Using all or a combination of any of these strategies would allow an employer to provide virtual care to plan members without an increase in plan costs.
What’s the difference between intensive pharmacist-led medication review and Pharmacogenetics and when should each be used in disability management?
Answer from Jeff May, President, HumanisRx
Disability costs are a growing concern for Canadian businesses. There are two medication targeted tools that help improve treatment outcomes, pharmacogenetic testing and MedCheckUp by HumanisRx.
Both focus on improving medication therapy so employees get better and return to work sooner. Medications are often crucial to an employee’s treatment and ensuring medications are effective, safe, and taken as intended is critical for best results.
Simply put, pharmacogenetic testing checks for metabolism variations on roughly 150 medications that may affect medication efficacy and safety and MedCheckUp is a new program that provides a comprehensive and holistic review of an employee’s medications.
MedCheckUp is different, it considers all medications available in Canada, and assesses all of the potential risks that may occur. This includes all prescription and OTC drugs, doses, side effects, adherence, proper use, education, and lifestyle factors affecting single and combinations of medical conditions.
Employees on MedCheckUp receive personalized and private consulting to address and resolve any problems and, when needed, consultation with their physician. Better adherence, reduced impact of side effects, optimized medications drive improved health outcomes.
Pharmacogenetic results can positively impact mental health, cardiology, oncology, gastrointestinal disease, and pain. Some medications have well-documented recommendations based on test results. That’s why MedCheckUp Pharmacists evaluate the need for pharmacogenetics so money isn’t wasted on unnecessary testing.
The cost of MedCheckUp is similar to pharmacogenetic testing and it’s the right starting point when medication is part of employee treatment plans and when plan sponsors want to reduce disability costs.
What’s new in disability and work absence management – how can better medication management make a difference?
Answer from Jeff May, President, HumanisRx
Mental health, anxiety and pain drive many work absences and disability claims. In all these cases, medication therapy is a cornerstone of treatment to improve the condition so the employee can get back to work. Adding an in depth medication assessment by a pharmacist to your return to work / disability management strategy, will help employees get the most benefit from their medications so they feel better sooner.
While anti-depressant, anti-anxiety and pain medications (including opioids) are needed for treatment, they can also negatively impact work performance and contribute to illness if not taken correctly. If additional medications are used for chronic conditions or if multiple prescribers exist, there is a higher risk of health problems contributing to disability costs.
In the HumanisRx MedCheckUp program, consulting pharmacists work with employees off work to provide comprehensive one-on-one medication assessments, using a telehealth model that ensures convenience and privacy. The pharmacist performs a full medication review and creates a care plan, identifying and resolving existing or potential problems with therapy, including pharmacogenetics tests where appropriate.
MedCheckUp employee results show a 30% improvement in pain, depression and anxiety symptom scores and an 87% improvement in adherence. In several cases, significant health issues were resolved that most certainly would have led to a disability claim.
With the pharmacist’s comprehensive and holistic medication assessment available through the MedCheckUp program, employees feel better and as a result can either return to work earlier or prevent progression of claims - better health and reduced costs!
Virtual healthcare is a hot button topic right now. As a leading Canadian physician, what's your take on it? Is it worth the investment for employers?
Answer from Dr. Vivien Brown, Vice President, Medical Affairs, Medisys Corporate Health
Current research shows that Canadian employees want health benefits that save time, help them achieve work-life balance and provide easy access to healthcare for their families. Virtual healthcare is a revolutionary way to meet this demand while supplementing our traditional healthcare system.
Unfortunately, barriers like long wait times and difficulty taking time off work for medical appointments lead many Canadians to delay or avoid seeking medical care, which can be very problematic. According to Statistics Canada, 4.5-million Canadian residents also don’t have family doctors and as a result, many wind up in crowded clinics or emergency rooms for routine issues.
