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Green Shield Canada

Episode 12: Re-imagining Health Benefits

In episode 12, hosts Sarah and David, along with guests Erin Crump (GSC’s Leader of Strategic Innovation) and Ned Pojskic (GSC’s Leader of Pharmacy and Health Provider Strategy), discuss why private health benefits plans have been so static for so long, and why measuring value (health outcomes) for spend has not been made a priority in Canada.
And now for something completely indifferent

And now for something completely indifferent

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Episode 12 Transcript


[0:00:14.9] SM: Hello and welcome to another episode of GSC’s podcast, And Now For Something Completely Indifferent, where we will be discussing the hottest topics and trends in Canadian health benefits. I am one of your hosts, Sarah Murphy.

Before we get started with today’s episode, we would like to remind our listeners that the views expressed in this podcast are those of the individuals speaking and not necessarily the views of GSC. We may talk about possibly controversial subjects, and therefore reserve the right to potentially offend some listeners but are apologizing for it up front.

You can download this podcast from our website at or subscribe to it from wherever you get your podcasts. We also encourage you to read our publications, The Inside Story, and follow the script, which you can also download from our website and please be sure to follow the conversation on Twitter and LinkedIn.

Now, let’s get started.


[0:01:04.9] SM: Now let’s get started, today’s episode is hosted by David Willows, GSC’s Chief Innovation and Marketing Officer. Hello, David.

[0:01:12.8] DW: Hi Sarah. So yesterday, we had a meeting with our friends at Delvinia and on our last podcast, we had the CEO and Chief Innovation Officer, Steve Mast in here and people probably have listened to that podcast. But I guess his description of this recording studio, he did mention, again for frequent listeners, all eight of you, that we have a bed sitting right besides us. This sort of single bed that folds out.

[0:01:40.9] SM: It’s a medical bed, like the chair, it’s a chair that you would see in a hospital room that folds out into that bed for those guests who – like those people who have to stay overnight. Yeah, it’s an actual medical bed I think.

[0:01:51.2] DW: His team listen to this podcast and they were quite fascinated by the bed and I think they’ve spent weeks talking about it. I’m not sure that they have enough work over there but they came up with an idea that they shared with us, like this meeting was about like our brand and our brand strategy but they were sort of locked in on how we should amend how this bed is sitting here. What do they want to do?

[0:02:08.7] SM: They came in and saw it when they were here for the meeting and they were like, “Oh yeah, you know, that bed, it is kind of strange that people sleep on it.” They’re like, “You should turn it into like a real medical bed and use the paper.” When you go to a doctor’s office.

[0:02:20.8] DW: That crinkly paper that you sit on.

[0:02:22.3] SM: It’s tissue paper, basically. Maybe a little bit thicker. Yeah, you go into the doctor’s office and their assistant or whatever is like, “Oh just a second, I’ll get the bed ready for you,” and they pull that paper out for you and then the next person that comes in, they rip that off and they bring in a clean set of paper, that’s what they suggested we should have in or wellness room for our GSC employees to lay on that medical bed.

[0:02:39.9] DW: I’ve got very vivid memories of what sounds like to sit on and it’s never like a – you're never enjoying yourself in that moment. That would be a very negative, I think, image to have in the room here.

[0:02:48.4] SM: Oh I think so and it’s not like, let’s be honest, for anybody who has laid on those, that paper is really narrow. Most of us have wider bodies than that paper. When you sit on that bed, where you lay on that bed on that paper, really, you’re still touching the bed that the sick people before you touched because it’s not wide enough to cover you. So I don’t know that it would actually –

[0:03:04.3] DW: You’ve given this a lot of thought.

[0:03:06.7] SM: You know, my history with germs and hypochondria and all that stuff, yeah, I’ve given that thought, even with the paper here, I still would not touch that.

[0:03:11.9] DW: Okay, well we’re going to talk to our office services team and we’re going to have a real – we’re going to do a business case around this whether the paper –

[0:03:17.9] SM: We should have paper.

