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Responding To A Rapidly Changing Healthcare Environment

pulse chartEarlier this year, Connex Health conducted an online employer survey in which 34 representatives from medium and large employers in Ontario and Alberta participated. There are numerous benefit trends, human resource practice, and wellness surveys, so why conduct yet another employer survey?

Benefit plans can no longer function in a vacuum and plan sponsors are, therefore, under increasing pressure to examine external factors that will affect their benefits plans. Prescription drug innovations, claiming trends, research, new standards, and legislation are all affecting the environment for employee benefit plans.

New Pharmacy Models

The prescription drug landscape has been changing. Some of the pressures include the prevalence of innovative new drug therapies, provincial reimbursement models, new formulary restrictions, changes in generic pricing, the elimination of professional allowances for pharmacy, and the first steps towards new pharmacy models.

There is an increasing focus on mental health driven by higher claims for drug and disability benefits and research that demonstrates the ripple effects on workplace performance and physical wellbeing. New centres of excellence, workplace tools, partnerships, and processes have been introduced to bring new focus to mental health, along with the new Standards for Psychological Health and Safety in the Workplace that was released in October.

These innovations put pressure on benefit plans and human resource professionals to review their internal strategies to address new norms. We wanted to develop a baseline understanding of their knowledge and decision-making trends in this evolving environment.

Those who participated were professionals in occupational health, human resources, or employee benefits. The organizations they represented organizations with between 100 and 16,000 employees and included police services, oil and gas companies, municipal government, retirement and nursing care facilities, hospitals, and manufacturing plants.

The survey consisted of just 21 questions relating to group plan design, utilization analytics, knowledge of new drug trends, interest in drug plan formularies, and the extent of involvement in healthy workplace initiatives, including commitment to creating a psychologically healthy workplace.

Most respondents continue to rely on traditional plan advisors such as benefit consultants (62 per cent), insurers (32 per cent), and internal resources (38 per cent) when making decisions regarding their plan. Similar percentages rely on their benefit consultants and insurers for plan analysis. Most of those who had conducted an analysis of their benefit plan utilization limited their analysis to drugs only and did not combine drug and disability data to attain the most comprehensive analysis. Limiting this analysis to just drug benefits will compromise the understanding these employers have of the health of their employee population.

Significant Role

External consultants are playing a significant role in providing services to plan sponsors with 71 per cent saying that they follow advice from these consultants at least some of the time. The majority of employers (85 per cent) work with an employee assistance plan provider, 28 per cent a disability management consultant, and 21 per cent an employee health and wellness consultant. These results tell us that at least some plan sponsors are looking to specialty providers for some aspects of managing employee health.

Almost half do not plan to make changes to their drug coverage as a result of drug reform. One in 10 planned to look at a mandatory generic drug plan and almost one-quarter planned to review their drug formulary. The advice of their consultants will be critical to making an informed decision, unless they are presented with opportunities to become more informed, as approximately 70 per cent of respondents stated that they have only a fair or poor knowledge of new drugs trends such as biologics, oncology drugs, and other high cost (but more effective) drugs.

Similar to finding in other surveys that include questions on employee health and wellness, including the Conference Board of Canada's June research report, 'Making the Business Case for Investments in Workplace Health and Wellness,' survey findings indicate that employers are not taking a strategic approach to employee health. Many told us that they planned new health and wellness initiatives as a result of a benefits analysis, but admit they have not conducted a comprehensive employee health risk assessment to determine employee health issues and program priorities and evaluate organizational health and culture. Limiting programs to those that are identified through a benefits analysis does not meet with best practices for a healthy workplace strategy. In order to produce the best design, participation, and outcomes, programs must be part of a larger overall strategy that targets the employee population based on identified health risks and, needs and preferences, that also collects data so that program outcomes can be evaluated.

Respondents are open to other new initiatives in the workplace that will help their employees with chronic health issues manage their condition. This includes disease management support programs, drug access programs, and patient support programs that would be reimbursed under their group plans.

Take Action

Although almost one-third were not aware of the new standards, but the majority planned to take action once the new Standard for Psychological Health and Safety in the Workplace was released. This included manager training, evaluation of initiatives related to psychological health, and a review of the standards to ensure compliance. This presents a promising opportunity for the private healthcare sector to work with plan sponsors to meet the new guidelines.

Based on survey responses, plan sponsors appear to be open to responding to change, but lack some of the knowledge, expertise, and resources to do so most effectively. This is particularly true in their knowledge of new drug innovations such as biologics, oncology, and other new drug trends, as well as best practices in healthy workplace and psychological well-being.

Education and resources either need to be made available to plan sponsors or they need to take the initiative to source out the knowledge and skills that will help them best respond to innovative practices, services, and resources to meet the health needs of their employees in our rapidly changing healthcare landscape.

Denise Balch is president and Jacquie Evans, consultant, workplace health, at Connex Health (www.connexhc.com).

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