There needs to be new ways of thinking of healthcare and reimagining it, says Daniel Kraft, executive director, exponential medicine and faculty chair, Medicine Singularity University. In the opening session of CPBI Forum 2015, ‘The Future of Health & Medicine: Where Can Technology Take Us,’ he called on attendees to use technology which is growing exponentially to become disruptors instead of disruptees. He noted that it was 167 years ago that the first patient was given general anesthetic for surgery. However, hospitals and doctors are still using practices used then and the healthcare system has moved from acute care to dealing with chronic conditions. The system needs to be redefined out of these old boxes to take advantage of the connected age. To do so, it needs to move from a volume based system to one based on value which uses technology to measure outcomes. Some of this is still happening, he said. There are hospitals in the U.S. which are not paid if a patient returns for treatment of the same condition.

In seven years, smartphones have become part of the healthcare system and offer opportunities to collect data, determine medical conditions, and help monitor chronic conditions for better outcomes. Still, challenges remain. One is that the system doesn’t know how to charge for technological innovations and it is already facing competition from others. Uber, the taxi service, is one example of a use of technology to provide service faster and cheaper and similar competition is developing in the healthcare system.

The most important thing a pension fund can do if it wants to reduce the risk of litigation is to hire qualified investment consultants. The next most important hire is qualified legal counsel, says Rory Judd Albert, a partner at Proskauer Rose LLP. In the session ‘How to Prudently Make, Execute, and Monitor Employee Benefit Plan Investments ‒ An Antidote for Costly Mistakes and Expensive Law Suits’ at the CPBI Forum 2015, he also said a prudent process should be used to hire these as they need to have advisors who understand due diligence. After that, he said they need to monitor four key things including adherence to investment documentation and this is where most sponsors err. They set the policy, put it away, and forget they have a written policy. Then, a decision is made contrary to the policy opening the door to legal action. This is also important because investment mistakes can be made, but fund sponsors can avoid liability if they followed procedural prudence. Sponsors of small plans can be a little less rigorous in the hiring process because, unlike larger plans, they are not heavily invested in alternatives. However, any plan with complexity and investing in private assets not traded daily on a securities exchange needs to be rigorous in the hiring process. And, he doesn’t recommend small plans use less rigorous processes because they do get larger.

Now is the time to take action on decumulation is the conclusion of a CPBI Forum 2015 session. In ‘Decumulation: Time To Take Action,’ Jean Daniel Coté, a partner at Mercer, and Lucie Dutil, vice-president, pensions and benefits, Bell Canada, discussed the growing need for employer and employee efforts to prepare to use their retirement savings. Coté discussed CAPSA Guideline 8 which, he said, is an indication of the industry moving in that direction. It suggests that sponsors should now offer more information on decumulation options and give them access to tools and education to prepare them on how they can use their savings going forward. However, it also says defined contribution pension plan members are now responsible to plan for their retirement income. Dutil said she has been pushing for decumulation programs since 2005 because it is as important as the accumulation. However, in 10 years very little has been done. She said, however, plan sponsors have to be careful over who gets what responsibility. While it is important equip plan members to manage their retirement savings, at some point they need to make sure the retiree knows they will need to take over. One solution, said Coté, would be default decumulation options. There are already many default programs to improve outcomes for members of DC plans, default options would give retirees time to think. Dutil also said the opportunities for DC decumulation are not as restrictive as for defined benefit plans. However, products need to be developed which allow retirees to manage their savings as circumstances in their retirement change. 

It is the time for a return to active investing, says David C. Saunders, founding managing director, K2 Advisors. In the session ‘Innovative Alternative Investing: A Global Perspective’ at the CPBI Forum 2015, he said the move to passive and shrinkage of active investing is a continuing trend. However, the low rate of return for the foreseeable future means increased volatility makes it a good time to be back in active investing. One way to do so is to tilt and there are always point in time when investors should tilt back and forth. Another option is cash which is ideal because it allows investors to side-step market occurrences. However, any move to equities means investors will want to reduce volatility and one way to do so is to use alternatives for risk mitigation. One growth area is hedge funds which take advantage of the growing demand for liquidity. These allow investors to pick where they want to be in terms of liquidity.