[0:03:18.6] DW: Yes. No, I think it’s an important question. I thanked Delvinia for bringing it up but that’s last podcast, let’s not talk about Delvinia anymore. This podcast, we’re going to talk about one of our favorite topics, which is value and benefit plans and we’ve been rather mouthy the last couple of years around how we think benefit plans have not evolved to where they’re supposed to, this one might be a little controversial, we’re going to talk about taking away stuff from people. Yeah. People don’t like to do that. So we’ve got our friends Ned and Erin here, and I think it’s a good one so let’s get right to it.


[0:03:54.7] DW: So, in the podcast studio and wellness room today, we have colleagues Ned Pojskic, our leader of pharmacy and health provider relations, and Erin Crump, our leader of strategic innovation and Erin has been on this podcast before and I will repeat, she wants you to know, she’s an actuary.

[0:04:15.1] EC: I was just going to say, not as many times as Ned though.

[0:04:17.1] DW: No.

[0:04:17.4] EC: I’m officially — am I in the race now?

[0:04:19.7] NP: This is my fourth I think? Podcast?

[0:04:22.3] EC: No, I’m not in the race then.

[0:04:23.4] DW: Are you still in actuary?

[0:04:24.4] EC: I am still, they haven’t taken those letters away.

[0:04:26.6] DW: Okay.

[0:04:27.5] EC: Yeah.

[0:04:27.8] DW: Our listeners should know that. Okay, people might notice already that although we’re sitting in a wellness room, my voice is a bit off, it’s my first sickness in the wellness room. I apologize in advance are what you’re going to have to listen to.

Sarah, your concerned about my coughing.

[0:04:43.7] SM: Yes.

[0:04:44.5] DW: I’m going to try to turn the cough into my arm.

[0:04:48.8] SM: That’s right.

[0:04:49.5] DW: People may still hear it but I think it adds sort of flavor to the podcast.

[0:04:53.7] SM: It’s good for our listeners, it’s good for those of us in the room with you, when you couch into your arm.

[0:04:56.0] DW: Yeah.

[0:04:57.0] SM: I think the wellness room with you. If you cough into your arm.

[0:04:57.8] EC: Locked in the wellness room with this coughing person?

[0:04:59.6] DW: Improper ventilation.

[0:05:01.2] EC: The wellness room is going to have the opposite effect on us today.

[0:05:04.9] DW: The wellness topic is far too important for me to beg off and take a week or two, sick leave, which I definitely would do otherwise. We are going to talk about benefit planned designs, specifically health benefits. This has been a fascination of this team, our company, for the last few years and then we’ll have some listeners that have seen one of our health studies the last few years.

I think it’s fair to say we have been somewhat questioning, dare I say critical of the state of health benefit plans in Canada and I think our suggestion is that they have not evolved with the times. We’ve added lots of stuff for no apparent reason sometimes. But we haven’t been really rigorous about saying, “Are there things on there that no longer provide value?”

We talked a lot about elements of planned design and things that plan members like and want but do they, in the end, need them? We have probably spent tens of millions of dollars on things they like and want but arguably do not have long term health outcomes associated with them. Erin, you and I are from the advisory world before we were here. Why do you think there’s been so little evolution of health benefit plans in Canada?

[0:06:16.3] EC: So I’ve thought a lot about this question and it’s obviously not an easy one, there’s a lot of contributing factors to it. But I think you know, the biggest one of all and I think you touched on it is that you know, real change, real evolution requires a lot of courage on you know, the planned sponsor.

I think as new things have come to market, I mean, client sponsors and I think our community have been so keen to look and add things new. But I think there’s a general fear among planned sponsors and I was a planned sponsor at one point too, so I understand that fear totally of taking away from planned members or upsetting plan members or putting plan members through change that they don’t understand.

I do think true evolution doesn’t just mean adding things, it does mean like looking critically at what we have and considering taking away. Coming back to the fundamental question of why do I have this plan in the first place, right?

I think we’ve talked about this before. You know, is this plan just compensation and that’s your real – your goal is just to have an additional form of compensation in which case, yeah, you want to add as many things to please as many people as possible. Or —

[0:07:22.4] NP: That’s more the norm I would say these days.

