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Transcript of The Sanofi Canada Healthcare Survey
THE SANOFI CANADAHEALTHCARE SURVEYC A N A D A ’ S P R E M I E R S U R V E Y O N H E A L T H B E N E F I T P L A N S
Benefits 2020:Shifting gears toward health management
2015
SECTION 1PHILOSOPHY OF HEALTH BENEFITS
SECTION 2IMPACT OF CHRONIC DISEASE
SECTION 3THE WORKPLACE: BRIDGE OR BARRIER TO HEALTH?
SECTION 4FUTURE FORWARD FOR HEALTH MANAGEMENT
SECTION 5RETIREMENT CONUNDRUM
METHODOLOGY
ADVISORY BOARD
SANOFI GROUP IN CANADA
THE SANOFI CANADAHEALTHCARE SURVEYCANADA’S PREMIER SURVEY ON HEALTH BENEFIT PLANS
As we approach the year 2020, analogies between time and “20/20” vision come to mind—and when it comes to health benefit plans, such comparisons are apt. Indeed, we are especially excited to present the 2015 edition of The Sanofi Canada Healthcare Survey. One of its key revelations is that plan members and plan sponsors appear ready to see health benefits in a new light.
Growing concerns over sustainability certainly spur the need for change. Equally important is the growing awareness of health-driven solutions that can tackle barriers to workplace health, such as chronic disease. This year’s survey shows that more plan sponsors are seeking a deeper, multi-dimensional view of their health benefit plan, trying to understand the connections between different benefits and, ultimately, productivity. Employees also want to get involved in this space, stating a willingness to engage in decision-making and offerings based on personal health.
Members of our advisory board—dedicated opinion leaders in the Canadian health benefit industry—enthusiastically endorse this broadening of outlooks, and provide insights for health management strategies. While benefits will always help attract and retain employees, their greatest value lies in supporting workplace productivity—and to do that we must refocus attention on health and well-being.
Sanofi is committed to partnering with all stakeholders to be part of a system that cost-effectively delivers the best possible health outcomes while also improving employee productivity. Our goal with The Sanofi Canada Healthcare Survey’s 18th edition is to convey the latest opinions around health benefit plans and offer perspectives and practical tips that help plan sponsors and providers embrace the tenets of health management—which is as much about the well-being of the organization as it is about the well-being of the employee.
Benefits 2020: Shifting gears toward health management
THE 2015 EDITION OF THE SANOFI CANADA HEALTHCARE SURVEY
Danny PeakSenior Manager, Private Markets – NationalSANOFI CANADA
THANK YOU TO OUR 2015 SPONSORS!
DIAMOND SPONSORS GOLD SPONSORS
3
12
16
22
31
33
34
35
CONTENTS
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 3
SECTION 1
irtually all plan members are positive about their current health benefit plans, yet at
the same time almost two-thirds prefer a plan design that is significantly different from what’s typically in place. What does this apparent contradiction tell plan sponsors and their providers?
It suggests that member satisfaction is not as black and white as it first appears, and it’s time to look more critically at how health benefit plans are evolving—or not evolving, say industry leaders on the advisory board for the 2015 edition of The Sanofi Canada Healthcare Survey.
First, the numbers: 94% of plan members are positive when describ-ing the overall quality of their health benefits, with 58% describing them as very good or excellent. This result has
been consistent since the survey first posed the question in 2006. Similarly, 93% of respondents believe their health benefit plan meets their needs,
of whom 56% judge that it does so extremely or very well. Health benefits also continue to be an effective means to attract and retain employees, as
20%
19% 21
%
17%
17%
13% 14%
11%
16%
16%
39%
39%
36% 37%
42%
41% 42%
38%
43%
42%
36%
36%
36% 38
%
37% 40
%
38%
44%
35% 36%
0%
10%
20%
30%
40%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
BASE: All plan members (2015 n=1,504)
Quality of employer-sponsored health benefit plann Excellent n Very good n Good
Plan members are satisfied … sort of
PHILOSOPHY OF HEALTH BENEFITS
V
Plan members value their health benefits but are open to plans that are more responsive to personal needs.
SECTIONTAKEAWAY
PLAN MEMBERS
4 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
77% of respondents say they would not move to a job that did not include health benefits (increasing to 85% in Atlantic Canada and decreasing to 66% in Quebec).
When asked which statement most closely describes their plan, 77% of plan members selected “a traditional plan that defines what is covered and the levels of coverage” and 23% selected “a ‘flex’ plan that allows them to choose levels of coverage.” When then asked which type of plan they prefer, 64% of members opted for the less-prevalent flex plan and 36% opted for the traditional plan. As well, almost all respondents (91%) agree
they would like to be able to choose specific benefits that are best suited for their current personal situation.
A separate survey of plan sponsors indicates that 32% offer flex plans. Larger employers (more than 500 employees) are more likely to do so at 50%, followed by mid-size (34%, 101–500 employees) and smaller employers (18%, up to 100 employees). Plan members, meanwhile, are consistent no matter the size of their organization: approximately two-thirds prefer a flex plan over a traditional plan.
“Plan members see great value in having a health benefit plan, but they also want to have a voice in decisions around what is covered. That’s a huge challenge for plan sponsors, but perhaps this is an opportunity and the time is right to make change,” says Susan Belmore-Vermes, director,
group benefits solutions, at Health Association Nova Scotia. “The ques-tion is, how do we as an industry create a strategy to redesign plans that are decades old for many of us?”
Plan members’ high satisfaction levels can also contribute toward a sense of complacency in benefits management, warn members of the advisory board. As a result, change is generally a response to “burning platforms” rather than evolving needs. “Plan members are telling us there’s a desire for flexibility and personaliza-tion, and the timing is right because we’re seeing greater differences between the generations and we have
this great ‘bulge’ of baby boomers in the workforce right now. The ‘one-size-fits-all’ approach of traditional plans doesn’t really suit this reality,” says Marilee Mark, vice-president, market
development, at Sun Life Financial. As well, plan members’ changing needs do not necessarily point to added costs for the employer. “For example, there’s a growing interest in getting access to resources and education,” says Mark.
Board members also point to a potential sleeping giant: chronic dis-ease. “Chronic disease in the workplace is very prevalent and employers are not paying attention to it. We can’t wait for it to become a burning platform,” notes Carol Craig, director of human resources, benefits and pensions at TELUS. (For more on the impact of chronic disease, see page 12.) l
77%
23%
64%
36%
Current type of health benefit plan versus preferredn Traditional plan (defines what is covered and the levels of coverage) n Flex plan (allows plan members to choose levels of coverage)
BASE: All plan members (n=1,504)
Current plan Preferred plan
0% 20% 40% 60% 80% 100%
Total
British Columbia
Alberta
Manitoba/Saskatchewan
Ontario
Quebec
Atlantic Canada
77%
83%
79%
80%
79%
66%
85%
Would not move to a job that did not include a health benefit plan
BASE: All plan members (n=1,504)
SECTION 1: PHILOSOPHY OF HEALTH BENEF ITS
‘‘ Susan Belmore-Vermes, HEALTH ASSOCIATION NOVA SCOTIA
Plan members see great value in having a health benefit plan, but they also want to have a voice in decisions around what is covered. That’s a huge challenge for plan sponsors, but perhaps this is an opportunity and the time is right to make change.
‘‘
PLAN MEMBERS
PLAN MEMBERS
IT’S ALL CONNECTEDA HEALTHY WORKFORCE MEANS A HEALTHY BUSINESS
Our 360° approach to health management improves healthcare quality and reduces costs. And we constantly build on it to help employees live healthier lives.
We connect with your employees to keep them healthy.
Part of your ecosystem.
PRODUIT : GROUP BENEFITSFORMAT : 7,875’’ X 10,75’’DATE DE PARUTION : 2015PUBLICATION : BENEFITS CANADA
desjardinslifeinsurance.com
Desjardins Insurance refers to Desjardins Financial Security Life Assurance Company.
Proud Partner of
6 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
Employee reward, competitiveness or core strategy—if plan sponsors had to choose one to explain why they provide health benefits, which would it be? Not unexpectedly, they most likely (at 39%) gravitate to the statement that describes benefits as a form of reward or compensation: “Benefits are a way to reward and support employees and we know employees appreciate them.” Another 26% tend to view benefits as essentially a cost of business: “We have to offer benefits to be competitive with other organizations in our industry and/or region.”
And then there are 31% who make the link between health and the bottom line: “Healthier employees are more productive employees; our health benefit plan is one of our corporate strategies to grow or improve our core business.” Several factors characterize plan sponsors that are more likely to
choose this statement: organizations with more than 500 employees (43%), unionized environments (40%), public sector employers (40%) and organiza-tions with wellness programs (38%).
Members of The Sanofi Canada Healthcare Survey advisory board are encouraged that 31% of plan sponsors take this holistic view, and suggest that all would be well served by such an outlook. “Right now there is clearly a disconnect between traditional plans and what will be required in the workplace due to chronic disease. Plan designs require more strategy along
the lines of health and productivity,” says Nathalie Laporte, vice-president, product development, marketing and strategy, at Desjardins. (For more on the impact of chronic disease, see page 12.)
The board also cautions that the 31% more likely reflects a desired
philosophy than today’s reality. The current paradigm for plan design is very traditional and decades old, and clearly reflects a reward or compensa-tion type model.
For example, recent Green Shield Canada claims data reveal that one of the fastest-growing benefits over the past years is massages for teenage girls. “Is that what we want the fastest-growing costs to be if we say we’re interested in managing health and doing good things around productivity? Have we taught a generation of employees and dependents that what they ‘need’ from a benefits program is a regular massage for everyone in their family, when what they actually need could be a health coach to prevent or manage a chronic disease?” asks David Willows, vice-president of strategic market solutions at Green Shield Canada.
“Unless we change what plan designs look like today, we’re not going to get the health and productivity results that we want,” agrees Serafina Morgia, senior consultant at Towers Watson. “We can reshape how to use benefits dollars more effectively—for exam-ple, so that dollars can be put toward health risk screenings. To do that we would have to evolve the reward and compensation type of model into more of a risk management type of model.”
Such an approach addresses not only the risks to individuals but also to organizations. “Managing health becomes as important as managing turnover, competitive compensation, etc. Investing in biometric screenings can seem costly but early detection of chronic conditions reduces the risk of more drug costs and absences down the road. Employers can create a benefit plan that covers this and other
The higher purpose of health benefits
‘‘ Serafina Morgia, TOWERS WATSON
Managing health becomes as important as managing turnover, competitive compensation, etc.
‘‘
SECTION 1: PHILOSOPHY OF HEALTH BENEF ITS
Plan sponsors want to understand the connections between drug, disability and other claims data.
SECTIONTAKEAWAY
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 7
types of health services that reduce and manage health risks,” says Morgia.
Risk management also establishes a context that’s more relevant for decision-makers, including CFOs. “This becomes a business issue, not something that seems out in left field because it has to do with healthcare,” says Chris Bonnett, president of H3 Consulting.
Plan sponsors and providers can also look for guidance based on examples set in other areas, such as occupational safety and pension funds. “When CAP [Capital Accumulation Plan] guidelines were established, plan sponsors had to sit down and consciously write down the purpose of their retirement savings plan. And based on that purpose they built
objectives and methods of evaluation. We don’t have the same requirements in the group benefits world. Without a clearly articulated purpose and objec-tives it’s difficult to effectively manage a plan, especially in a rapidly chang-ing landscape,” says Lisa Callaghan, assistant vice-president of product and group benefits at Manulife. l
As a design and software firm,
Macadamian is all about the “user
experience.” The company of 100
employees in Gatineau, Quebec, has
taken that to heart internally as well,
with a benefit plan that’s built upon
personal preferences and the latest
in technology. Its ability to do so
demonstrates that plan sponsors of
all sizes can get creative with win-win
benefit offerings.