It’s clear that this supply and demand challenge requires a modern solution — and a recent study by Truven Health Analytics showed that 70% of ER and clinic visits can be replaced by virtual consultations without any impact on quality of care.
But what does this mean for employers? With Canadians taking two to six days off annually for doctor’s visits, and with each visit taking roughly two hours of time away from work, the financial benefits to companies who adopt virtual care are significant.
Perhaps most importantly, employers offering virtual care may have the power to help bring mental health out of the shadows: virtual care apps that include mental health services, like Medisys On Demand soon will, may encourage more employees to seek help with mental health issues.
What are the key findings of the recent Cost Drivers Report (published by Innovative Medicines Canada), and what does this mean for the Private Market?
Answer from Joe Farago, Executive Director, Private Payers and Investment, Innovative Medicines Canada
When you read reports about total growth of the private drug plan market, often those numbers are presented without any details on what factors in claimant behavior are influencing total plan costs. This report seeks to illustrate the underlying drivers of cost growth for private drug plans in Canada, including utilization, for the period between 2012 and 2016.
The report found that over this 5-year period, total private drug claims in Canada grew by 4.7% combined annual growth rate (CAGR). Seventy-five percent of this growth can be attributed to increased utilization - in other words, more claimants making more claims.
The report also identifies that growth is being driven by increased utilization of high-cost drugs, largely from preventable chronic diseases. Employers looking to manage costs should consider investing in comprehensive wellness and prevention programs to offset this trend.
The findings also bring greater clarity to how insurers calculate prescription trend factor as part of annual premium rates. It would appear that there is a large gap between the projected and actual growth seen in the market. Given these discrepancies, plan sponsors might want to consider asking their plan benefit advisers or brokers for more information on the rationale for any premium and pooling increases at renewal time.
This Question of the Week was sponsored by Amgen
How can employers better support the increasing number of employees diagnosed with cancer?
Answer from Dr Lewis Levy, Chief Medical Officer, Teladoc Health, the global leader in virtual care
According to the Canadian Cancer Society, about one in two Canadians will develop cancer in their lifetime. There’s no question, a cancer diagnosis can be overwhelming. Anyone who has been diagnosed will want to know what lies ahead. Does the treatment involve surgery, radiation or chemotherapy? Will I have to miss work? How can I be sure that this treatment plan is right? For a patient, significant peace of mind comes from knowing that a diagnosis is accurate and that I am receiving the right course of treatment.
There is good news for proactive employers who are looking for ways to better support their employees. Advances in virtual care now allow patients to access the world’s top experts to provide that needed assurance that the right diagnosis and best treatment plans are in place. Throughout Canada, a growing number of plan sponsors are relying on Best Doctors, an expert medical service from Teladoc Health. It’s a powerful tool that enables individuals with a cancer diagnosis to receive an in-depth medical review from a panel of carefully selected world reknowned physicians. These specialists can even access cognitive computing technologies to provide evidence-based guidance and identify the most effective treatments. When the best minds in medicine are then interpreting that information into clinical practice, it delivers improved health outcomes and important peace of mind.
Teladoc Health has a passion to ensure that those diagnosed with cancer receive the best care possible. Employers can now provide access to the brightest minds in medicine to ensure that their employees facing cancer get the right diagnosis and care.
How can medical cannabis be incorporated into benefits plans to bring value to plan sponsors and their members?
Answer from Angelo Tsebelis, President, Starseed Medicinal Inc.
With an increasing body of evidence surrounding medical cannabis, individuals are looking to it as an alternative to current medications – especially opioids. While individuals are exploring the benefits of medical cannabis to relieve some of their symptoms, employers/plan sponsors are trying to find responsible ways to navigate the complexity of this nascent category.
However, many plan sponsors are unsure of how to implement safe and responsible coverage for their members. This is primarily due to the fact that there are over 110 authorized Licensed Producers (LP), few coverage options, and a limited understanding of medical cannabis dosing and the distribution channel.