[0:07:24.1] EC: Yeah, you hear that a lot about you know, the multi-generational workforce and wanting to have things for everybody and I totally get that and that’s – if that’s the answer, that’s cool. Or is your plan protected? Is it financial protection, in which case we need to really think about these drug caps and things that we see or it’s a health plan, is it actually meant to drive health outcomes? In which case, let’s talk about the things that actually do change the long term health outcomes of our – You know, let’s focus on the things that actually drive health outcomes in our members.

I think, coming back to the plan sponsor communicating this change, I think people fundamentally don’t understand their benefits and so managing through a change, massive change where you're actually asking your members to behave differently or to claim differently or go do different things, that is very difficult to do. Let’s not take away from the massive communication effort there to do that. But I think, you know, looking forward, depending on again, depending on what the purpose of your plan is, it’s necessary.

[0:08:20.7] DW: I know the last year’s health study, the last one we did, we used the word courage and I know you’ve got – you recently did a presentation. What was it called?

[0:08:27.7] EC: Meaningful Change Requires Courage. You know, change is change but true change, meaningful change is going to disrupt people.

[0:08:36.6] DW: Let me just say as we get deeper in this conversation, we’re going to talk about concepts of value, in health benefits plans, we are going to put forward some ideas that we’ve developed here and we’ll be launching into the market place in the next couple of months.

But all of us I think around this table do recognize as you suggested, a plan sponsor may make a conscious decision that the value of this plan is the employing engagement of the consumer. The contentment that comes from the benefits that are there. I think we’re going to, today, talk about steering towards more of a health benefits plan based on driving health outcomes and some ROI there.

I think some of our value-based concepts that we’ve talked about in the last podcast and that is our main spokesperson for, is going to come into this and I’ll just state, our definition of value for this podcast is value equals health and better health, services to plan members.

Ned, a number of podcast you’ve talk about sort of value and healthcare services. How do you attach that concept to health benefits themselves?

[0:09:38.3] NP: Yeah, so that’s a really good starting point, David. Because you mentioned, you know, the notion that value equals health outcomes and I mean, you could argue, value is in the eye of the beholder, right? In some ways. But if we start with the premise that indeed, we are trying to drive better health outcomes, then we go to a very different type of place. In that place, we sort of automatically have to assign a certain sort of value to everything from perspective of what it achieves in terms of outcomes.

If we take that route, then we automatically turn to sort of modern science and say, what are we looking for in terms of evidence in order to conclude that something actually has value? But value again, so from the perspective of what it is that we require to attach ourselves to a level of value is, also the other part of the dialogue, right?

If you look at drugs as an example, in a drug space, we have a concept of quality adjusted life years. This is what somebody that comes up quite often, right? The notion that we’re going to attach $50,000 to one quality adjusted life year that a person is going to live longer for.

We think that’s a sort of a value that we think is worth paying for. If a drug costs $100,000 and it adds one more quality of adjusted life here, that’s not worth it because now we’re sort of off that scale. It’s arbitrary to some degree, from that perspective but we at least have sort a certain guidelines and parameters around which we work to say that, if it meets this type of criteria, then it’s sort of inherently has value.

Now, we can extend that notion to be on drugs obviously to other services whether they be paramedical, whether they be dental or any other aspects of the health benefits plan. It has to produce something and that something has to reach a certain threshold and –

[0:11:12.5] DW: The industry has not done that tin those areas. Reportedly done it on the drug side, not in other areas.

[0:11:18.8] NP: Absolutely, I mean, that’s currently constructed, benefit plans were never constructed with that particular thought in mind. If it produced any level of perceived value, it was considered to be something that should be included.

[0:11:29.6] DW: Tell the listeners, how GSC and it’s not just GSC, certainly other of our competitors manage incoming drugs and the decision around reimbursing them.

[0:11:39.6] NP: When it comes to drugs, I mean, I think, the process is quite rigorous and whether you look at it from GSC’s perspective or as any PBM in the world, there’s an extensive process by which you know, we look at the drug, we look at the multitude of clinical evidence that it has, before it ever sort of came to market, we critically review that evidence from every perspective. Understanding this structure of trial design, the number of people included, potential for bias, et cetera.