Struck by the changing needs of its
employees, many of whom have been
with the company since its start in 1997
and are now raising young families,
Macadamian decided to replace
its traditional benefit plan with a flex
plan—with a few twists. In addition to
the usual buckets for prescription drugs,
extended health, dental and health
spending accounts, Macadamian’s
flex plan includes a fitness allowance
and funding for public transportation
or a parking pass. Employees can also
allocate credits to retirement savings.
The fitness allowance starts with $400
annually for all employees. “The com-
pany’s founders are into fitness them-
selves, and want to encourage that
in employees,” says Virginie Bastien,
director of HR.
Enrolment is online, and last year
the company’s design team worked
with the benefits provider to build and
launch a mobile platform. They are now
working towards apps that give access
to benefit-dollar balances and send
texts about benefits and health tips.
“Our employees travel a lot so having
access to group insurance information
where and when they need it is very
important. And mobile access is really
a necessity considering our core
business,” says Bastien.
If employees exceed coverage limits,
the system automatically notifies them
(by email, at this point) and the differ-
ence is deducted from their pay. So
far, plan members have rarely exceed-
ed their chosen levels of coverage;
instead, Bastien says “they seem happy
to see that we are so generous. By ask-
ing them to make conscious choices,
they really see that they are getting the
most value from their benefits.”
An annual employee survey helps eval-
uate the plan and Macadamian receives
detailed reports on utilization patterns.
Employees’ satisfaction levels increased
from 80% to 87% after just two years, and
last year the company added critical ill-
ness insurance for all employees. The plan
is “definitely an attraction and retention
strategy,” adds Bastien. “When we do
offers to employees and tell them about
our benefits, they’re always amazed.” l
Flex plan with a twist
P R O F I L E : B E N E F I T S I N M O T I O N
Plan sponsors’ views on why their organization provides health benefits
39%
31%
26%
4%
Benefits are a way to reward and support employees and employees appreciate them.
Healthier employees are more productive employees; the health benefit plan is one of the corporate
strategies to grow or improve the core business.
Have to offer benefits to be competitive with other organizations in the industry and/or region.
Other
0% 10% 20% 30% 40%
24%29%
40% 40%
27% 28%
43%
0%
10%
20%
30%
40%
Company Size Union/Non Sector
1 to
100
101
to 5
00
501+
Unio
n
Non-
unio
n
Publ
ic
Priv
ate
Breakdown of those who said healthier employees are more productive employees:
PLAN SPONSORS
BASE: All plan sponsors (n=504)
8 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
Just under half of plan sponsors (42%) anticipate making changes to their plan design in the next two years. Large employers (52%) are more likely than small employers (34%) to make changes, as are plan sponsors with wellness programs (52%).
Interestingly, when asked why they anticipate making changes, plan sponsors almost equally pointed to the need to better reflect the utilization patterns and needs of employees (51%) as they did to the need to reduce or better manage costs (50%). The desire to add or expand offerings is also a motivating factor for 38%. As well, 37% expect to invest more per employee on health benefits within the next five years, increasing to 43% among plan sponsors with wellness programs. Just 5% anticipate spending less (leaving 52% who will spend the same and 5% who do not know).
On the plus side, the results indicate that plan sponsors are looking at more than costs when it comes to chang-
ing plan designs. The consideration of utilization and needs can guide decision-making toward changes that address health and productivity, note members of the advisory board.
On the other hand, not enough plan sponsors are contemplating change in the first place. “Overall there is no sense of urgency when you look at these
results and when you consider the level of activity today,” says Anne Nicoll, vice-president of health and disability management for Medavie Blue Cross. “Yet it is important that more plan spon-sors start making changes to plans now in anticipation of what’s coming in terms of chronic disease and other trends.”
“We need to start converting benefits and health promotion into a single strategy over the next few years to protect benefit plan sustainability,” says Chris Bonnett of H3 Consulting. It starts by stepping outside the tradi-tional benefits box and looking more broadly at the costs of chronic health
issues. “Studies suggest these costs are meaningful and that, more impor-tantly, they’re manageable and pre-ventable. Insurers and consultants can help change the way employers look at their benefits and encourage more active management,” says Bonnett.
Carriers, benefits consultants or advisors and brokers are vital to that
evolution. “We can see a desired shift toward supporting employees more on health and wellness, but until the components are better defined, it’s hard to move beyond the focus of traditional plan design. We need to identify the obstacles before we can overcome them, and what feeds into this is deeper data analytics,” says Ben Harrison, director of group strategic relationships at Great-West Life.
Perhaps the first obstacle to over-come is a fixation on drug costs only. “One of the biggest problems is we look at benefits in silos, and drug benefits are trapped in perhaps the biggest silo of all. We make decisions based on silos instead of taking a strategic approach,” says John McGrath, senior vice-president, human capital practice leader at Willis Canada.
“There are a lot of mixed messages about drug costs, and people don’t know what to do with the information. More needs to be done to interpret the information in order to make informed decisions based on the com-pany’s strategies and health outcomes,” adds Steve Semelman, CEO of Gemini Pharma Consultants. l
Benefits outside the box
SECTION 1: PHILOSOPHY OF HEALTH BENEF ITS
‘‘ Ben Harrison, GREAT-WEST LIFE
We need to identify the obstacles before we can overcome them, and what feeds into this is deeper data analytics.
‘‘The potential for benefits to support health and productivity is largely untapped; the time is right to close that gap, urges the advisory board.
SECTIONTAKEAWAY
A NEW PHARMACY
BENEFITS LANDSCAPE
REQUIRES A
NEW APPROACH
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Dr. Rance’s appointment is one
more reason you can count on
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manage your prescription drug
plan costs.
To learn more about our pharmacy
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10 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
Plan sponsors say they’re happy with their providers and not many are planning to change carriers or advisors in the near future—yet a notable majority also want more from their current relationships.
Nine out of 10 plan sponsors (92%) indicate they’re satisfied with their insurance carriers, although only 29% are very satisfied. Eighty-five percent say the same about their benefits consultant, advisor or broker, their employee assistance program (EAP) provider and their occupational health provider (if these are applicable).
Yet when questioned about possible approaches to evaluate the utilization of benefits, a majority of plan sponsors or employers consistently agreed they would like a better understanding of:• how their health benefit plan
affects health outcomes, productivity and absenteeism (76%);
• the connections between drug expenditures, disability claims and other services such as the EAP (68%); and
• their organization’s claims data in general (62%).Mid-size employers (101–500
employees) are especially eager for more knowledge: 94% would like a better understanding of the impact on health outcomes, productivity and absenteeism; 84% want to
know more about the connections between claims; and 76% would like a better general understanding of claims.
“It’s encouraging that plan sponsors are looking for more information in these areas. It tells us there could be an appetite to do more, which we really haven’t seen before,” says Marilee Mark of Sun Life Financial.
These results also caution against a false sense of security. “Plan sponsors say they like their carriers and their advisors, but if we think more globally about our role in the
Canadian healthcare system, and in light of the challenges that are coming due to chronic disease and an aging workforce, we know there is much work still to be done,” says David Willows of Green Shield Canada.
Providers that address plan sponsors’ growing interest in the integration—and interpretation—of data will have a competitive advantage, adds the board. “Employers generally think providers and consultants are doing a pretty good job. We need to take advantage of these good working relationships to get to the next level of information sharing and understanding how programs work, and can potentially be improved to be more effective,” concludes Telena Oussoren, manager of benefits for Suncor Energy. l
Knowledge, a powerful “benefit”
How their organization’s health benefit plan affects health outcomes, productivity and absenteeism in their workforce.
Their organization’s claims data.
The connections between their organization’s drug claims, disability claims and utilization of other services (such as the EAP).
n Strongly agree n Somewhat agree
100%
76%
70%
94%
68%
75%
52%
62% 68%
57%
83%
75%78%
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%
Total
1 to 100
101 to 500
501+
Total
1 to 100
101 to 500
501+
Total
1 to 100
101 to 500
501+
22%
18%
26%
27% 51%
68%
52%
54% 17% 45%
36%16%
15%
18% 50%
60%
19% 49%
42%15%
26% 57%
54%21%
Com
pany
siz
e
Com
pany
siz
e
Com
pany
siz
e
100%
76%
70%
94%
68%
75%
52%
62% 68%
57%
83%
75%78%
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%
Total
1 to 100
101 to 500
501+
Total
1 to 100
101 to 500
501+
Total
1 to 100
101 to 500
501+
22%
18%
26%
27% 51%
68%
52%
54% 17% 45%
36%16%
15%
18% 50%
60%
19% 49%
42%15%
26% 57%
54%21%
Com
pany
siz
e
Com
pany
siz
e
Com
pany
siz
e
100%
76%
70%
94%
68%
75%
52%
62% 68%
57%
83%
75%78%
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%
Total
1 to 100
101 to 500
501+
Total
1 to 100
101 to 500
501+
Total
1 to 100
101 to 500
501+
22%
18%
26%
27% 51%
68%
52%
54% 17% 45%
36%16%
15%
18% 50%
60%
19% 49%
42%15%
26% 57%
54%21%
Com
pany
siz
e
Com
pany
siz
e
Com
pany
siz
e
Plan sponsors would like to have a better understanding of…
BASE: All plan sponsors (n=504)
‘‘ Marilee Mark, SUN LIFE FINANCIAL
It’s encouraging that plan sponsors are looking for more information in these areas. It tells us there could be an appetite to do more, which we really haven’t seen before.
‘‘
SECTION 1: PHILOSOPHY OF HEALTH BENEF ITS
PLAN SPONSORS
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 11
According to an analysis of drug and
disability claims for 38,000 Canadian
employees over a three-year period,
plan members with chronic conditions
who take their medications as
prescribed may be less likely to take
disability-related leaves of absence.1
OverviewWithin drug claims, 10 disease states
accounted for 59% of spending:
diabetes, hypertension, depression,
dyslipidemia (high cholesterol), asthma,
rheumatoid arthritis, ulcers, Crohn’s
disease/colitis, cancer and bacterial
infections.
Within short-term disability claims,
six conditions accounted for 61%
of spending and 63% of days lost
due to disability claims: muscle or
bone inflammation/spasm, cancer,
depression, bone fractures, neurologic
pain or nervous system disorders, and
pregnancy complications.
For long-term disability claims, these
same conditions, minus pregnancy
complications, accounted for 64% of
spending and 66% of days lost.
Among employees with one or
more chronic conditions, including
hypertension, high cholesterol, diabetes
or depression, those who took their
medications as prescribed (i.e., were
adherent) had 17% fewer short-term,
and 15% fewer long-term, disability
claims than employees not taking
their medications as prescribed
(i.e., were nonadherent).
Adherence vs. nonadherenceUnfortunately, rates of adherence
among employees living with one
or more chronic conditions are
poor, ranging from a low of 45% for
depression to a relative high of 58%,
for hypertension.
Of those adherent claimants being
treated for depression, 2.6% were on
short-term disability for depression, as
compared to 3.5% of the nonadherent
claimants. For those adherent claimants
being treated for hypertension, 1.0%
were on short-term disability for
cardiovascular reasons, as compared
to 1.3% of the nonadherent group.
