High-cost drugs, disease management among top health concerns for employers​

Wellness cultures, targeted communications shown to help: survey​
By Sarah Dobson
|Canadian HR Reporter|Last Updated: 08/30/2019
benefits
When it comes to workplace health, employers are continuing to struggle with persistent issues such as higher-cost specialty drugs and chronic disease management, according to a survey. Shutterstock

When it comes to workplace health, employers are continuing to struggle with persistent issues such as higher-cost specialty drugs and chronic disease management, but there are a few promising solutions to be had, such as a strong wellness culture, a focus on mental health and more targeted communications, according to a Sanofi survey.

Wellness culture pays off

Having a workplace wellness culture can definitely pay dividends, found the survey. For one, 59 per cent of employees with a workplace wellness culture say they are managing their chronic condition or disease very well, compared to 44 per cent of those without

In addition, 61 per cent of those with a wellness culture rate the quality of their health benefit plan as very well, compared to 28 per cent of those without such a culture. And 85 per cent of those with a wellness culture are satisfied with their job, compared to 62 per cent of those without.

A wellness culture can include anything from providing gym memberships to organizing walking competitions, says Andrea Frankel, private payer lead at Sanofi in Toronto.

“It's more[about] the plan sponsor realizing that it's important to get their employees moving and healthy from a preventative perspective, not just from a drug coverage perspective. Certainly, the drugs are important to provide a robust health benefit plan. But also, let's focus on earlier[issues] upstream.”

Without a workplace wellness culture, a benefits plan is seen as a way for an employee to fix something that's broken, such as a sore back, so it becomes almost reactive and negative, says Ryan Weiss, vice-president of product and experience at Great-West Life in Winnipeg.

“If you switch that on its head, a wellness culture then becomes enabling, it becomes proactive, it becomes ‘My employer, my organization is investing in me before I get sick, not just paying for things after I get sick.’ Obviously, that's a much more positive way to spin it.”

For most employers, a culture of health starts with looking at the needs of employees“and understanding how those needs can affect the performance of the organization, says Chris Bonnett, principal consultant at H3 Consulting in Guelph, Ont.

However, smaller employers tend to focus less on wellness, even though they know they should have a healthy work environment. It’s mostly about keeping benefit costs low, says Robert Crowder, founder and president of the Benefits Trust in Vaughan, Ont.

“In the larger employers setting, where there's a professional HR departmentthey can use their drug plan to manage chronic disease, and they can use their benefit plan to look at mental health and wellness and so on. So, it's a bit of a different beast.

Targeted communications

When it comes to plan fixesemployers cite “improved coverage options for higher-cost specialty drugsas most important (39 per cent), followed by more benefits to prevent illness (36 per cent), more benefits to manage chronic disease (34 per cent), improved disability management (25 per cent) and fraud detection or prevention (19 per cent).

One of the challenges is what to do with the information around all this once employers get it, says Bonnett.

“They're not necessarily clear on what to do with it, how to organize the information, how to set priorities… Some people figure that ‘Well, we just need incentives, and that'll be enough to get people to look after their own personal health.’ And a lot of employers, I think, are still thinking that it's just about personal lifestyle, not about the way they manage, not the way that they lead, not the cultures that they build in their organizations.”

Enabled by insurers and advisors,organizations need to do better, and plan members also need to be more responsible for their own health, and how they use the benefit plan, he says, “knowing that we want that plan to be sustainable in the long term.”

Sanofi found that 74 per cent of plan sponsors are interested in having their benefits providers send targeted personal health information to plan members.

More targeted solutions can also help, with layered claims data and context-based messaging providing employees with information and reminders, says Weiss.

[It’s about] ‘Hey, did you know your employer offers this?’ and ‘Here's how you get access to it.’ And ‘Do you need any help?’ and ‘Click here.’ And so, it just becomes a much easier way for people to access and lowering those barriers. And we don't really have to blanket-target the whole population, we can go up to people that really need it most and make sure they're engaged,” he says.

“It’s a simple technology that ties all these pieces together, because before, the member had to navigate this on their own, and it was somewhat effective, but it wasn’t as effective as it could be.”

Benefits communication is critical, and it’s often overlooked, says Crowder.

“People think about benefits when they need them;they don't think about benefits when they don't need them. So, communication is something that's extraordinarily difficult when it comes to benefits, regardless of where it comes from.”

If plan members self-select or consent to receive additional information, insurance companies can better reach people in need, says Bonnett.

I don't know how widespread it is. And I think it's a cautionary exercise;you walk before you run there. And you start in a very targeted and thoughtful way to get the information out. And, of course, if you're in a collectively bargained environment, where you've got a union partner around benefits and health, and occupational health and safety, you want to be engaging your union colleagues on how to do this appropriately as well.

While targeted, personalized communications can help increase engagement in wellness programs and benefits for chronic disease management, more than one-third of plan members are still not confident that their privacy will be protected and that personal information may be shared with employers, says Frankel.

“Plan sponsors can more effectively communicate how privacy will be protected and help plan members to control the use of data and how the importance of those personalized communications can help plan members manage their health and the health of their families.”

People are becoming more comfortable sharing information with trusted organizations, says Weiss

“They're starting to see the value in doing so.”

And having people opt in for this kind of communication helps alleviate the sponsors concerns, he says.

“They know that all their members have been displayed the right disclaimers and understanding of information and they positively opted in versus ‘Well, now I'm on the hook as a sponsor if something happens.’”

Personalized wellness

As for other possible solutions, there is strong support for personalized medicine, according to Sanofi. Seventy-four per cent of plan members would consent to giving a sample of their DNA so their physician could prescribe a medication that is most likely to work well for them.

And 65 per cent of plan sponsors are interested in providing coverage for pharmacogenetic testing, says the survey.

It's extremely promising technology, says Weiss, and it’s also about reducing waste by making sure people have the right solutions right out of the gate. 

If someone, for example, starts a claim for a mental-health issue on the drug side, the insurance company could send a prompt asking if they’d like to take test, he says.

“It just cuts out the pain and suffering for these individuals as they go in and have to find the right types of medications. And it's way less waste for the sponsor, because they’re not paying for drugs that aren't as effective.”

Genetic testing costs money, but it’s worth it, says Bonnett.

If, for example, it’s known that particular kind of chemotherapy is not going to help an employee with cancer, why put them through the ordeal? 

“If pharmacogenetic testing or biomarkers can help predict a better response by this patient over another patient —this drug over another drug —we ought to be doing that,” he says.

“That seems to be not only a very cost-effective way to spend money but a very patient-sensitive way to help them get the right treatment as quickly as possible and not go through unnecessary trials with drugs that are unlikely to work for them.

In addition, 64 per cent of employees think medical cannabis should be covered by a workplace benefit plan, while 45 per cent of plan sponsors feel the same  up from 34 per cent a year ago. Twelve per cent say their health benefit plan already covers medical cannabis, up from eight per cent in 2018.

Also popular are pharmacist-led assessments and prescribing for minor common ailments (according to 51 per cent of plan members), along with access to 24-hour virtual care or telemedicine for medical opinions, including diagnoses and prescriptions (45 per cent).

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