Legislation is not a solution to deal with health issues, says Peter Gove, innovation leader ‒ health management, at Green Shield Canada. He told the CPBI Forum 2015 session ‘Innovation in Benefit Plan Design’ that efforts to mandate changes in behaviour to improve health just create more problems, citing an experiment in Los Angeles, CA, to reduce obesity in one part of the city. It banned fast food outlets in the hopes grocery stores would come into the area. However, with nothing to support this effort, the population there just got fatter and the ban was eventually lifted. He is currently watching Mexico which is fattest populated country in world and in the past 15 years has gone from being healthy to unhealthy. In response, it has put a tax on American style fast food and sugary drinks and banned TV ads for these outlets during the prime television watching time for kids. The question is whether it will make a different by imposing a financial penalty. One approach that has worked, he said, is in South Africa. There, one insurance company is offering premium reductions for those who change their behaviour. And any program needs collaboration between stakeholders, outreach efforts to draw those at risk in, and accessibility to programs. The future of employee health, he said, is behaviour and the current focus on employee health and wellness has created the momentum to make these kinds of changes.

In its defined pension ambition, the UK keeps looking at New Brunswick's shared risk plan as a model, says Henry Tapper, of First Actuarial, Pension Playpen, and Friends of Auto-enrolment in the UK. In the session 'Who's Risk Is It Anyway? British And Canadian Perspectives On How Pension Risk Should Be Allocated' with Simon Nelson, a consulting actuary at Eckler Ltd., at the CPBI Forum 2015, he said, however, while the UK is looking at New Brunswick as a risk-sharing model, it is taking other approaches now. It has created an auto-enrolment plan for the 10 million workers with no pensions. Employers have three years to have a plan in place. healthy businesses are all in. These plans must be high quality, with fees regulated. There are also changes in the way advisors are remunerated. It cannot be through the fund. Instead, the employer or employee must pay. This, he said, is a radical change. Canada is moving towards workplace plans with innovative design, moving from traditional DB and DC to plans where risk is shared, said Nelson. There is still a paternalistic view, he said, but the belief is risk still has to be shared.. A number of employers are already embracing a different healthy workplace with a healthier environment. The key here is leadership, she said, as leaders at

In November 2011, facing a looming crisis, Italy was advised to reform its pension system if it wanted help from the ECB. The country saw its debt worsening and unsolved structural weakness were causing a widening of its deficit, lower growth than other EU countries, and a shift in employment from high productivity sectors to low productivity ones. The government resigned amidst mounting political uncertainty and the new government called on Elsa Fornero to serve as minister of labour and welfare and to solve the pension issue. Now a professor of economics at the University of Turin, she told the session 'Economic-Financial Literacy And (Sustainable) Pension Reforms' at the CPBI Forum 2015 that the reform had to look not just at immediate issues, but more at the medium and long run to adjust the system. Ideas had been wrongly cultivated in Europe and Italy, such as if you have an unemployment problem, allow people to retire to solve it or if women want to work, it means a man does not get a job. As well, Italians thought of pensions as acquired right. They didn't understand that their children would have to pay for their retirement so they didn't accept it. The 2011 “cold shower reform” she implemented called for a sharp increase in retirement age, the equalization of the retirement age for women and men, application of DC formula to all workers, indexation of eligibility, and a temporary freeze for average high pensions. It was aimed at dismantling the “deep rooted: notions that workers over age 54 are lost to the labour force. However, implementing reform meant its citizens needed clear information that they understand. Instead, politicians exploit people's ignorance, she said. “We all know what to do, but don't know how to stay elected once we have done it.” Until citizens are educated on the reasons and need for reform, politicians who put in reforms that result in some sacrifices will not be re-elected, she said.

One of things that drives employer costs for mental health claims is the time built into the process, says Sean Slater, executive vice-president and marketing, Homewood Health. In the session 'How Employers Got On The Hook For Employee Mental Health And How To Make The Best Of It' at CPBI Forum 2015, he said areas that drive the adding of time in the process include stigma and access to information and privacy. Stigma is an issue because it keeps people and organizations from starting conversations about issues. Any delay in time not only costs an organization more, but reduces the likelihood the employee will return to work. The longer they are away the less likely they will return. Access to information and privacy is a minefield for employers, he said. It is critical that they understand limits created by privacy. However, an environment has resulted where employers are challenged to make decisions because they don't feel they have access to the information needed to make the decision. The result is more time is added. He advised employers to keep calm and make a plan. They should focus on building program components that short circuit wait times. "It's the best opportunity to improve your outcomes as well as your costs," he said, as well as a critical part of the process they can exercise some control over.