The cost of adherence was calculated
on average to be between $101 and $198
annually for hypertension and depres-
sion, respectively. The rates of nonadher-
ence for all conditions were extrapolated
based on the following figures:
• 71% of claimants living with one
or more chronic conditions did
not fill their prescriptions at the
correct intervals in order to receive
the maximum benefits from their
medications;
• 23% discontinued their therapy
after the first filling of the
prescription; and,
• 4% discontinued their therapy too
soon after initially being adherent.
“Many employers are concerned
with how to address the challenges that
come along with managing the impact
of chronic disease on benefit plans,”
says Ben Harrison, director of group
strategic relationships for Great-West
Life. “What’s really exciting about this
analysis is it has the potential to start
to help employers more effectively
direct their limited resources to services
like adherence or chronic disease
management programs, because
they’re able to see the value these
programs can have on real-world
claims data.” l
1. Integrated Analytics Initiative: Summary of Key Findings. Cubic Health, Great-West Life, Sanofi Canada. Analysis of drug, short-term disability and long-term disability data sets for 38,000 Canadian employee claimants, 2010-2012.
Breaking down the silos between drug and disability
R E S E A R C H N E W S : I M P A C T O F A D H E R E N C E
12 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
orty-five percent of plan members report being told by a physician that they have
one or more chronic diseases such as diabetes, arthritis or depression. When high blood pressure and high cholesterol are added to the list—two chronic conditions that often lead to or are associated with certain diseases—the number of employees living with chronic health conditions climbs to 56%.
Not unexpectedly, age is a contrib-uting factor. Seventy-eight percent of plan members aged 55 and older say they have at least one chronic condition, dropping to 52% among those aged 35 to 54, and 42% among employees who are 18 to 34 years old. Nonetheless, the rates of prevalence across all ages are high enough to warrant closer attention from plan sponsors, stresses the advisory board
for the 2015 edition of The Sanofi Canada Healthcare Survey.
“If an employer discovered that almost 80% of their older workforce had these conditions, would they
not be compelled to act?” asks Chris Bonnett, president of H3 Consulting. “Insurers and advisors can help employers better understand the health and workplace conditions that affect their workforce. We can help employers understand the magnitude of the problem.”
“Employers underestimate the prevalence of chronic disease in their workplaces and they underestimate the positive impact they can have on employee health,” notes David Willows, vice-president of strategic market solutions at Green Shield Canada.
For their part, plan sponsors estimate that 26% of their workforce have a chronic disease or condition such as high blood pressure, diabetes or depression. While these numbers fall short of employees’ reports, they reflect an important perceptual reality. Among employers, 26% may actually seem high because the perception is that the majority of employees are at work and appear to be healthy, notes the board. Yet many chronic diseases
Total
1 to 100
101 to 500
501+
0% 25% 50% 75%
48%14% 34%
37%31%6%
11% 45%34%
65%38%27%
Com
pany
siz
e
BASE: All plan sponsors (n=504)
Plan sponsors who know the “top” disease states in their workforcen Strongly agree n Somewhat agree
SECTION 2 IMPACT OF CHRONIC DISEASE
Sicker than we seem
FPLAN SPONSORS
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 13
are “silent” and as a result employers underestimate their impact on produc-tivity over time.
Mental illness, such as depression or anxiety, is the most prevalent chronic disease according to surveyed plan members (18%), followed by arthritis (14%), and asthma or other chronic lung conditions (9%). Respondents who are 55 and older are more likely to have arthritis (27%) and diabetes (12% versus 8% across all ages), and far more likely to have the related conditions of high cholesterol (34%, compared with 19% for all ages) and hyperten-sion (33% versus 16%). (For more on prevalence rates, see “Sobering reality of chronic disease,” page 14.)
“In the last couple of years, we’ve been seeing the need for more chronic disease management coming to the forefront, but our industry has been almost singularly focused on higher-cost specialty drugs such as biologics. Now the numbers on chronic disease are starting to stare us in the face and we as providers have to move that conversation forward,” says Willows.
“Chronic disease is not a contained issue, it is an organizational issue. You only have to look at your drug
claims to see that,” adds Ben Harrison, director of group strategic relationships at Great-West Life.
By making the connection between an organization’s claims data and its top disease states, providers can help plan sponsors understand the unintended consequences that cost-cutting can have on health outcomes, stresses Dr. Alain Sotto, occupational medical consultant at Toronto Transit Commission (TTC) and director of Medcan Wellness Clinic. “Right now, there is this big disconnect between health benefits, wellness and chronic disease management. How does the workplace offer programming in all three of these areas? We have to look at all three in combination because they’re intertwined.”
Currently, not quite half of plan sponsors (48%) know the top disease states in their workforce and only 14%
strongly agree with this statement. Employers with more than 500 employees are far more likely to know (64%) than those with up to 100 employees (37%). “Providers should be able to supply reports that tell plan sponsors their drug utilization
profiles and top disease states while still protecting plan member confidentiality,” notes Pierre Marion, senior director of sales and business relations at Medavie Blue Cross. l
‘‘ Dr. Alain Sotto, TORONTO TRANSIT COMMISSION & MEDCAN WELLNESS CLINIC
Right now, there is this big disconnect between health benefits, wellness and chronic disease management. How does the workplace offer programming in all three of these areas? We have to look at all three in combination because they’re intertwined.
‘‘TM
Plan sponsors underestimate the prevalence, and hence the possible impact of chronic health issues in the workplace.
SECTIONTAKEAWAY
14 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
Fifty-eight percent of adult Canadians
have at least one chronic disease
or condition, according to a 2013
consumer survey by the Canadian
Foundation for Healthcare Improve-
ment.2 That’s up from 37% reported in
2007. Respondents were most likely to
indicate they have arthritis (22%) and/
or heart disease (including high blood
pressure, 22%), followed by a mental
health condition (16%), a respiratory
condition such as asthma (14%) and
diabetes (11%).
As prevalence rates climb, drugs are
increasingly important components
of treatment. “We have better drugs
today to control chronic diseases and
risk factors, so more people are able
to stay in the workplace,” says Dr. Alain
Sotto of TTC and Medcan. “When you
take drugs to treat hypertension or
high cholesterol, you are less likely to
have a stroke or heart disease.”
Additional research reports the
following details on some of the most
common chronic conditions.
High blood pressure It’s estimated that 52% of Canadians
aged 60 to 79 and 24% aged 40 to 59
have hypertension. Among them, 68%
take medication and their blood pres-
sure is controlled, 12% take medication
but their blood pressure is not con-
trolled, 4% do not treat their hyperten-
sion and 16% are unaware they have
the condition.3
High cholesterol Fifty-nine percent of Canadians aged
60 to 79, 40% aged 40 to 59 and 23%
aged 18 to 39 have unhealthy cho-
lesterol levels, or dyslipidemia. It’s
estimated that half are unaware they
have the condition—jumping to 86%
among those aged 18 to 39. Among
those who are aware they have the
condition, 30% have brought their cho-
lesterol levels under control and 21%
continue to have unhealthy levels.4
Diabetes Ten percent of Canadians aged 20 and
older have diabetes5 and another 22%
have prediabetes. If current trends con-
tinue, one in three Canadians will have
diabetes, prediabetes or undiagnosed
diabetes by the end of this decade.6
Mental illness Eleven percent of Canadians aged
20 and older have mood disorders
and/or anxiety.7 One in five will experi-
ence a mental illness in his or her
lifetime, and approximately half of
those who feel they have suffered
from depression or anxiety have not
seen a doctor for treatment.8 l
2. Canadian Foundation for Healthcare Improve-ment. 2013 Health Care in Canada Survey. POLLARA, December 2013–January 2014.
3. Statistics Canada Health Fact Sheets. “Blood Pressure of Adults, 2012 to 2013.” Canadian Health Measures Survey, 2012 to 2013. Catalogue no. 82-625-X. Accessible at www.statcan.gc.ca/pub/82-625-x/2014001/article/14101-eng.htm.
4. Statistics Canada Health Fact Sheets. “Cholesterol Levels of Adults, 2012 to 2013.” Canadian Health Measures Survey, 2012 to 2013. Catalogue no. 82-625-X. Accessible at www.statcan.gc.ca/pub/82-625-x/2014001/article/14122-eng.htm.
5. Public Health Agency of Canada. Chronic Disease and Injury Indicator Framework Quick Stats. Chronic Diseases and Injuries in Canada 2014:34(4). Accessible at www.phac-aspc.gc.ca/publicat/cdic-mcbc/34-4/assets/pdf/CDIC_MCC_Vol34_4_12_CDIIF_eng.pdf.
6. Canadian Diabetes Association. Canadian Diabetes Cost Model. Toronto, May 2014. Accessible at www.diabetes.ca/getmedia/513a0f6c-b1c9-4e56-a77c-6a492bf7350f/diabetes-charter-backgrounder-national-english.pdf.aspx.
7. Public Health Agency of Canada. Chronic Disease and Injury Indicator Framework Quick Stats. Chronic Diseases and Injuries in Canada 2014:34(4). Accessible at www.phac-aspc.gc.ca/publicat/cdic-mcbc/34-4/assets/pdf/CDIC_MCC_Vol34_4_12_CDIIF_eng.pdf.
8. Canadian Mental Health Association. “Fast Facts about Mental Illness.” Accessible at www.cmha.ca/media/fast-facts-about-mental-illness/#.VQ2y2mTF-V8.
Sobering reality of chronic disease
R E S E A R C H N E W S : P R E V A L E N C E R A T E S
SECTION 2 : IMPACT OF CHRONIC DISEASE
Forty-eight per cent of plan sponsors know the top disease states in their workforce, underlining the need for better interpretation of claims data.
SECTIONTAKEAWAY
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 15
Almost half of plan members (44%) with chronic conditions told their immediate managers or supervisors, and 82% report their managers were supportive afterwards. In fact, 43% describe their managers as very supportive. “It’s extremely positive that eight in 10 managers were supportive of the individual when personal health information was shared. That’s something that should be leveraged,” says Ben Harrison of Great-West Life. “These results suggest that people don’t have to deal with their health challenges alone, and given the opportunity, managers can be an important part of the support system.”
The high level of support may be an indicator of trust levels, says Anne Nicoll, vice-president of health and disability management for Medavie Blue Cross. “Perhaps employees choose to tell their managers because they already know they will get the support. If they don’t feel the support is there, they’re not going to tell.”
Results differ based on the condition. While plan members with
a mental illness are likely to disclose their condition (42%), they report a somewhat lower level of support (76%, with 37% saying managers are very supportive). Plan members with heart disease are somewhat more likely to disclose their condition (54%) but, as with mental health conditions, describe a somewhat lower level of support (76%, although they also report a higher level of managers being very supportive, at 52%).
Plan members with high cholesterol are less likely to disclose their
condition (38%). Those that do, however, report the highest level of support (88%, with 51% of managers being very supportive). “Plan members and employers often overlook high cholesterol because it doesn’t impact performance. But it is a major risk factor that can lead to heart disease and stroke, which are very costly for plan sponsors,” says Dr. Alain Sotto of TTC and
Medcan. Indeed, the World Health Organization estimates that 60% of all cases of heart disease and 40% of strokes are due to elevated cholesterol levels.9
Among those who did not disclose their condition, most did not do so because they feel their condition does not impact performance (49%) or it is a
personal matter (45%). Far fewer were concerned about general perceptions in the organization (14%) and the impact on advancement (10%); however, these numbers jump to 26% and 20%, respectively, for plan members with a mental illness, and 29% and 19% for those with heart disease. l
9. World Health Organization. The World Health Report 2002. Reducing Risks, Promoting Healthy Life. Geneva: WHO, 2002:97.