Insurers and plan sponsors are tasked with delivering products and services that provide value and, most importantly, health outcomes, to members. All that, while at the same time managing the long-term sustainability of plans. Therefore, taking prudent steps to ensure that members’ coverage is appropriate based on previous claims history could certainly be beneficial.
One of the concerns most often cited is that of cost. But with the proper plan design, and appropriate controls, this can be managed as effectively as the current therapies covered under traditional benefit plans. This entails partnering with the right LPs, as well as healthcare providers, that can effectively diagnose and appropriately prescribe medical cannabis.
With these partnerships in place, plans can ensure that individuals are recommended workplace safe products that can help deliver pharmacoeconomic benefits – including reduction of presenteeism and absenteeism. In addition to this, medical cannabis has the potential to serve as an opioid replacement therapy by reducing the initiation of these more addictive drugs.
Taking the above into consideration can simplify the process and provide more comprehensive coverage that further supports health and wellness by ensuring that members can access medical cannabis in a manner that is safe and responsible for the workplace.
With the need for mental health support growing, what should benefits providers prioritize?
Answer from Stephany Verstraete, CMO, Best Doctors
In any given week, at least 500,000 Canadians are unable to work due to mental health problems. That’s a staggering number, and for employers, it is imperative to protect their most valuable asset: their workforce.
During Mental Health Week (May 7-13), the Canadian Mental Health Association’s #GETLOUD campaign revealed major gaps in how we approach mental health. While many organizations have taken positive steps, there is still much work to be done. For employers, this means taking a close look at existing programs and policies. The reality is that many lack timely and appropriate access to mental healthcare services. Likewise, GPs, who are often the first point of contact, lack expert support, and without someone to coordinate care, patients are often misdiagnosed, mistreated, or discontinue their treatment. The cost of inadequate programs to employees – and employers – can be huge. In order to recruit and retain talented employees, employers must be proactive and offer innovative programs and benefits.
What can be done? Start by asking: How can we ensure that our employees get the right care, at the right place and time? For example, employers and employees who have a benefit like Best Doctors as part of their insurance policies can access and build an ongoing relationship with a mental health professional of their choice, from the location of their choice. Virtual care solutions for mental health are focused on removing the biggest barriers to accessing, and adhering to, the most appropriate care – such as stigma and inconvenience of in office treatment, accurate diagnosis and ongoing support through the process. The Best Doctors experience, for instance, is designed to guide someone all the way from diagnosis through to timely treatment with qualified, licensed psychologists and therapists, with proven results and positive outcomes.
When the status quo is not working, employers should look to the virtual delivery of mental health care for their employees. It’s too important not to.
This Question of the Week was sponsored by Best Doctors
What are the benefits of pharmaceutical manufacturers’ Patient Support Programs (PSPs) for patients and employers?
Answer from Jay Mayers, Vice President, Business Development, McKesson Specialty Health
Patient Support Programs (PSPs) represent a valuable component of healthcare in Canada. With a focus on supporting patients prescribed high cost/high value or complicated to use medications, these programs provide numerous medical and non-medical services that help patients focus on managing their disease to remain productive members of the workplace and society.
Staffed by compassionate medical and reimbursement professionals, PSPs are typically available during hours more convenient for patients such as evenings and some even during the week-end.
PSPs provide patient education, assistance with side effect management and help navigating the public and private insurance systems while diminishing the administrative burden that physicians face in prescribing these medications. One patient commented:
"She (PSP nurse) answered all my questions and provided the support I needed so I could be an independent young adult and manage my disease", says Kadi, a patient and regular support program user for her chronic condition.
In certain cases, patients may also be eligible for financial assistance to help with their out of pocket plan costs.
Insurers also provide case management programs that are often designed to refer patients to pharmaceutical PSPs. These insurer programs also benefit from preferred network pharmacies to achieve cost savings to their plans.
