Rising numbers around chronic disease, paramedicals among concerns
Organizations that offer employee health benefits are looking for more information and analysis regarding the plans, according to the 2015 edition of the Sanofi Canada Healthcare Survey.
Seventy-two per cent desire better reporting or evaluation of the ROI of the health and wellness program; 76 per cent want a better understanding of how the benefit plan affects health outcomes, productivity and absenteeism; 62 per cent want a better understanding of the claims data; and 68 per cent want a better understanding of connections between claims and utilization of programs.
The desire for better reporting is fabulous, according to Marilee Mark, vice-president, market development, group benefits, at Sun Life Financial in Toronto.
“It’s only if you measure and you see objective information that you really get and maintain traction with offering these programs. So you’re offering them in part because you know employees want them but, wow, now you’re offering them because you understand that there’s a strong link between your benefits program and how it’s utilized and the cost of your benefits program and employee productivity. To link all those together, that’s terrific.”
Employers want to know if they are investing in the right areas. But they also know employees appreciate these kinds of wellness programs, said Mark.
“So they’re looking at ‘How do I incorporate that in as part of my overall benefit offering?’ and ‘Can you give me information that suggests that I’m focusing on areas that are not only what employees want but that can give us better results in terms of health?’ I think that’s really the driver,” she said.
“And I think there’s an expectation that with technology, employers are going to have better access to give them that data.”
What’s difficult is trying to make the link between wellness programs and the health benefits, but that’s something that’s coming along, said Daniel Peak, senior manager, national, private payer strategy at Sanofi Canada in Montreal.
“Today, with the rising costs, plan sponsors or employers are trying to see a better return on investment of this investment.”
The conundrum is some plan sponsors don’t understand what they don’t know, so education is a big part of it, said Peak.
“And those solutions… are not necessarily around cost-containment solutions but more around solutions that will help around productivity, maybe tools to analyze or plan a bit more to understand the disease case in their organization.”
The ROI on wellness and health management is difficult for employers to measure but key to the success of any program, said Lisa Jandali, COO of TRG Group Benefits & Pensions in Vancouver.
“Few employers can track that stuff well. It’s a commitment and it’s an investment in tracking with data in every way — absence, health-care drug utilization, all of it, productivity — some of that stuff’s hard to measure.”
But with technology, the more measurable items are easy to track and the carriers are also good at sharing data around health-care and drug utilization, she said.
“What’s emerging now, in my opinion, is the linkage between disability and absence data, drug data and EAP utilization, because it’s when all those three things are strung together, you get a really good understanding of what’s happening in your organization and what EAP consultations and medication use might translate to as far as an absence or a disability.”
When you talk about ROI, it’s important to take a broader definition as opposed to just a financial one, said Mark.
“When you’re looking purely at those that participate and the impact on benefits utilization, some of that takes time to see… you also want to factor, when you look at the wellness programs, is what is it doing for giving employees a sense of well-being — management of stress, for example.”
Chronic disease
But plan sponsors and plan members are not making the link when it comes to their plans and the prevalence of chronic disease in the workplace, according to the Sanofi survey of 1,504 primary holders of group health benefit plans. While employers estimated about one-quarter (26 per cent) of their workforce has a chronic condition, 56 per cent of plan members indicated they have such a condition.
There’s a big opportunity for providers to refocus their energy on chronic disease, said Peak.
“There’s a disconnect there so we certainly think there’s an opportunity for everybody maybe to refocus at least on something they have control (over). Chronic disease is something that a plan sponsor can do something about, providers can do something about,” he said.
“When you talk about higher-cost biologics, there’s not too much you can do about that because, to be honest with you, the patient program is in fact supporting the patients around adherence… so there’s not too much you can control there except not putting the drug on the plan. And that becomes another issue.”
On the other hand, compliance or adherence to medication is a big issue when it comes to chronic disease, said Peak, “and probably responsible for between 70 to 75 per cent of costs for plan sponsors and their plans.”
The prevalence of chronic disease is growing, and at younger and younger ages, said Mark.
“But the probability of having a chronic disease is higher as you get older, and as we have that demographic change a little bit in the workforce, it’s going to be more prevalent for the next number of years because we have more people in the category that are likely to have a chronic disease,” she said.
“Many chronic diseases are not visible in the workplace, so that’s where employers would underestimate what the numbers are because I could have high blood pressure or diabetes and my employer would not know. And mental health is a chronic disease as well, cancer is increasingly a chronic disease.”
We’re seeing the thin end of the wedge and it’s definitely a demographic issue, said Jandali.
“And that’s going to continue, particularly as employees postpone retirement and stay in the workforce. So I think the screening and the prevention and the coaching and the managing of this health risk, particularly in the chronic disease state area, is going to be so critical going forward.”
For employers concerned about the cost of screening, it’s an investment, no question, she said.
“But it’s a tradeoff — can you save money by knowing sooner that your employee might get cancer and what things they can do or they might be prone to high blood pressure or cholesterol? Can you target better health coaching at some of those emerging risks and prevent future drug claims or disability claims?” said Jandali.
“Doing a health-risk assessment throughout an organization is a best practice and a lot of employers are getting there. It’s hard to get good takeup — you really have to promote and incent people to participate — but once you do, then you can target messages accordingly, and then keep targeting and then coach, and then re-measure to see if you’re having a positive impact, as well as then concurrently tracking absence data, drug utilization, disability data to see if you’re impacting things at the end of the line.”
Paramedical services
Almost one-half (47 per cent) of plan members submitted at least one claim for paramedical services in the past year, and those that did submitted a total of 7.3 claims on average — a frequency second only to prescription medications (9.5), found Sanofi, adding this level of use may suggest the need for eligibility based on clinical criteria rather than self-perceived needs.
“If we’re… having clinical reviews for new drugs coming in, if we’re having to put restrictions or putting a lot of interests on different costs around drugs, why are we not that way with paramedicals when they’re probably a high cost of the plan also?” said Peak. “(Paramedicals are) may be an area plan sponsors need to look at a bit more to make sure it does serve the plan like it’s supposed to.”
The challenge is paramedicals are a smaller overall dollar amount but are growing more quickly, said Mark. So, again, are employers getting value for what’s being invested? And do employees value the benefit?
For example, massage therapy is one of the highest utilized paramedical services, she said.
“Some would say, ‘Jeeze, is that really where we should be spending our money when we know mental health and other things are such a concern in the workplace?’ On the flipside, you’ve got some employees saying, ‘I really value that as a personal health promotion and I have no other disease, I have no other issue, but I want to get value from my benefit plan.’ So it they value it and they’re utilizing it, then that may be a good outcome from an employer’s standpoint as well. It’s not black and white.”
Employers need to be careful, said Jandali.
“You want to take a good look at what paramedicals they’re using and why. So if it’s just massage and it feels good, of course, that’s not as preventive as you would want but there’s probably a lot of really useful paramedical utilization that is helping keep people at work — chiropractics, physiotherapy.”