Employees willing to share health status
Did plan members tell their immediate manager/supervisor about their chronic health condition(s)?
Plan members who told their manager/supervisor about their chronic condition had:
44%
56%
n Yes
n No
66%
61%
54%
49%
46%
43%
42%
38%
Cancer
Diabetes
Heart disease/heart attack
Arthritis
Asthma or chronic lung disease
Hypertension/high blood pressure
Depression, anxiety or other mental health problems
High cholesterol
0% 25% 50% 75%BASE: Plan members who have chronic condition (n=822)
‘‘ Anne Nicoll, MEDAVIE BLUE CROSS
Perhaps employees choose to tell their managers because they already know they will get the support. If they don’t feel the support is there, they’re not going to tell.
‘‘
Management training may be beneficial to appropriately support employees with chronic conditions.
SECTIONTAKEAWAY
PLAN MEMBERS
16 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
n the 2015 edition of The Sanofi Canada Healthcare Survey, a clear majority of
plan members (85%) state having one or more health or fitness goals—and 21% feel the workplace is a barrier to reaching those goals.
Eating healthier foods is the number 1 goal of respondents (57%), followed by achieving a certain weight (43%), getting more sleep (41%) and reaching a certain fitness level (30%). Employers should make special note of how important sleep is to employees, states Dr. Alain Sotto, occupational medical consultant at Toronto Transit Commission (TTC) and director of Medcan Wellness Clinic. “Sleep is a big determinant of health and wellness, and we’re not just talking about feeling well rested so you can put in a good day’s work. Sleep apnea is linked with obesity, hypertension, diabetes, coronary artery disease and strokes.”
When asked how their workplace affects their ability to reach their goals,
38% of respondents described their workplace as supportive, 41% said it is “neutral” and 21% described it as a barrier. Not unexpectedly, employees who describe themselves as over-whelmed or overcommitted during
most days are more likely to indicate their workplace is a barrier (33%).
Among those who describe their workplace as supportive, the reasons are roughly split between work site programs (23%), an on-site gym or membership discount (20%), and the availability of time due to flexi-ble hours or adequate breaks (17%). Interestingly, although eating healthier is the most common goal for employ-ees, only 5% spontaneously cite the availability of healthier foods as a way in which their workplace is supportive.
Lack of time, including long or inflexible work hours, is by far the biggest reason given by plan members who describe their workplace as a barrier to personal health and fitness goals (46%), followed by a heavy or stressful workload (26%). Ten percent of all respondents also blame their desk job or too much sitting, a result that increases to 16% among those in administrative positions. l
Any goals (NET)
Eat healthier foods
Achieve a certain weight
Get more sleep
Reach a certain fitness level or goal
Reach a certain body fat percentage
Reach a certain BMI number
Other
No such goals
0% 20% 40% 60% 80% 100%
85%
57%
43%
41%
30%
13%
11%
2%
15%
Plan members with personal goals for their health or fitness
BASE: All plan members (n=1,504)
SECTION 3 THE WORKPLACE : BRIDGE OR BARRIER TO HEALTH?
Universal quest for better healthI
PLAN MEMBERS
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 17
Organizational wellness offerings, such as programs for weight loss and stress management, are a tangible way for employers to support the health and overall well-being of employees—yet their availability and use appear to have plateaued.
Forty-five percent of plan spon-sors indicate offering such programs, virtually unchanged from when the question was first asked in 2012 (47%). Meanwhile, 30% of plan members say their employers offer wellness pro-grams, a finding that has see-sawed between 23% and 43% since the question was first posed in 1999 (38%). This year’s gap between plan sponsors and plan members is likely due in part to a lack of awareness—22% of plan members say they do not know if their employers are active in this area.
Large, unionized and public sector employers do, however, appear to be more active. Seventy-two percent of plan sponsors with more than 500 employees report offering wellness programs, compared with 52% of mid-size employers and just 23% of small employers (up to 100 employ-ees). Sixty-four percent of unionized environments and 61% of public sector employers provide wellness programs, versus 35% and 39% among non-unionized and private sector work sites.
When it comes to participation, only 11% of employees say they definitely do so on a regular basis, and another 23% “kind of” or somewhat regularly partic-ipate. These levels have been generally consistent since the question was first asked in 2008 (when 13% definitely and 27% somewhat regularly participated). Interestingly, the greater availability of programs in large, unionized and/or public sector sites does not translate into greater participation:
• Only 8% of plan members working for large employers say they definitely participate, compared with a high of 21% among employees working for mid-size organizations.
• Those working for large employers are most likely not to participate at all (31%), compared with a low of 15% among those in mid-size organizations.
• Unionized or public sector plan members are also more likely not to participate at all (36% and 32%, respectively).
Age and health status also play their part. Forty-five percent of 18- to 34-year-olds definitely or somewhat regularly participate, versus 30% of those aged 35 to 54 and 31% of those aged 55 and older. Unfortunately, less than a third (30%) of employees with poor or very poor health
participate—even worse, 39% do not participate at all.
When asked to choose from a series of statements to describe how they feel about their workplace wellness programs, 51% agreed they are “great” whether or not they personally participate, and 33% indicated they try to participate in things of personal interest and are happy with their participation rates. Sixteen percent said they would like to participate but their job or workload prevents them from doing so. Only 12% reported they are not interested in the programs, 5% said they are uncomfortable participating, and almost none (3%) indicated that the attitudes or behaviours of managers or co-workers discourage participation. (For more on the future of wellness programs, see “Step back to move forward on wellness,” page 22.) l
Wellness programs in a rut?
Feeling better not quite its own rewardEighty-one percent of plan sponsors agree they need to offer incentives
to encourage employee participation in programs or activities related
to health, and 30% actually do so. Size is definitely a factor, with results
climbing from 14% among small employers to 39% among mid-size and 47%
among large employers.
When asked to select from a list of possible incentives offered, plan sponsors
most often selected financial incentives (33%), awards or recognitions (32%),
and prizes such as tickets to sporting events (25%). Nineteen percent also tie
incentives directly to increased benefits coverage, such as contributions to
health spending accounts. Social incentives—for example, team competitions
or fundraising for charities—can also be powerful motivators, suggest members
of The Sanofi Canada Healthcare Survey advisory board.
Personal digital or online tools are a growing opportunity to incentivize
employees, the board adds. Currently, 32% of plan members say they’ve used
at least one such tool—such as personal fitness tracking devices (12%), smart-
phone apps (11%) or websites that track personal progress (10%)—in the past
year. On the employer side, 16% indicate offering the use of free or loaned per-
sonal tracking devices. “This is an area to expand upon because use of these
tools will only go up,” says Ben Harrison of Great-West Life. l
The workplace can clearly help—or hinder—the achievement of employees’ health and fitness goals.
SECTIONTAKEAWAY
18 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
Forty-one percent of plan members report feeling overwhelmed or overcommitted on most days due to work, personal lives or a combination of the two. A number of telling variations emerge:
• Employees who describe their health as poor or very poor are far more likely to feel overwhelmed (58%) than those who say their health is excellent or very good (29%).
• Regionally, employees in Ontario are most likely to feel overstressed (46%), compared with 31% in Atlantic Canada.
• Younger (18- to 34-year-olds, 48%) and middle-aged (35- to 54-year-olds, 46%) plan members are much more likely than their older counterparts (55 and older, 26%) to feel overwhelmed.
Now let’s consider that the plan spon-sor survey reveals that 87% of employers believe their overall culture promotes wellness. In answering this question, are plan sponsors speaking to wellness programs such as fitness challenges or sessions on stress management? If so, the
availability of such programs—45%—falls far short of what one would expect based on 87% of plan sponsors indicat-ing that their culture promotes wellness. (For more on the availability and use of wellness programs, see “Wellness programs in a rut?” page 17). Does this result therefore also speak to strategies or policies that address the day-to-day work environment? According to this year’s survey of plan members, the answer is, at best, “maybe”—and more likely “no” among those who feel over-whelmed or who are in poor health.
For example, keeping in mind that good health includes taking breaks to eat proper meals and recharge the mind, the survey found that almost half of employees (47%) continue to work while eating their lunch. This jumps to 66% among employees who feel overwhelmed. Men (51%) are more likely to work while eating than women (43%), and again employees under 55 are far more likely to do so (52%) than those 55 and older (35%).
Twenty percent also report that their current job or workload has caused them to regularly eat unhealthy foods or snacks—increasing to 43% among
those in poor or very poor health, and to 33% among employees who feel overwhelmed.
These numbers should be a cause for concern, notes the advisory board. “Employers believe they are doing really good things, whether in wellness programming or by offering flex time to promote work-life balance, but when you look at that against the number of people eating lunch at their desk and who report being overwhelmed, employers may want to consider whether there could be a disconnect,” says Telena Oussoren, manager of benefits for Suncor Energy.
What about the ability to keep appointments directly related to health, or meet personal commitments for rec-reation or physical activities? Nineteen percent of plan members report that their current job or workload has caused them to cancel or reschedule appoint-ments with healthcare professionals, climbing to 31% among those in poor or
Many feel overwhelmed—and health suffers
Six years after launching its wellness
program, London Hydro couldn’t be
happier with the results—and momen-
tum continues to build. “Since 2009, we’ve
seen a 30% reduction in sick leave,” says
Jeff Harrison, manager of health and
safety for the London, Ontario-based
company of 330 employees. Equally
important are the results that are more
difficult to quantify. “You can see employ-
ees feel better about themselves, and
this benefits our culture. It creates a family
feeling at work.”
When asked what advice he would
give to other employers, Harrison boiled
the wellness equation down to three
components:
1. Bring in the expertsFrom the get-go, London Hydro hired an
independent wellness firm, which works
Wellness in three parts“I started with the wellness program three years ago and have benefited in many ways. [My coach gave me] an exercise program and diet that helped me lose approximately 25 pounds. I had also taken on a new job that was filled with new challenges. I have learned how to [manage stress and] maintain a healthy work and personal life. I am truly appreciative!” —Employee testimonial
P R O F I L E : H E A L T H C U L T U R E
SECTION 3 : THE WORKPLACE : BRIDGE OR BARRIER TO HEALTH?
Employees in poorer health require more targeted supports, since they are less likely to participate in traditional wellness programs.
SECTIONTAKEAWAY
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 19
very poor health and 30% among those who feel overwhelmed.
Employees who feel overwhelmed are also more likely to be late for or miss personal recreational activities (23%, compared with 13% overall) and to reschedule or cancel plans for physical activities (19% versus 12%). l
41%
37%
35%
34%
45%
43%
31%
48%
46%
26%
37%
58%
Total
British Columbia
Alberta
Manitoba/Saskatchewan
Ontario
Quebec
Atlantic Canada
18-34
35-54
55+
Excellent/Very Good/Good
Poor/Very Poor
0% 20% 40%
Regi
onAg
ePe
rson
al
Hea
lth/F
itnes
s
10% 31%
8%
8% 27%
31%3%
13% 32%
34%9%
8%
6%
23%
12% 36%
11% 35%
20%
29%
8% 29%
40%18%
60%
BASE: All plan members (n=1,504)
with management and a volunteer
committee of employees. “We could
not be at this level without them,” says
Harrison. The provider organizes events,
employs health coaches and supplies
detailed reports to management.