Then, we go further and say, okay, would all of that, what other drugs in the market that treat that particular condition? Does this drug produce additional value on top of that, does it justify the cost, where does it fit in the treatment paradigm, doesn’t meet an unmet need, et cetera.

I know we take all of that and derive value from the combination of all those factors put together and we ultimately make the decision to list the drug, list it with conditions or not list it. That process and the methodology and all of that has many decades of experience. Their international bodies that work on this, there are standards and there’s a lot to draw in sort of undertaking that type of process.

[0:12:39.5] DW: How would you compare that to the world of paramedical services and how we start to think about that?

[0:12:46.1] NP: On the paramedical side, obviously, the challenge becomes one, is that we simply don’t undertake that process. Any service provided by a paramedical provider currently, if a planned sponsor pays for medical services. Any service provided by that paramedical provider is fair game because we don’t question what the service being provided is.

The level of value provides, we simply say, if it’s provided by that paramedical provider and it’s within a certain dollar threshold, whether that would be 500 or a thousand dollars per year, it is paid. We don’t have the same level of rigor and we also don’t have the same level of international and other experience to draw on. We don’t have guidelines and tools to be able to say, “How do we value the particular service, the particular modality, et cetera?”

But, we need to get there and part of the challenge in the paramedical community and certainly not across the paramedical community but certain components of it is that there is an implicit rejection of the very kind of thinking that we’re sort of espousing here. The idea of value and science and scientific paradigm is not only foreign but it’s despised to some degree in some paramedical circles. Then that creates a real conundrum because now you have a problem whereby we go through the scientific paradigms as the basis for everything we do and that, in parts of that community reject that. How do we have that conversation and on what level?

[0:13:58.3] DW: Okay, let’s be specific about the communities that reject that because not certainly all of them do. But certainly, I think the Globe and Mail has been sort of leading the dialog around this. What are sort of the ones on the fringes I would say that simply reject science?

[0:14:12.4] NP: Yeah, I think they go on a spectrum, right? You have some paramedical professions that are much more closely aligned with the sort of modern as I said, scientific paradigm, scientific inquiry evidence, et cetera. Professions like physiotherapy are squarely within that paradigm. We sometimes consider them paramedical but they’re really squarely in the scientific paradigm. Then you sort of move away from that to things like homeopathy on the complete other end of the spectrum where indeed, it’s a philosophy, more than a science and it is based on a rejection, to some degree, of modern science.

Then you have some professions in the middle, chiropractic and perhaps massage therapy, that sort of straddle both worlds and you have camps within these professions that will attach themselves to one end of the spectrum or the other. To their credit, the professional associations for a lot of these professions are indeed trying to steer the entire profession towards a scientific based paradigm. But there are certainly many factions within them that do not wish to be dragged in that direction.

[0:15:04.0] DW: And I think we have seen that in our dialogue with them. I guess famously, a couple of years ago we had our 30 minutes of fame around a health study that had called out our rising rates of teenagers getting massage and most famously, babies getting chiro and I know those communities didn’t love us for talking about those things but certainly I think we’ve had constructed dialogues since then around look at we need this sort of level of evidence and research.

Coming from your communities that we’ve always expected from pharma and we’re hardly universally happy with things that come out of pharma, usually around drug prices that we have our disagreements. But we get volumes of evidence of their products and we were able to assess them through that process. So the reason we’re back on this topic today is that our company is about to come out to the world with a different kind of plan design.

We are calling it our SMARTspend plan designed. SMARTspend brand has been out there about a year and it is about having planned sponsors, dollars, aimed towards things that have more perceived value certainly in terms of health outcomes and more evidence behind them. Erin has been an essential part of the team that has been looking at this and doing work on this and Erin, why don’t you tell us about how you’ve transferred some of the thoughts that Ned just gave us into the practical work of constructing this plan design.

[0:16:28.8] EC: Yeah, absolutely because that who process that Ned just described around how we decide to list a drug or not list a drug or list it with conditions is exactly the type of thinking that we’ve tried to apply to all the other benefits that are typically included in plans in Canada. So we are trying to replicate that process as best as we can. So really what we did is we really started from scratch. We literally pulled all of our claims by a procedure code and that was an interesting experience.

