As we head into the last week of summer and with fall just around the corner, our thoughts turn to pumpkin spice and everything we find comforting… like booking our next massage. David Willows, Vice President of Strategic Market Solutions at Green Shield Canada (GSC) gave attendees at last Thursday’s session much to think about over your next benefit plan renewal or pumpkin spice latte.
A quick historical look at benefits plans showed us that while pension plans have been with us since the early 1900s and prescription drug coverage since the 1950s, there really wasn’t benefit plans as we know them today until the 1970s. The emergence of paramedical coverage (e.g. physio, chiro, massage, etc.) in benefit plans came in the 80s and 90s although was considered unlikely to have significant utilization. Benefit plan design has traditionally been a dollars in – dollars out approach, not focused on behavior change.
The information David presented is based on GSC’s vast book of business and speaks to the trend of prescription drug costs reducing as a percentage of total group healthcare spend from about 70% a few years ago to more typically now 60%, and in some cases just 50% of the healthcare pie. This trend begs several questions such as should benefit plans start looking at need vs. want, evidence-based science vs. anecdotal data about “feeling better,” and how benefit plans are ultimately going to be funded between employer and employee.
David presented an age banded study of both prescription drugs and health services utilization beginning with kids and ending with seniors, with a focus on the working population between ages 35 – 65. Of note on the drug side of equation, GSC’s data shows:
- mental health drugs on the rise in all age bands including those under age 10;
- biologic drugs are having a significant cost impact in all age bands including 70+ where they’re being seen for the 1st time, and
- a host of chronic disease states are dominating the working population.
The good news, and yes there is some, is that the majority of what are deemed as ‘chronic disease states’ are the same ones that can very much be positively impacted by changes in behavior around health and wellness.
David shared data indicating that 56% of employees report having chronic disease state(s), 26% of employers say they have employees with chronic diseases; and 48% of employers say they are aware of the high cost claimants in their workforce. Also of note is that from a drug perspective, when it comes to high cost claimants, the top 5% account for 45% of the overall cost.
David also touched briefly on the wave of specialty drugs on the horizon that are arriving with some very hefty price tags, including the 1st biologics for treating cholesterol, a biologic for treating cystic fibrosis and one for asthma. It is unknown yet what public vs. private split will be to pay for these high cost specialty drugs. With this wave fast approaching it’s time to look at what insurance is really for and where it’s best and most effectively utilized.
GSC has looked at adherence within their book of business and David shared some of the results pertaining to the top 4 chronic disease states: hypertension (63% adherent), cholesterol (54% adherent), depression (42% adherent), and diabetes (45% adherent) – room for improvement on adherence for sure.
From the Health side of the equation, most significant items that jumped out for consideration were increased utilization in massage, physio and chiro from both volume and cost perspectives in all age bands until 65+. It is felt that the rationale behind this, particularly as it relates to massage, is simply that older generations haven’t grown up with it being part of their lives and thus don’t have the same sense of entitlement for such services.
One might conclude there would be a case for the concept that massage as a preventive care would equate to healthier employees that wouldn’t be utilizing prescription drugs in addition to the massage. The GSC data did not support this; and from a health perspective, when it comes to high cost claimants, the top 5% account for 36% of the overall cost.
As users of our benefit plans, administrators of benefit plans, and HR and other health & wellness professionals, there are things we can all do to change behaviors in an effort to ultimately change the drug and health profiles for each succeeding generation of 50-, 60- and 70-somethings.
Eat healthy, stop smoking, moderate alcohol consumption, and get moving… the most impactful of which is get moving! David also spoke to the importance of Task Shifting e.g. Pharmacist Health Coaching, Health Screenings, and Dietician Services as examples, in order to better utilize existing expertise and resources in the delivery of health and wellness support services.
In conclusion, it’s time to start looking at what is it employers want from the benefit programs they offer their employees, what employees want and expect and how best to share the cost. When we look at our programs, is ‘Like and Want’ winning over ‘Need’? When it’s getting harder to pay for the benefit program, can organizations afford to continue serving ‘Like and Want?’ – much to ponder.
– Carol Clancy