2. Make it personalIn 2014, 97% of the company’s office
employees regularly participated
in the monthly, one-on-one health
coaching sessions. The coaches
develop individual wellness goals
based on health risk screenings, and
aggregate results so far include reduc-
tions in cancer risk from 71% in 2009 to
45% in 2014, and in high stress levels
from 34% to 19%. Group programs and
events help employees reach personal
goals. For employees working in the
field, the health coaches give presen-
tations at health and safety meetings
and regularly reach out with more of a
personal touch—for example, serving
fresh porridge with berries prior to the
start of the work day.
3. Take internal stockLondon Hydro also assessed its
work environment. “We are always
looking for ways to improve our
culture,” says Harrison. Changes over
the last year include the renovation
of the cafeteria into an internet
café, with Chromebook computers,
televisions and, of course, a range
of healthy foods, a quiet room
where employees can relax and
an updated fitness centre that’s
open 24/7. l
n Strongly agree n Somewhat agree
Plan members feeling overwhelmed most days
Sixty-one percent of plan sponsors
with wellness programs create or
run the programs themselves, while
equal numbers work with their insur-
ance carrier (28%) and/or a wellness
provider (28%). Seventeen per cent
work with their benefits consultant,
advisor or broker, and 5% draw support
from their employee assistance pro-
gram provider. As well, 20% indicate
their consultant, advisor or broker and/
or insurance carrier helped coordinate
a wellness-based program in the past
year, such as on-site flu shots or an
initiative tied to chronic disease.
Only 25% of plan sponsors formally
measure participation or outcomes of
wellness programs; another 55% “infor-
mally” do so. Among those that do,
whether formally or informally, tracking
participation levels is by far the most
common measure (77%), followed by
the frequency of participation and
participant surveys (both at 48%).
Twenty-five percent seek to determine
the impact on absenteeism.
“The most important measures
of outcome are not there, and that
includes the impact on absenteeism.
You need to tailor your program for
your workforce and measure, mea-
sure, measure to make sure you get
what you’re paying for,” says Steve
Semelman, CEO of Gemini Pharma
Consultants.
“Metrics are key to determining the
return on investment of any wellness
program, specifically linking health
and disability data to health risk
assessments and wellness initiatives,”
adds Douglas Yep, senior director,
total rewards, at Air Canada. “Achiev-
ing such measurable metrics would
encourage companies to include well-
ness at the core of their benefit plans,
for the benefit of both employees and
the bottom line.” (For more on wellness
as a core benefit, see “Step back to
move forward on wellness,” page 22.)
The fact that the majority of
employers create or run their pro-
grams internally is likely a key reason
why the measurement is not there,
notes the advisory board. Indeed, 72%
of respondents agree they would like
better reporting or evaluation of the
ROI of health and wellness programs.
“Perhaps for carriers the opportunity
is to provide tools for plan sponsors to
measure these programs that are run
internally,” says Ben Harrison, director
of group strategic relationships at
Great-West Life. l
Employers can take better measures
PLAN MEMBERS
20 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
When 56% of the workforce report having chronic health conditions—increasing to 78% among employees 55 and older (see “Sicker than we seem,” page 12)—what steps can employers take to ensure their work environment is not a barrier to per-sonal health? Plenty, according to some of Canada’s largest patient groups.*
Healthy foods, flexible hours and alternate work arrangements top the list of accommodations for employees with chronic conditions. To help employers provide the first objective, Hypertension Canada recently launched the 4 STAR Food Environment program (www.4starfood.ca), a step-by-step guide to implement a healthy food
policy (including, for example, the renegotiation of vendor contracts).
Healthy foods are one thing; healthy eating habits are another. Senior man-agers can walk the talk by taking regular lunch and coffee breaks away from their workspace. Dietitians caution that peo-ple who work while they eat tend to eat more and enjoy food less, and are more likely to crave unhealthy snacks later.
Flexible work hours, more frequent, shorter breaks and the ability to
work at home can be important to accommodate self-care routines, the use of medications and medical appointments. As well, a “quiet room” in the workplace, with private areas for those who need to rest, take medication or use medical devices can boost employees’ ability to manage their conditions. l
* Hypertension Canada, Canadian Mental Health Association, Canadian Diabetes Association, The Arthritis Society
Workplace supports for chronic disease
A D D E D P E R S P E C T I V E : A C C O M M O D A T I O N S
• Raising general awareness of the growing prevalence of chronic conditions and the importance of lifestyle behaviours for prevention and treatment.
• Stairwells that are well-lit, clean and spruced up with artwork or greenery.
• Disposal receptacles for testing lancets and injection needles used to treat diabetes.
• Stress management training for all employees.
Additional suggestions to support chronic disease management:
SECTION 3 : THE WORKPLACE : BRIDGE OR BARRIER TO HEALTH?
• An ambulatory blood pressure monitoring machine in on-site gyms or wellness areas.
• Heightened consideration of employees who work shifts, since eating and sleeping at different times affect hunger, fatigue and blood-sugar levels.
• For employees with arthritis, individualized ergonomic workspaces and more frequent breaks.
• Implementation of the Canadian Standard for Psychological Health and Safety in the Workplace (www.mentalhealthcommission.ca/English/issues/workplace/national-standard).
Better measures are needed to connect wellness initiatives with benefits and disability data.
SECTIONTAKEAWAY
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22 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
ith ongoing lack of aware-ness and lukewarm partic-ipation levels, especially
among people most in need—what’s an employer with wellness programs to do? Step back and start fresh, urge members of the advisory board for The Sanofi Canada Healthcare Survey.
“Employers and the industry have been talking about the wellness
concept for 25 years,” says Susan Belmore-Vermes, director, group benefits solutions, at Health Association Nova Scotia. “We believe it’s important, but we continue to struggle with putting programs in place and increasing participation.”
Results reveal that younger, health-ier people are more likely to par-ticipate in the programs currently
available (see “Wellness programs in a rut?” page 17.) How do we reshape wellness so it also motivates those who likely need it more? Members of the advisory board agree it’s time to view wellness from a different perspective. “We need to find out how to make more employees part of the decision to change their own behaviour,” says Nathalie Laporte, vice-president, product development, marketing and strategy, at Desjardins.
A large part of the problem, observes David Willows, vice-president of strategic market solutions at Green Shield Canada, is that “we have set up
SECTION 4
Step back to move forward on wellness
FUTURE FORWARD FOR HEALTH MANAGEMENT
W
Plan sponsors appear to be some-what ambivalent about the man-agement of claims for higher-cost specialty pharmaceuticals: 79%
are satisfied with how their carrier
responds to these claims, yet virtually
the same number (78%) would like
their carriers to provide more options
for coverage. As well, 64% feel they
do not have enough information to
understand the benefits of covering
these medications. Small employ-
ers (69%) are more likely than large
employers (58%) to feel they do not
have enough information.
As well, 33% of plan sponsors indicate
they do not have a program in place
to respond to claims for higher-cost
specialty pharmaceuticals, increasing
to 42% among small employers (and
dropping to 22% among large employ-
ers). Among those that do, the most
common programs involve stop-loss
insurance (19%), annual drug plan
caps (17%) or case management (16%).
As well, 17% of large employers use a
preferred provider network for specialty
pharmaceuticals, versus 9% of small
employers. l
What about specialty drugs?
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 23
a system where wellness is developed outside of health benefits. It’s this ‘extra thing.’ If we were to start from scratch today for plan design, I think many of us would agree that things like health coaching and adherence programs should be right there with reimbursing drugs and paramedicals.”
As with health benefits (see “The higher purpose of health benefits,” page 6), “the time is right to reframe wellness into a health risk manage-ment strategy to engage employees’ participation,” suggests Art Babcock, vice-president of Aon Hewitt. “As an industry, we’re not having a strategy discussion in general with employers, let alone connecting the dots to personal health risks and chronic disease.”
Past surveys consistently show plan members’ high level of willingness to participate in programs that identify
and address personal health risks (see “What’s my risk? Members want to know,” page 26).
“Companies already do risk man-agement in other areas, such as occu-pational safety. If wellness were framed in this way, perhaps it would get more attention,” says Chris Bonnett, president of H3 Consulting. Then, he adds,
“wellness becomes an organizational responsibility that affects productivity. Employers will see their role in improv-ing the work environment and culture as a foundation for a healthy and pro-ductive business. It’s not about blaming ‘unmotivated’ employees—employers
have a very important influence on both risk and health.”
Providers can also collectively play a stronger role. “It’s difficult to get to a place where we can educate employers on the right programs to offer and how to be more strategic if there continues to be a lack of clarity amongst indus-try stakeholders. As providers, we can
see this as an opportunity to lead the charge to better define wellness and the objectives that need to be in place in order to determine strategy,” says Lori Casselman, assistant vice-president, practice excellence and innovation, at Sun Life Financial. l
Wellness has been defined in many
ways, but a general understanding
is that wellness (sometimes called
well-being) is broader than health and
usually includes a state of balance in
body, mind (emotional and intellec-
tual), spirit and social domains, with an
emphasis on prevention and resilience.
It incorporates the quality of a person’s
life as well as general life satisfaction. It
often means having a sense of purpose
and mastery over life. Importantly,
wellness is not the same for everyone:
it includes subjective, perceptual and
relative elements. Wellness is seen as a
continuum measured in degrees, rather
than a discrete condition.10
In the workplace, that description
probably seems ethereal and unattain-
able and may appear disconnected
from an employer’s goals and inter-
ests. So, wellness is often reduced to a
series of fitness and health education
programs that are typically sporadic,
not evaluated for need or impact, and
not integrated with each other or with
the organization’s strategy. Sometimes
wellness programs simply focus on the
individual’s lifestyle—exercise, diet,
weight, smoking, alcohol, stress—and
overlook the employer’s ability to influ-
ence health through leadership and
management policies, programs, and
practices. These latter factors create a
culture that employees interpret in order
to gauge levels of trust, fairness, respect,
recognition and support. Lifestyle is
certainly important but it is not sufficient
to determine health and it does not exist
in a vacuum. Beyond work, wellness is
influenced at home, in the community
and by the broader environment.
Based on many years of experience
in this field, the following definition of
a healthy organization is the best I’ve
come across: “. . . one whose culture,
climate, and practices create an envi-
ronment that promotes both employee
health and safety as well as organi-
zational effectiveness.”11 This is short,
simple, integrative and adaptable.
Beyond a program or a slogan or the
best of intentions, this should become
our benchmark for wellness at work.
Inherently then, wellness should
be strategic and therefore sustained.
It ought to focus on education and
behaviour at all levels of the organiza-
tion, and aim to improve the worker,
the workplace and the employer. How
does your workplace measure up? l— Chris Bonnett, president,
H3 Consulting
10. These key dimensions have been extracted from the British Columbia Atlas of Wellness, First (2007) and Second (2011) editions. Accessible at www.geog.uvic.ca/wellness.
11. Lim S-Y, LR Murphy. The Relationship of Organizational Factors to Employee Health and Overall Effectiveness. American Journal of Industrial Medicine 1999;36(Suppl):64–65.
The right benchmark for wellness at work
A D D E D P E R S P E C T I V E : D E F I N I N G W E L L N E S S
‘‘ Nathalie Laporte, DESJARDINS
We need to find out how to make more employees part of the decision to change their own behaviour.