PSPs ensure that patients have the tools necessary to achieve the best possible chance at success with their disease, which are generally associated with severe, acute and chronic conditions. These conditions often have fear, stigma and complexity associated with them. PSPs can help alleviate these challenges ensuring patients can focus on managing their disease to get back to a sense of normalcy and remain productive members of the workplace.
This Question of the Week was sponsored by Amgen
How can Product Listing Agreements (PLAs) help private payers obtain better value for medicines?
Answer from Ben Peacock, Director of Pricing, Contracting and Private Payers
Product Listing Agreements (PLAs) are contracts between payers and manufacturers that address economic concerns related to the use of a medication. They are one of many tools that payers can use to maximize the value proposition that medicines offer their beneficiaries. Other standard tools used by private payers include mark-up and dispensing fee limits, generic substitution, formulary management, prior authorization and so on. PLAs have been used by public plans since the early 2000s and by hospital accounts since well before that, and come in many forms to suit the needs, concerns and capabilities of the payer and the merits or uncertainties of the drug.
At the most basic level, a PLA can offer a simple discount on a drug. However, there are often better ways to maximize value for all parties. For example, if a payer is concerned about utilization causing a huge hit to a plan’s budget, the parties can agree to an expenditure cap. If efficacy is uncertain, the initial doses can be provided for free or at a discount until efficacy is demonstrated. If a drug has different cost-effectiveness in different indications, then different prices or measures can be applied to the different indications.
PLAs aren’t just for carriers; other private payer stakeholders have engaged in PLAs, including plan sponsors. And, while the above examples sound complex, more and more players have cleverly found ways to provide competitive advantage by adding innovative PLAs to their toolbox to ensure the right patient can access the right medicine at the right price.
Are you among them?
This Question of the Week was sponsored by Amgen
Will the proposed drug pricing regulation reforms at Patented Medicine Prices Review Board (PMPRB) result in lower private drug plan costs?
Answer from Suzanne Lepage, Private Health Plan Strategist
The Patented Medicine Prices Review Board (PMPRB) regulatory reforms proposed by Health Canada may put downward pressure on many drugs’ list prices, however the changes may not translate directly to bottom line savings for plan sponsors because of the many other contributors to the cost of the drug plan.
For plan sponsors, the cost of drugs is actually reflected in the premiums they pay insurers for drug plan coverage, which include many components beyond price. PMPRB only regulates the list price of a drug, whereas the cost of drugs for private drug plans also includes wholesaler and pharmacy markups and dispensing fees, which are not regulated for private drug plans. Other factors that drive premiums are insurers' charges, plan advisors' commissions, trend factors and pool charges.
These costs are multiplied by utilization, which are influenced by an aging population, overall increased use of medicines and a growing number of claims and claimants.
When private drug plan claim costs and growth are analyzed at the overall market level, they show a modest single-digit growth. However, each individual plan’s claims experience and their potential specific risk drives their premium, and as a result, their individual costs may differ. In order to take advantage of the relatively stable and modest growth across the industry, perhaps it’s time to consider fully pooling drug plan risk across all the plans to ensure sustainability in the benefits industry?
This Question of the Week was sponsored by Amgen
What is the downside of using public payer HTA evaluations to assess the value of medications vs. tailoring decisions based on the needs of private payers?
Answer from Dr Judith Glennie, President, J.L. Glennie Consulting Inc.
There are many differences in the way private payers evaluate new medications vs. the approach of public payers. Private payers look at factors important to employers and employees (e.g., return to work, adherence, time away from work, burden on patients and caregivers, etc.). These factors are not considered by public payers, who focus on changes in drug budget, hospital stay, or physician visits to determine value. These differences result in different priorities for medication access: private payers tend to fund medications that help avoid disability costs, while in some cases public payers may not fund these same medications as the public payer health technology assessments (HTA) are tailored for a different group of individuals.