And we really looked, “Okay, where are we spending our money and are we spending that money in the best place that we possibly can?” It started with conversations with internal experts. So internal part design folks, internal claims folks or internal pharmacy experts and our internal dental experts as well and external experts. We pulled in experts from the dental community. We pulled in optometrist and all of these folks pointed us in the direction of which areas had research and evidence and which areas didn’t.

So then, it went with us reading lots of stuff. You know, really understanding where the evidence is and where the gaps exists. We also looked to other payer. So around the world, we looked at what government plans were paying for. We looked at what carriers in other jurisdictions were paying for. If you look to the US where they have the whole purse, right? So what they’re deciding to put in benefit plans is interesting. So we took what made sense there and brought it north of the boarder.

And so we have ended up with our now smart spend plan design and just to give you a couple of examples of where we have landed on a couple of things. So if you look at vision, I think vision is pretty much uniform. Probably any plan in Canada is exactly the same, right? It is a two-year maximum and some amount, right? But what if we could design a plan that actually met people’s needs and gave them an amount based on need as measured by their prescription, right? So can we vary the amount that people get access to base on their prescription?

Dental, we looked at again, stepping away from this one size fits all and having the treatment based on what the plan design covers rather than what the treatment is, what people actually need. We’ve introduced something, age-based frequency limitation. So the need, children have a different need than adults. Young children have a different need than older children. So how can we get people going at the time based on the need of their teeth? And when they go, we want to make sure that they are covered.

So this plan actually has a 100% coverage for those things because we know about cost based non-adherence. We don’t want people to not go to the dentist because of the co-pay. So we want you to go, we just might want you to change the frequency that you go at. Paramedicals, we talked about a little bit but really looking critically at what plans cover and where the evidence is and what we should be spending.

So just an example from our book of business, so for every dollar that we spent on psychologists last year, we spent $4 on massage therapists. So if a plan sponsor really wants to think critically about where they are spending their money, we have decided to remove massage from the SMARTspend plan design. Coupling that though, we are making a health care spending account and a personal spending account as an option into this plan design recognizing if you look at a personal spending account, there are things that we know drive better health outcomes for plan members, like exercise, that aren’t allowed to be covered under benefits plans, right? They are not allowed to be included by the CRA rules.

But we feel so strongly that those things should be included really as part of a whole plan to drive health outcomes that we have recommended to include a personal spending account and a health spending account as well so that plan members can use those funds to do things that make them well and whole and addresses the whole intergenerational workforce.

[0:20:12.2] DW: So massage, I think that’s our thinking there because I think what we have said about massage in the past is that, as far as we can determine and with the available research, it is short term pain relief but it does not have long term lasting effects on somebody’s health and I would certainly say, look at short term pain relief has a value. There is a value attach to that and people that chose to do that will have funds available in this plan to spend their money on that.

But I think what we are saying as per your data just a few minutes ago, with amount, the millions of dollars of reimbursing for that particular service is that the wisest service if we are trying to drive longer term health outcomes?

[0:20:53.4] EC: Absolutely. Yeah, short term pain relief and relaxation is certainly important. I think the other thing we are arguing is there are more cost effective ways to achieve that same outcome either through a yoga class or exercise or a walk. You said you said a nap, which is free.

[0:21:06.9] DW: I love naps for the record.

[0:21:08.9] EC: You know remember when naps were punishment as children? Now it’s just hilarious when you think about it to how should we differentiate where massage sits? Let’s put it in with the HSA and PSA where you could also reimburse for things like a yoga class or your fitness reimbursement of things like that.

[0:21:24.1] NP: Yeah and just to add to that, I mean even in the notion of massage there is value. I usually could argue there is value. It is just the level of value, right? And the opportunity cost of the dollars invested in that versus whatever else it could be invested in and so that opportunity cost isn’t often considered because there isn’t a defined budget in employee benefit plans like we are not holding – the employers don’t typically say we have to hold to a 3% increase across the board next year and go ahead and make hard decisions based on the 3% increase.

If it goes up 7% then it gets absorbed typically and people think through that right? If we were held to a defined budget, we would then have to make those hard decisions and say, “Okay, well maybe massage isn’t covered next year because we are now over budget” right? So we have the principles behind how we are going to try to invoke those decisions around opportunity costs in what goes in and what goes out and a budget is one useful way to look at it.