‘‘
24 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
Plan members submitted at least one claim for prescription drugs (89%), basic dental care (82%) and vision care (61%) in the past year—no surprises there. When it comes to frequency of claims, however, para-medical services come second after prescription drugs—and while the number 1 ranking for medications is again no surprise, the high use of paramedicals generates growing debate over value and the need for controls.
Based on all respondents (including those who did not submit a claim), the average number of claims in the past year was 8.6 for prescription drugs, 3.8 for paramedical services, 3.2 for basic dental care and 1.5 for vision care. When you remove those respondents who did not submit any claims, the averages increase to 9.5 for drugs, 7.3 for paramedicals (a much bigger jump since 47% of respondents did not make a single claim), 3.7 for basic dental care and 2.2 for vision care.
Plan members in poor or very poor health on average submitted 8.8 claims for paramedical services, compared with 6.8 from those in excellent or very good health.
Massage therapy is the most popular paramedical service (57%). Women are more likely to use massage ther-apy (62% versus 52% for men), and 68% of claimants aged 18 to 34 receive massage therapy compared with 45% of those 55 and older.
These results for paramedical services, and in particular massage therapy, gen-erated much discussion among members of the advisory board. For one thing, their level of use signals the need for greater scrutiny. It also brings questions around philosophy back to the surface.
On the one hand, employees who are light users of traditional benefits and have few or no health issues perceive paramedicals as “lifestyle” offerings
that help communicate that benefits are a form of compensation or reward. On the other hand, paramedical services help make the connection to health and productivity by being an effective part of treatment for those with injuries or chronic pain, for example. As well, carri-ers have begun to explore the role of new paramedical offerings in chronic disease management: Medavie Blue Cross, for
example, recently added asthma coaches to its list of eligible providers.
No matter how plan members regard paramedical services, the fact remains that the frequency of use is coming close to rivalling that of prescription
drugs among those who made at least one claim. The time has come to consider establishing criteria based on objective, clinical measures (such as proof of an injury) rather than plan members’ self-perceived needs, suggests the advisory board.
“If you want benefits to be evidence-based, then why would you give access to paramedicals to every-one? We have a lot of barriers to drugs but we have almost zero barriers to massage and other paramedicals,” notes Steve Semelman, CEO of Gemini Pharma Consultants.
“When you consider disability issues and issues around specialty pharma-ceuticals, which can be life-changing for members, the cost and use of some paramedicals just don’t seem to make sense,” says Paula Allen, vice-president of research and integrative solutions at Morneau Shepell. “Perhaps it makes more sense to first align investments to the health supports that are most crit-ical. Medications are at the top of plan members’ lists for both utilization and need. Mental health underlies all health and productivity. Both are great exam-ples of what needs to be well supported. The more discretionary services within the paramedical group are really more aligned with the intent of a healthcare spending account, and may be better addressed there.” l
Getting value for paramedicals
BASE: Used paramedical services as a health benefit (n=769)
57%
41%
37%
15%
10%
9%
3%
Massage therapy
Physiotherapy
Chiropractic
Acupuncture
Naturopathy
Osteopathy
Other
0% 20% 40% 60%
Twenty percent of plan members
can be described as heavy users
of health benefits, submitting 31
or more claims annually across all
types of benefits. Almost half (48%)
make moderate use of their benefit
plan, submitting 11 to 30 claims,
and the remaining 31% submit no
more than 10 claims a year.
Combined uses of any benefits; BASE: All plan members (n=1,504)
31%
48%
20%
1%
n Non-User (0)
n Light User (1-10)
n Medium User (11-30)
n Heavy User (31+)
One in five is a “heavy user” of benefitsNumber of annual claims
SECTION 4 : FUTURE FORWARD FOR HEALTH MANAGEMENT
PLAN MEMBERS
Paramedical services used in the last year
PLAN MEMBERS
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 25
More than half of plan members (57%) with health spending accounts (HSAs) did not use them at all in the past year, and those who did used 50% on average of the funds available. This level of use is not unusual and some plans will see levels closer to 40%, note members of The Sanofi Canada Healthcare Survey advisory board. Are the results telling us that plan members are uninterested in their HSAs? Should plan sponsors reallocate some of the unused funds to wellness and health management initiatives? What’s the right level of control or management by employers?
Lack of awareness is a key factor. “At the end of the year, employers look at all of these defaults for HSAs and ask what’s going on, but what they probably haven’t done throughout the year is continuously communicated to employees what the benefit is all about,” says John McGrath, senior vice-president, human capital practice leader at Willis Canada. As well, eligible claims can be restricted and plan members can find the process of using the fund too complicated.
“We have sessions on how to use the HSA and what it can be used for, but at the end of the day the people who go to the sessions are those who are already interested,” says Carol Craig, director of human resources, benefits and pensions at TELUS.
“We have to be cognizant of the fact that everybody has so much thrown at them and they’ll only pay attention when it’s important and relevant to them.”
Technology should eventually improve utilization, as carriers will be able to directly remind plan mem-bers of the funds available and the deadline for submitting claims, note members of the advisory board.
Employers are also exploring the evolution of HSAs to address plan
members’ expressed desire for more flexibility and personalization of benefits (see “Plan members are satisfied . . . sort of,” page 3). To that end, the advisory board notes a growing trend to offer taxable spending accounts that
plan members can use for products and services not always covered under HSAs, so long as they are health-related.
Based on the survey of plan sponsors, 32% of employers offer HSAs, ranging from 19% among small employers (up to 100 employees) to 25% among mid-size (101–500) and 53% among large (more than 500) employers. Unionized environments are also more likely (41%) to offer HSAs. l
Low uptake for health spending
‘‘ John McGrath, WILLIS CANADA
At the end of the year, employers look at all of these defaults for HSAs and ask what’s going on, but what they probably haven’t done throughout the year is continuously communicated to employees what the benefit is all about.
‘‘
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To reach higher-risk plan members, plan designs can incorporate new, wellness-oriented benefits such as health coaching.
SECTIONTAKEAWAY
26 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
Year after year, plan members indi-cate a strong preference for health risk screenings as a benefit offering. When one considers the growing prevalence of chronic disease, early detection—and the possibility of prevention—appears to be a logical first step toward managing long-term benefit costs (see “Impact of chronic disease,” page 12).
Two years ago, 88% of respondents to The Sanofi Canada Healthcare Survey stated they would participate in on-site screenings with healthcare profession-als. Last year, the survey broke down plan members’ willingness based on disease state: 91% would likely partici-pate in screenings for cancer risk, 89% for heart disease, 84% for diabetes, and 75% for stress or mental health issues.
This year, health risk screenings were one of seven possible new benefit offerings related to health, fitness or
work-life balance. On-site screen-ings ranked first (45%) as the benefit respondents would most likely use, followed by on-site immunizations for infectious diseases (40%) and fitness/yoga classes (34%).
Plan sponsors appear to be aligned with plan members. When presented with the same list of possible additions to their health benefit plan, employers most likely rank on-site screenings as their first consideration (19%),
What’s my risk? Members want to know
Employees with elder care responsi-
bilities would appreciate assistance
through their health benefits, yet plan
sponsors appear less inclined to expand
their plans in this way.
The 2012 National Study on Work, Life
and Caregiving, which surveyed more
than 25,000 employees, found that
9% of men and 15% of women provide
elder care. The incidence is slightly
higher in the 2015 edition of The Sanofi
Canada Healthcare Survey, with 15% of
plan members indicating they pro-
vide care for elderly family members,
climbing to 20% among those between
the ages of 55 and 64. Care activi-
ties include driving to appointments,
arranging for medical or other services,
and taking over regular tasks.
When asked to choose from seven
possible new benefit offerings, employ-
ees with elder care responsibilities put
“assistance with day-to-day care of
elderly parents” at the top of the list
(49%), ahead of the number 1 pick for
total respondents (on-site health risk
screenings, 45%). Plan sponsors, mean-
while, are not very likely to consider
expanding their benefit plan to accom-
modate elder care—only 6% ranked it
as their first consideration for expanded
benefits, well behind screenings (19%).
Employees providing elder care
mainly seek more time rather than
financial assistance. When asked which
benefits would be most helpful, based
on a list of eight options, their top-three
rankings most often went to paid days
off for caregiving (62%), flexible work
hours or compressed work weeks (59%)
and compassionate care leave (52%).
Coverage for the costs of assisted-living
services (45%) and coverage of mobility
equipment (25%) came next on their
wish list.
Among plan sponsors, 18% provide
paid days off for elder caregiving; on
the other hand, 44% say they already
offer flexible hours or compressed work
weeks and 42% offer compassionate
care leave. Only 6% and 4% provide
coverage for mobility equipment and
assisted living, respectively.
While plan sponsors may not wish to
change plan designs to accommodate
elder care, that does not mean they
do not want to support employees,
state members of the advisory board.
For older workforces in particular, elder
45%50%
40%35%
34%38%
29%27%
26%25%25%
32%23%
31%
14%8%
Health risk screenings with a healthcare professional to determine personal risks for certain diseases on-site in the workplace
Immunizations for infectious diseases on-site in the workplace
Coverage for a series of fitness classes/yoga classes
Coverage for a personal fitness trainer
Coverage for assistance with day-to-day care of elderly parents
Coverage for one-on-one health/wellness coaching
For those with a chronic condition, one-on-one education sessions with a pharmacist or nurse to better understand their medicines and health condition
None of these
0% 10% 20% 30% 40% 50%
Seeking support for elder care
Future benefits: which ones would members/sponsors likely use/consider?n Plan members (likely use) n Plan sponsors (top 3 choices)
SECTION 4 : FUTURE FORWARD FOR HEALTH MANAGEMENT
PLAN MEMBERS PLAN SPONSORS
BASE: All plan members (n=1,504); All plan sponsors (n=504)
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 27
followed by fitness/yoga classes (13%) and immunizations (13%).
Screenings are ideal benefits because “they reduce the risk of much higher benefit costs down the road through the early detection of chronic diseases and risk factors,” says Dr. Alain Sotto, occupational medical consultant at Toronto Transit Commission (TTC) and director of Medcan Wellness Clinic. He adds that today’s screen-ing devices are also better suited for on-site assessments.
Currently, 46% of large employers indicate they partially (29%) or fully (17%) cover health risk screenings with healthcare professionals, compared with 32% of mid-size employers (10% fully, 22% partially) and 29% of small employers (12% fully, 17% partially). For immuni-zations, 62% of large and 63% of mid-size employers already provide full or partial coverage, compared with 39% of small employers. l
Will preferred provider networks (PPNs)
play an important role in future plan
designs, or does experience show
they don’t deliver on expectations?
Twenty-four percent of plan sponsors
indicate their prescription medication
plan includes a PPN of pharmacies,
ranging from 13% of mid-size employ-
ers to 21% of small and 34% of large
employers. Pharmacy PPNs have been
around for years, but low participa-
tion rates have generally limited their
ability to reduce costs through lower
mark-ups and dispensing fees.
Some caution against mandatory
PPNs because plan members could lose
long-term relationships with pharmacists,
which are important for health outcomes
and reduce the risk of medication errors
and drug-related adverse events. A sin-
gle pharmacy also increases medication
adherence because the pharmacy can
monitor refill rates.
On the other hand, plan members
themselves appear to be willing to
join PPNs. Eighty-five percent say
they would use a PPN of, for example,
pharmacies or physiotherapists, if it
were part of their health benefit plan.