Several insurers are waiting for public payer HTA recommendations prior to making listing decisions. This has significant downstream implications. Waiting for HTA reviews delays access to new medications by an additional 6 to 12 months, thus undermining the employee’s treatment and potentially their return to full productivity.
The gaps created by the different perspectives of public vs. private drug plans are evident with Ontario’s launch of the OHIP+ program. Reports of families now paying out of pocket for a drug that had been previously covered by private insurance have been common.
Applying public payer HTA reports to private drug plan decisions can have negative impacts and underestimate the value of medications to beneficiaries and their families. A customized approach tailored to specific needs will support optimal decisions for plan sponsors and members alike.
This Question of the Week was sponsored by Amgen
How are new technology trends affecting global real estate investing?
Answer from Tim Bellman, MA, Head of Global Research Invesco Real Estate
We see five trends with the potential to challenge and/or benefit global real estate investments.
- E-commerce and the sharing economy are boosting leasing demand for industrial office and data centre properties but are a headwind for some retail properties. In addition, online health care delivery could reduce demand for spaces dedicated to health care, medical offices and seniors’ housing.
- Job automation and artificial intelligence are a similar good news/bad news story. These trends benefit leasing demand in tech-centric locations but are a net negative for back offices. They could also change the nature of retail-space demand as retailers start to offer virtual shopping experiences.
- Autonomous trucks can drive further without stopping and, as they take to the road, could reconfigure supply chains. Meanwhile, autonomous cars may reduce the need for large parking lots, leaving those properties with adaptable parking better positioned.
- Robots can boost efficiency and reduce labour demand. As the number of people working in warehouses shrinks, so will the amount of space that must be allocated to parking. Robots may also change the execution of last-mile delivery, with the potential to decrease delivery costs as they become more autonomous.
- Related to this is the development of drones, which could reduce last-mile delivery demand. Of course, drones need a place to land, so we anticipate changes to building design to accommodate them. Office real estate may benefit from additional “roof income.”
We’ll be closely monitoring the impact of all of these trends – and others that emerge in the future.
How is cancer impacting the workplace and how can employers help their employees live with cancer?
Answer from Anjila Arora, Director, Pharmaceutical Benefits,Sun Life Financial
Did you know that 200,000 Canadians face a new cancer diagnosis each year1, and struggle with their families to move forward in their journey to recovery? Thankfully, with better treatments, recovery rates are now higher than before.
This new era in cancer treatment, along with an aging workforce, means cancer is having a greater impact on the workplace. The good news is that with the right treatment and support, many employees diagnosed with cancer can get well and return to work, or in some cases may not have to leave work at all.
Employees want to work for organizations that help them recover. And a good support system can help reduce time away – an important cost factor for plans, since cancer is one of the top three reasons for Long Term Disability (LTD) claims2.
Employers can help through:
- Access to cancer drugs, while incorporating the drug plan sustainability practices offered by their provider.
- Disability case management based on communication, accommodation and support.
- Third-party support and help navigating health care systems.
- Employee Assistance Programs (EAP) and counselling to support mental health, since 25% of cancer patients suffer from depression3.
To find out more about what you can do to help change the face of cancer, download your copy of Sun Life's Cancer Care Bright Paper.
- Canadian Cancer Statistics Advisory Committee. Canadian Cancer Statistics 2017. Toronto, ON: Canadian Cancer Society; 2017. EN.pdf
- 2009/2010 Willis Towers Watson Staying@Work Report.
- National Cancer Institute, Depression PDQ-Professional Version (https://www.cancer.gov/about-cancer/coping/feelings/depression-hp-pdq/)
What are the biggest challenges to controlling drug plan costs?
Answer from Chris Goguen, Strategic Pharmaceutical Partnerships Lead, Medavie Blue Cross
It is no secret that growing drug costs are putting substantial pressure on drug plans. Major change drivers in the current landscape include:
- An increasingly productive drug development pipeline of high cost speciality drugs - largely biologics and oncology treatments. Roughly 30 new treatments that didn't exist before are coming to market every year, often with complex delivery, administration and monitoring requirements.