However, more than half (54%) qualify
their participation by stating they
would personally have to save money,
a result that climbs to 61% among
those aged 18 to 34.
“These results speak to the need
to develop PPNs that provide incen-
tives for employees to participate. At
the end of the day, what matters to
employees is how they benefit from
the preferred provider arrangement,
as opposed to how they can save their
organization money as a whole,” says
Godfrey Mau, pharmacy consultant,
group benefits, at Manulife.
Almost one in five (19%) states that
their current provider needs to be part
of the network. Interestingly, those with
a chronic condition (22%) and those
who describe themselves as being
in poor health (25%) are not that much
more likely to want to keep their
current provider.
“There’s an opportunity to look at
PPNs from a broader perspective—as
more than just a cost-saving measure,
but also as an opportunity to establish
a stronger connection between plan
members and practitioners such as
pharmacists and nurses for health man-
agement purposes,” suggests Mau.
“The initial financial incentive still needs
to be there, for both plan members and
plan sponsors. But let’s say, for example,
plan members start to take medications
for complex or chronic conditions—the
preferred provider network of health
professionals is already in place to pro-
vide additional case management
and adherence support.” l
Jury out on preferred providers
‘‘ Godfrey Mau, MANULIFE
There’s an opportunity to look at PPNs from a broader perspective—as more than just a cost-saving measure, but also as an opportunity to establish a stronger connection between plan members and practitioners such as pharmacists and nurses for health management purposes.
‘‘care support can be a point of
differentiation—and reduces the
risk of losing valued employees.
Community supports and other ser-
vices are not always readily avail-
able, and if the parent becomes
a safety risk then employees may
be forced to quit their jobs or retire
early. Whether it’s the employer
who should help address this of
the government, the reality is that
employees are facing this and we
should not wait for it to become a
bigger issue, stresses the board.
Plan sponsors with employee
assistance programs can also pro-
mote their existing navigation and
support services. “These supports
are not being used enough when
you consider the level of need,” says
Paula Allen of Morneau Shepell. l
Plan sponsors can play a major role in prevention and detection based on employees’ strong support for on-site health risk screenings.
SECTIONTAKEAWAY
28 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
Year after year, plan members would rather pay more themselves than experience reduced levels of coverage due to increased costs—yet this year almost an equal number are not sure what they would do.
Since 1999, The Sanofi Canada Healthcare Survey has asked plan mem-bers what they would do if health ben-efit costs increased and their employer was unable or unwilling to pay the increase. Would they pay higher pre-miums to maintain the same levels of coverage? Would they rather opt for less coverage so that they would not have to pay more in premiums? Or would they prefer to pay a higher portion of the cost (or higher co-pays) when they use the covered products or services?
Employees have consistently opted for higher premiums first, higher co-pays second and, at a distant third, reduced benefits. In 2009, in
the move to online data collection, respondents saw a fourth option that was previously recorded only when volunteered as a response: that they do not know. Since then, the strength of opinion has steadily shifted (although reduced coverage remains the least-preferred option):
• In 2009, 43% preferred higher premi-ums, 23% preferred higher co-pays, 20% did not know and 14% were willing to accept lower levels of coverage.
• In 2015, 31% prefer higher premiums, 30% do not know, 20% opt for higher co-pays and 19% would consider reduced levels of coverage rather than having to pay more themselves.
“The number of people who don’t know what they would do keeps growing and now it’s at 30%,” says Jacques L’Espérance, president of
J. L’Espérance Actuariat Conseil Inc. And while the situation is hypothetical, the perceptual trending over a 16-year time frame indicates a growing sense of uncertainty—a trend that could reflect a growing awareness and use of higher-cost specialty pharmaceuticals (see “What about specialty drugs?” page 22). “A lot of people do not know what they would do and I believe many employers are in the same boat. There are no easy answers,” he says.
“The increased cost of healthcare is a great concern for many employers,” says Douglas Yep, senior director, total rewards, at Air Canada. “Cost-sharing fosters a more consumer-minded thought process among employees and moves them away from an entitlement mentality.”
However, while 72% of plan sponsors indicate they would like their insurer to suggest additional cost-sharing options for health benefits, the advisory board cautions against exploring this area without a greater understanding of the possible unintended consequences on health. For example, higher out-of-pocket costs directly correlate to rates of non-adherence to medications, which can in turn lead to more costs to treat the complications of unmanaged disease.
“While cost-sharing has its role in terms of accountability, it can backfire when pushed too far,” says Pierre Marion, senior director of sales and business relations at Medavie Blue Cross. “Instead we need to consider strategies that ensure everyone is getting full value from their benefits. Full value equals positive outcomes, which means you’re less likely to have to spend more down the road. That’s where we’re going to see the savings.” l
SECTION 4 : FUTURE FORWARD FOR HEALTH MANAGEMENT
‘‘ Pierre Marion, MEDAVIE BLUE CROSS
While cost-sharing has its role in terms of accountability, it can backfire when pushed too far. Instead we need to consider strategies that ensure everyone is getting full value from their benefits.
‘‘
Uncertainty over cost-sharing
Getting better value must come ahead of cost-cutting measures that could have unintended consequences.
SECTIONTAKEAWAY
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30 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
What do two physicians, two pharma-
cists, one dentist, one dental hygienist
and representatives for the Alberta
School Employee Benefit Plan (ASEBP)
have in common? A commitment to
the sustainability of health benefits—by
turning traditional plan designs on their
heads. “These healthcare professionals
are taking us to next levels we could
never have achieved on our own. It’s
heaven!” exclaims Jennifer Carson, CEO
of ASEBP, which administers health ben-
efits for 58 school boards (or 110,000 plan
members, including dependents).
ASEBP’s health benefit advisory panel
has met four times since its inception
in June 2014. Its task: “to tear our plan
apart and tell us what we’re doing well
and what we can do differently, based
on best professional practices,” says
Carson. For example, the panel pointed
out that certain medications can cause
dry mouth, which increases the risk of
dental problems. Hygienists would rec-
ommend more frequent preventative
scalings and fluoride treatments, but
plan members would usually decline
after learning coverage is not available.
“We were treating the benefit plan, not
the patient,” says Carson. In January this
year, ASEBP removed dollar maximums
on basic dental services as the first step
toward “oral care plans” that focus on pre-
ventative measures and health outcomes
support. Similarly, ASEBP is exploring how to
build upon Alberta’s government-funded
care plans provided by pharmacists to
people with chronic conditions and/or risk
factors (such as tobacco use).
Such out-of-the-box thinking is fuelled
by a deeper understanding of the links
between health and benefits. The process
began in 2012, when ASEBP worked with
its benefits consultant to apply predictive
modelling to determine what its present
plan would cost per employee in 10
years. A data analytics firm also began to
analyze drug, disability and other health
claims by disease state, starting with
diabetes. Among the findings:
• A plan member with reasonably
well-managed diabetes costs the plan
about $30,000 over 20 years, versus
more than $550,000 for a plan mem-
ber with poorly managed diabetes.
• Thirteen percent of plan members
under age 25 (excluding depen-
dents) were already being treated
for diabetes, and 42% across all ages
were not adherent to medications.
“Intuitively we knew that health ben-
efits are an investment, not a cost, but
the predictive modelling and analytics
really spelled this out,” says Carson. “The
question then became, ‘How do we get
in front of this?’ Working with the panel,
we’re convinced we’ll see improved
overall health as costs come down.” l
Treating the patient, not the plan
Cost management continues to drive changes to health benefit plans, yet not all changes have to do with cutting costs. That’s welcome news, say mem-bers of The Sanofi Canada Healthcare Survey advisory board.
“When considering change, there will always be some trepidation or uneasiness about what to do, which is why plan sponsors’ requests for more information and data that is not limited to a singular view are really important,” says Lisa Callaghan, assistant vice-president of product and group benefits at Manulife. “Employers are making new connections and pro-viders would do well to keep moving the conversation forward beyond cost containment only.”
Sixty percent of plan sponsors say benefit costs increased in the past three years, of whom 12% describe the increase as significant. When asked, 69% of plan sponsors reported making at least one change to their plan in the past two years—and their biggest reason for making the change was to reduce or better manage costs (47%). Yet four of the five top changes did not directly pertain to cost-containment:1. Efforts to improve employees’ under-
standing and use of their plan (31%)2. New communication methods (29%)3. New wellness program or informa-
tion on health (23%)4. Mandatory generic substitution (22%)5. Higher levels of coverage for non-
drug benefits (13%)
Plan sponsors could be looking for better management of costs rather than reduced costs, notes the advisory board. Health management may also be emerg-ing as a common theme when you con-sider that the reasons for change include the need to better reflect the utilization patterns or needs of members (31%) and a desire to add or expand offerings (24%).
Large employers appear far more likely to take this broader view. While all sizes had similar experiences with increased costs, a relatively low 56% of small employers made any changes to their health benefits, compared with 82% of large employers. As well, large employers were far more likely than small employers to increase education (44% versus 19%), expand communi-cations (43% versus 15%) and launch wellness programs (43% versus 8%). l
Education part of cost management
P R O F I L E : D A T A A N A L Y T I C S
SECTION 4 : FUTURE FORWARD FOR HEALTH MANAGEMENT
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 31
Twenty-six percent of plan members do not know what will happen to their health benefit plans when they retire, a finding that is consistent across break-downs for size, labour environment and public versus private sectors. Gender and age, however, influence results: 32% of women and 38% of younger employees (aged 18 to 34) do not know what will happen (versus 21% of men and 14% of those aged 55 to 64).
Among remaining employees, 25% expect their current workplace benefit plan to continue—jumping to 40% among employees closest to the age of retirement (aged 55 to 64). Another
39% know their provincial healthcare plan will cover some of their health-care costs, though not to the extent of their workplace plan, while only 9% believe the provincial plan will take over from the workplace plan with similar levels of coverage.
Thirty-five percent of plan spon-sors, meanwhile, indicate health benefit plans are available after retire-ment—but only 6% do so at no cost to the retired plan member (increas-ing to 12% among large employers and 10% in unionized environments). Most offer a separate plan for a price (16%) and the remaining 13% offer a
continuation of the workplace plan, again for a price. As well, only 16% of plan sponsors are concerned that the baby boomers in their workforce do not understand their health benefit options upon retirement.
“Plan members are generally not prepared for the change in benefits after retirement,” says Telena Oussoren, manager of benefits for Suncor Energy. “Employers need to add this to their retirement communications around benefits so that employees give them-selves enough time to plan for benefit needs in retirement before they retire. If decisions are made only at retirement, it
lan sponsors underestimate the impending impact of aging baby boomers on health
benefits, warn members of the advi-sory board for the 2015 edition of The Sanofi Canada Healthcare Survey.
Surveyed employers calculate that 42% of their workforce falls into the baby boomer generation, currently aged between 51 and 69 years. This is consistent with Statistics Canada’s most recent census data for 2011, which estimated that 42% of the work-ing population is between the ages of 45 and 64—a record high.12 Research by the Public Health Agency of Canada also shows that the rate of diagnosis of chronic disease is climbing faster among people below the age of 65 than it is among people older than 65.13
When asked to select from a list of statements to reflect their
organization’s perceptions of baby boomers, 44% indicated they had no concerns about the issue of baby boomers in their workforce and their health benefits, and 18% said they have not considered the issue at all. Meanwhile, 19% are concerned that too many of their baby boomers will not be in good health in the years before they retire (increasing to 31% among large and 30% among union-ized employers).
“Too many employers have no concerns or have not considered the impact of baby boomers on their health benefits. This goes back to the gap in awareness of the prevalence and impact of chronic disease in the workplace. There is a real disconnect here,” says Carol Craig, director of human resources, benefits and pensions at TELUS.
“We know that drug costs per individual tend to increase as we age and with 42% of baby boomers in the working population, that’s a significant risk to the future sustain-ability of drug plans,” agrees Susan Belmore-Vermes, director, group benefits solutions, at Health Associa-tion Nova Scotia. To lower that risk, members of the board urge plan spon-sors and providers to facilitate the early detection of chronic conditions through screenings in the workplace for cancers and cardiometabolic dis-eases. (See “What’s my risk? Members want to know,” page 26.) l
12. Statistics Canada. “The Canadian Popula-tion in 2011: Age and Sex.” Statistics Canada Catalogue no. 98-311-X2011001.
13. Elmslie K. “Against the Growing Burden of Disease: Protecting Canadians from Illness.” Public Health Agency of Canada. Accessible at www.ccgh-csih.ca/assets/Elmslie.pdf.
Boomers make noise;are we listening?
Retirement benefits, sooner than later
SECTION 5 RETIREMENT CONUNDRUM
Plan sponsors may underestimate the impact of aging baby boomers on health benefits, suggests the advisory board.
SECTIONTAKEAWAY
P
32 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
Plan sponsors anticipate that 22% of their current workforce will retire within the next five years. Twenty-one percent are concerned that too many employees in the baby boomer generation will want to work past retirement, a number that jumps to 31% among large and unionized employers, and to 30% within the public sector.
For their part, one in five (19%) plan members expects to continue working beyond the traditional retirement age of 65, with a somewhat lower likelihood among unionized members (14%) and a higher likelihood among those working for small employers (28%). Most say they plan to work longer because they need the money (65%), while 22% indicate needing the health benefits. Almost half (48%) plan to continue because they enjoy the work.
On the other hand, far more plan members, 46%, plan to retire before 65—jumping to 57% of unionized plan
members and 59% in the public sector. The higher rates of early retirement for unionized and public sector plan members likely demonstrate the influence of defined benefit pension plans (versus defined contribution plans that are more typical in non-unionized and private sector environments). When considered by age, 47% of employees aged 18 to 34 plan to retire early, increasing to 57% in the 55- to 64-year-old age group.
That leaves 19% of plan members who plan to retire at the traditional age of 65, with no significant varia-tions by size, labour environment, sector or age.
The plans for early retirement appear to be somewhat overly optimistic when compared with actual retirement data. Accord-ing to Statistics Canada, in 2009 a 50-year-old worker could expect to work another 16 years, resulting in an average age of 66 for voluntary retirements—up from an average of 63 in the late 1990s.14 When invol-untary retirements (due to personal or economic reasons, such as illness
or layoff) are factored in, the average expected retirement age for 50-year-old employees in 2009 was 64.5 years.
It also appears that plan sponsors can induce employees to work past their planned retirement age. Among employees aged 55 and older, continued coverage for prescription drugs would likely encourage them to work longer (72%), followed closely by a flexible work schedule (71%). Other possible motivators, all scoring well, are: dental coverage (67%), disability insurance (61%), life insurance (59%) and the ability to work from home (56%).
“Despite the fact that there are provincial drug plans after retirement at age 65, plan members still place an extraordinarily strong value on additional prescription drug cover-age. People understand the impor-tance of access to the right medica-tions for them,” notes Paula Allen, vice-president of research and integra-tive solutions at Morneau Shepell. l
14. Carriere Y, D Galarneau. “How Many Years to Retirement?” Statistics Canada, Catalogue no. 75-006-X. Dec. 2012. Accessible at www.statcan.gc.ca/pub/75-006-x/2012001/article/11750-eng.pdf.
Retirement “cliff” casts large shadow
may be too late to qualify for or be able to afford private insurance.”
Twenty-eight percent of plan mem-bers will most likely purchase private insurance for health benefits if their workplace plan ends at retirement, and another 19% will definitely do so. Twenty-eight percent may do so, 15% are uncertain and 10% say they will not purchase private insurance.
“There can be more activity among providers in post-retirement products,” says Nathalie Laporte, vice-president, product development, marketing and strategy, at Desjardins. “It’s an oppor-tunity for carriers to make a stronger
connection between health and wealth,” agrees Lori Casselman, assistant
vice-president, practice excellence and innovation, at Sun Life Financial. l
13%
16%
6%
27%
38%
29%
35%
Plan at a price (net)
There is a plan available (net)
n Yes, they can continue with current plan at a price
n Yes, there is a separate plan available at a price
n Yes, they can continue with current plan at no cost
n We provide contact information for our plan provider if they are interested in purchasing a plan privately
n No, we do not provide a plan or contact information
Benefit options for plan members in retirement
BASE: All plan sponsors (n=504)
SECTION 5 : RETIREMENT CONUNDRUM
One in five (19%) plan members expects to continue working beyond the traditional retirement age of 65; are we ready ?
SECTIONTAKEAWAY
PLAN SPONSORS
CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS THE SANOFI CANADA HEALTHCARE SURVEY | 2015 33
MethodologyTHE 2015 EDITION OF THE SANOFI CANADA HEALTHCARE SURVEY
Ipsos Reid fielded the plan member survey on behalf of Rogers Insights Custom Research group using an online (Internet) survey methodology from January 5-8, 2015. In total, a national sample of 1,504 primary holders of group health benefit plans completed the study. At the time of each interview, these adults were the primary holders of employee plans with a health benefit portion. The online completes were conducted using a random sample drawn from the 200,000+ members of the Ipsos Reid Canadian i-Say Panel. The total results of a probability sample of this size would be considered accurate to within +/- 2.5%, with 95% certainty of what they would have been had the entire population of Canadian plan members been polled. It is
important to note, though, that the margin of error would be larger among sub-sample respondent groups. The data has been statistically weighted to ensure that the age, gender and regional composition of the sample reflect those of the adult population according to the 2011 census data. Additionally, some response categories in this report do not add up to 100%—this is due either to the rounding of numbers or questions that allowed plan members to provide multiple responses. In addition, Rogers Media Inc. conducted separate online surveys with 504 benefit plan sponsors from across the country from January 5-15, 2015. The data was statistically weighted to accurately reflect the geographic distribution of business and business size according to Statistics Canada.
ORGANIZATION SIZE
POSITION
AGE LOCATION LANGUAGE GENDER
EDUCATION
INCOME
n 10% Fewer than 50 employeesn 11% 50 to fewer than 250
employees n 11% 250 to fewer than
1,000 employeesn 15% 1,000 to fewer than
5,000 employeesn 17% 5,000 or more employeesn 36% Did not know the size of
their organization
n 33% Aged 18 to 34n 20% Aged 35 to 44n 19% Aged 45 to 54n 20% Aged 55 to 64 n 8% Aged 65 and older
n 74% Most frequently speak English at home
n 25% Most frequently speak French at home
n 2% Most frequently speak a language other than English or French at home
n 47% Femalen 53% Male
n 12% Live in British Columbian 11% Live in Albertan 7% Live in Saskatchewan/
Manitoban 36% Live in Ontarion 26% Live in Quebecn 9% Live in Atlantic Canada
n 44% University degree or post-graduate degree
n 8% Some universityn 32% College education
(some college or diploma)n 16% High school education
or less
n 21% Professional positionsn 18% Administrative/clerical/
secretarial positions n 17% Technical/trade positionsn 13% Managerial/supervisory/
executive positionsn 11% Retired/not currently working n 10% Sales/service positionsn 5% Teaching/academic positionsn 1% Self-employed
n 4% Household incomes of less than $30,000
n 27% Household incomes of between $30,000 and $59,999
n 33% Household incomes of between $60,000 and $99,999
n 26% Household incomes of $100,000 or more
10%
11%
11%
15%17%
36%
21%5%
10%
11%
13%
17%
18%
44%
8%
32%
16%
4%
27%
33%
26%
Note: Due to rounding, response categories may not add up to 100%
PLAN MEMBER DEMOGRAPHICS
34 THE SANOFI CANADA HEALTHCARE SURVEY | 2015 CANADA’S PREMIER SURVEY ON HEALTH BENEF I T PL ANS
Advisory BoardTHE 2015 EDITION OF THE SANOFI CANADA HEALTHCARE SURVEY
The Sanofi Canada Healthcare Survey is shaped through the guidance and expertise of the advisory board. The members of
the advisory board tapped into the concerns of today’s plan members and plan sponsors. Throughout the year, they took time
out of their schedules—as key stakeholders in the Canadian health benefits industry—to participate in every stage of The Sanofi
Canada Healthcare Survey, from reviewing the questions asked of Canadian plan members and employers to promoting the
report and answering questions about the findings. Their continuing support of this important project is essential.
Dr. Alain SottoOccupational medical
consultant/directorTORONTO TRANSIT
COMMISSION/MEDCAN WELLNESS CLINIC
David WillowsVice-president, strategic market
solutionsGREEN SHIELD CANADA
Douglas YepSenior director, total rewardsAIR CANADA
Paula AllenVice-president, research and
integrative solutionsMORNEAU SHEPELL
Art BabcockVice-president
AON HEWITT
Susan Belmore-Vermes
Director, group benefits solutions
HEALTH ASSOCIATION NOVA SCOTIA
Chris BonnettPresident
H3 CONSULTING
Lisa CallaghanAssistant vice-
president, product and group benefits
MANULIFE
Lori CasselmanAssistant vice-
president, practice excellence and
innovationSUN LIFE FINANCIAL
Carol CraigDirector, human
resources, benefits and pensions
TELUS
Ben HarrisonDirector, group
strategic relationshipsGREAT-WEST LIFE
Nathalie LaporteVice-president,
product development, marketing and
strategyDESJARDINS
Jacques L’Espérance
PresidentJ. L’ESPÉRANCE
ACTUARIAT CONSEIL INC.
Pierre MarionSenior director, sales
and business relationsMEDAVIE BLUE CROSS
Marilee MarkVice-president,
market developmentSUN LIFE FINANCIAL
Godfrey MauPharmacy consultant,
group benefitsMANULIFE
John McGrathSenior vice-president,
human capital practice leaderWILLIS CANADA
Serafina MorgiaSenior consultantTOWERS WATSON
Anne NicollVice-president,
health and disability management
MEDAVIE BLUE CROSS
Telena OussorenManager, benefits
SUNCOR ENERGY
Steve SemelmanCEO
GEMINI PHARMA CONSULTANTS
GENZYME CANADASANOFI PASTEUR SANOFI CONSUMER HEALTH MERIAL CANADASANOFI CANADA
THE BENEFITS OF HEALTHY
For decades, Sanofi has been committed to providing valuable healthcare solutions in Canada and around the globe, a cause made possible by our greatest strength: our people. That’s why we’re passionate about health and wellness within our own walls.
We know that healthy, happy individuals are more satisfi ed in their personal lives, more inclined to be socially engaged, and more productive in the workplace. The benefi ts of good health go beyond reducing costs. It’s great for people – and for business. To learn more about us, visit sanofi .com or sanofi .ca.
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The Sanofi Canada Healthcare Survey is published by Rogers Media Inc.
For an electronic version of The Sanofi Canada Healthcare Survey
and the Survey at a Glance, visit sanofi.ca
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