- An increasingly complex drug pipeline and product mix in terms of delivery, monitoring and adherence driven largely by the emerging biologics class of drugs and oncology treatments.
- Drug cost inflation. 74% of the new drugs reviewed last year by our expert review committee were well over $10,000 per year.
- Changing patient demographics and workforce composition and increasing prevalence of chronic disease and comorbidities. The diabetes class of drugs is a perfect example of both increasing use (utilization) and increasing cost of medications (drug cost inflation).
- The changing workforce and an increasingly competitive marketplace are putting pressures on plan sponsors benefit plan budgets and philosophy to rethink traditional benefit plan design. One size does not fit all.
To address these challenges, benefit providers need to work directly with advisors, consultants and plan sponsors to balance plan sustainability and access to care. Activities like clinical analysis of prospective drugs by medical professionals, and pharmacy and manufacturer agreements to ensure maximum impact from every dollar spent, act as a foundation to sound drug management. In addition, plans can reflect their philosophy through optional approaches like step therapy and mandatory generic substitution.
To ensure private drug plans are viable and relevant into the future, it is essential to address the challenge with committed purpose to achieving the right balance.
How can data be further leveraged to make more informed decisions?
Answer from Chris Dalseg, Vice President, Strategy & Industry Relations, BioScript Solutions
There has been a lot of buzz surrounding real-world-evidence and how this data can be utilized to help stakeholders in the payer, prescriber, patient and manufacturer communities make more informed decisions. We have reached a tipping point where this data is becoming a critical factor in the decision making process.
I would like to highlight some key benefits of new data sources and the associated strategies to make the most of this information.
- Feedback loops are dramatically shortened when the right technical infrastructure is in place. Real-time access to insights allows for proactive identification and intervention while optimizing program attributes.
- Consistent data structure across a network provides enhanced visibility to the patient journey. When using advanced analytical tools, this data can be utilized to identify which patients may require specific interventions to both avert potential problems and optimize outcomes.
- By capturing patient reported outcomes, stakeholders have the ability to understand and articulate the true value of a specific therapy/program in a real-world setting. New digital health tools continue to provide unique and novel ways for stakeholders to engage patients and capture this valuable information beyond traditional healthcare settings.
New technology offerings and data analytics platforms continue to evolve and provide innovative ways for the industry to use data to optimize patient outcomes. Those who find ways to employ and utilize these tools will move the needle for their patients and partners.
How can employers play a role in managing chronic disease?
Answer from Derek Weir, Manager, Group Benefit Solutions,
Medavie Blue Cross
There is an urgent need – and an opportunity – to do things differently in the way we tackle the surging prevalence of chronic disease.
Chronic disease now affects 6 in 10 Canadians in the workforce, resulting in income and productivity losses alone of $122 billion annually. No wonder chronic disease is described as the "silent strain" on employers' bottom line.
But by taking a holistic, collaborative approach to managing chronic disease, employers can balance member health and plan sustainability:
- Connect the dots
– Examine your health plan utilization to understand what is driving your costs before developing a risk mitigation plan.
- Lead the change
– Start the conversation with employees by addressing the causes and effects of chronic disease through targeted communications.
- Engage employees
– Provide ongoing education to help employees self-identify their condition, adopt healthy behaviours and learn new approaches to self-care.
- Be Strategic – Invest in a complete care package that reflects a strategic blend of treatment and prevention supports based on the needs of your employee population.
- Empower Employees – Remove barriers to self-care by giving employees access to and reimbursement for specialized services.
Our disease management education studies have consistently demonstrated positive returns on benefit investment by improving health literacy, self-care and adherence to treatment. Ultimately, this enhances quality of life, increases workplace productivity and leads to better organizational health.
Chronic disease is responsible for more benefit plan spend than any other category. Now is the time to address this challenge proactively.
Why is it critical for companies to help employees find meaning or purpose in their work?
Answer from Gary LeBlanc, B. Eng, MBA, CCP, PTS, CEO of Ikkuma Inc.,ikkuma.com/
In The Art of Happiness, the Dalai Lama highlights that creating meaningful connections requires deep work. For companies, these connections result in increased engagement, better morale, and a stronger culture.
As employers we're often role focused, and miss the opportunity to connect employees with the company's authentic purpose. With millennials favoring companies with a greater purpose, companies can't dismiss this deep work any longer.
If you don't have a defined purpose, where do you begin? Regardless of 'what' your company does, there is always a 'why'. As a leadership team, look back to the roots of your company. Why was the company started? How has that purpose evolved? What greater good are you solving?
Every company has a reason-for-being beyond increasing shareholder value. It may not be obvious at first but spending time with employees to connect to the heart of the company will pay dividends.
Once you entrench your company's purpose (often in the company mission), you'll need to work with employees to understand their contribution. Their contribution to the mission is paramount for it to have intrinsic value. Take every opportunity to not only live your purpose, but ensure employees are feeling connected to it, via their contribution.
Put energy towards well-defined company messaging, visual aids, regular communication, and employee well-being platforms. Making employee well-being a priority will not only increase trust but will support mental health and reduce absenteeism.
'Times are a changing'. Connecting employees to a greater purpose and caring for their well-being will transform your organization.
What health conditions can be treated through a video visit?
Virtual visits with a healthcare provider – typically carried out by video through a phone, tablet or computer – can be used for almost any non-urgent health condition. At Medcan, the top health conditions treated through virtual visits are musculoskeletal (joint pain, back pain, minor injuries); skin issues (rash, acne); cold and flu; mental health (anxiety, depression, sleeplessness) and digestive issues (abdominal pain, diarrhea, nausea).
Video visit appointment bookings at Medcan are increasing each year as the preferred method for employees to see a doctor, and for good reason: they provide easy access to medical help from anywhere within Canada, save time, and are highly effective in resolving health issues.
A recent study in the Journal of Medical Internet Research found that patients who had video visits with doctors had fewer hospitalizations and emergency department visits within a three-week period after their appointment than those who saw providers in a conventional face-to-face setting.
The study mirrors our own experience with virtual visits at Medcan. We consistently solve around 90% of patient's conditions via virtual care, meaning that only 10% of the time patients have had to go in to physically have a physician appointment. It's a highly effective form of care, and one we believe will continue to grow.
Virtual care is a broad term used to describe a technology-based medical appointment (often via video on a mobile device) through which physicians can treat their patients on a variety of medical conditions. The most common issues supported include musculoskeletal (joint pain, back pain, minor injuries); skin issues (rash, acne); cold and flu; mental health (anxiety, depression, sleeplessness) and digestive issues (abdominal pain, diarrhea, nausea).
The challenge with in-person visits are two-fold: availability of appointments and the length of time in the waiting room. 46% of Canadians can't get an appointment with a physician either the same day or next day when they need it - and 33% of Canadians have to wait six or more days for an appointment. During these waits, employees are often at work sick, are less productive and potentially spreading their illness to others. And when an in-person visit takes place, productivity losses mount as employees miss an average of four hours of work.
The advantages of virtual care, especially appointments via video, is that appointments can take just minutes to complete and can be done from anywhere. Studies have found that video visits with doctors resolve medical issues for minor ailments - such as sinus infections, pink eye and ear aches - and support chronic condition management and behavior change just as well as in-person visits with a healthcare provider.
In fact, at Medcan, we consistently resolve around 90% of patient's conditions via virtual care - meaning that only about 10% of the time patients had to have an in-person physician appointment because issues couldn't be resolved on the phone.
How does the new Genetic Non-Discrimination Act impact pharmacogenomic testing in group benefits plans?
Pharmacogenomic tests are covered by the Genetic Non-Discrimination Act, which means that the results can't be used or considered in any way when an individual buys or applies for something, most notably insurance.
Pharmacogenomic testing helps doctors understand how a specific patient will respond to a given medication, based on that person's DNA through genetic testing. The test is done in a lab with a simple cheek swab, and more employers are using it – especially in disability leave situations. It can avoid prescribing trial and error and help employees identify the most effective medication for them much faster.
While Canadian insurance companies didn't request genetic tests upfront as a condition for buying insurance, many applications required people to disclose the results of any previous genetic testing. Insurance companies can no longer ask for or use this information, including information from pharmacogenomic testing. The new law provides important reassurance to employees that they can participate in pharmacogenomic testing without a worry that results could be used against them.
In addition, for federally regulated employers such as banks or transportation companies, genetic test results can't be used in decisions about hiring, firing, job assignments, or promotions – and these employers can't request or require genetic test results of any employee. The new law also changes the Canadian Human Rights Act to ban discrimination based on genetic characteristics. Ontario has proposed a similar change to its Human Rights Code.
As fraud schemes and financial crimes increase in sophistication and complexity, the battle to manage fraud and contain costs becomes even more critical. What are some key strategies employers and insurance carriers can use to help combat group benefits fraud?
Answer from Shelley Frohlich, Director, Investigative Services, Fraud Risk Management, sunlife.ca/fraudmanagement
Awareness is key
Fraud prevention starts with awareness. Plan sponsors and members need to know how to respond to fraud; without this knowledge, anyone can become a fraud victim or offender.
Plan sponsors can help activate their employees as a first line of defence in the fight against fraud. Plan members have three important roles to play: understanding their plan and what is covered, refusing to participate in fraudulent schemes, and reporting them.
Role of the carrier
Insurance carriers need to step up their game with leading-edge technology and analytics to prevent and detect sophisticated fraud schemes. A diverse team of investigative experts, combined with predictive modeling and social network analysis can help identify irregular claiming patterns and threats. When fraudulent activities are identified, carriers should partner with plan sponsors to share information and coordinate efforts. Working together to deter fraud should be the common goal. Delisting suspect providers can also stop benefit plan losses quickly while sending a powerful message.
The power of deterrence
To successfully deter fraud, the perceived opportunity must be removed. Many who commit fraud may rationalize it as "a victimless crime", or believe they won't get caught. Deterring fraud starts with ensuring a clear understanding of consequences, including loss of benefits, restitution of monies owed, termination of employment, criminal charges and prosecution.
While fraud will never be eliminated, it can be significantly reduced, and everyone has a part to play.
What do you see as the risk/return trade-off for Canadian investors investing outside of their home real estate markets?
Answer from Matt Johnson, Head of Americas - Global Multi-Managers for
UBS Asset Management, Global Real Estate
Over the past 15 years the range between the best and worst performing core property market has averaged over 25 percentage points. This indicates that there are opportunities to enhance returns by investing in real estate outside of Canada. While it is not possible to perfectly pick those regional, country, and sector combinations that will outperform in the future, tactical allocations to certain markets and regions can help to maximize the probability of delivering higher returns, particularly after accounting for volatility.
The correlation between real estate markets is lower compared to the correlation between equity and bond markets. This means a global portfolio of real estate has proportionately lower risk when compared to local real estate than is the case for equities.
The returns that are available to domestic investors in a market are not necessarily those that would be experienced by a Canadian investor. Critically, returns will be delivered net of tax and so it is important that any decision to invest outside of Canada into global real estate looks at a net of tax position. Canadian investors also need to consider the potential impact of foreign currency volatility. Hedging foreign currency exposure can reduce the volatility of returns, but the cost of hedging may reduce the returns received by Canadian investors relative to domestic investors.