[0:22:13.5] SM: You have plans about those, it’s just gotten very used to the cost of high – these plans go up at a rate much higher than inflation and everyone is just holding onto their seats and seeing what the cost will be next year but absolutely, what could we do to actually be able to better manage that increase here over a year?

[0:22:28.4] DW: What new benefits are a part of this plan design? Because it is not just taking away.

[0:22:33.1] EC: No, not at all. So yeah, we have included all of GSC’s coaching programs because we know that behavior change thrives better health outcome. So we have funded and designed those programs. So our cardiovascular health coaching, our smoking satiation, our dietician health coaching, all of those programs will be part of this. We are also including digital health programs that we know drive better health outcomes as well.

So things like Beacon will be included as part of this program and as we move forward and as other similar digital health offerings come to market that can deliver the same value for lower spend, those will absolutely be included in this plan design as we move ahead and then similar process to what Ned described earlier.

Also the concept of we say we want to include an HSA and a PSA but we want plan members to be able to influence the amount that they receive in those funding accounts. So we want to link behaviors from change for life into funding those HSA and PSA amount. So a core amount but plus the opportunity to get more through behavior change linking your steps things like that.

[0:23:38.7] DW: And on the drug side, what does this plan design?

[0:23:42.2] EC: Well, if we are modeling the rest of it after what we do on the conditional formulary, any logic would say that we’re including the conditional formulary at a 100% because we come back to we are going to include the things that we know work and are the best value per spend and then we are going to pay for them at a 100% because we want you if we believe in those things, we want you taking them. We don’t want cost to be a factor so that’s what’s been included.

[0:24:03.3] DW: For Ned, just for our listeners, define what are our conditional formulary looks like.

[0:24:07.5] NP: So basically GSC’s version of a managed formulary, which has existed for well over 20 years now and has been refined time and again and I think we’re biased but we’d argue it is by far the strongest management formulary in the industry and the philosophy behind that is one of ensuring that what folks will need access to what they will get access to, right? So we don’t use crude measures that sometimes you see in the industry.

Things like not listing drugs and 20 or 30% of all drugs or are things like that. We certainly do not list every drug but most drugs are listed but the sophistication I think of this formulary is how we craft the criteria associated with drugs to ensure that the five percent or one percent of people who truly need access to that drug therapy will have access to it are not going to fall through the cracks. So in some ways it is the formulators is again, much more rigorous but it ensures at the end of the day that there is no lack of coverage for the appropriate therapy.

[0:24:58.8] DW: So we will have lots more material flowing out into the industry through the late summer and early fall about this SMARTspend plan design. So Erin let me ask you, I mean we are grownups, we know that this is going to be sort of a major departure potentially or a plan sponsor, what do you realistically think the response to a plan design like this,” given that we've just had talked about plan design has not changed this country really over 30 or 40 years. Realistically what do we think people are going to say to this?

[0:25:36.1] EC: I think the expectations are reasonable. I think this will be a little bit like giving broadly to a child, you have to put it in front of them five times before people understand that it is good for them. I think it is a conversation starter. I think it will resonate with some plan sponsors but I do think it is something we’ll probably talk about for a while before it gets a little bit more acceptance.

[0:25:57.4] DW: Just go back to the massage thing, because I think that will be the headline from this is like, “Oh massage is not a normal covered benefit like it has been for a couple of decades.” But tell us a bit about other jurisdictions. I mean that is in Canada, that is in private plans but where else in the world would massage be covered?

[0:26:15.2] EC: Is it covered in the US?

[0:26:16.8] DW: No.

[0:26:17.0] NP: No, paramedical services in general are almost uniformly excluded from benefits plans in the United States.

[0:26:22.9] DW: So when people are sort of taken aback by that approach, not very far away this is the norm. It has been in Canada that we had just added on and added on and added on. Where others have applied sort of more disciplined to vetting a certain services and they simply don’t exist in modern western economies with all sort of thrift about the points.

[0:26:43.0] EC: Yeah, I mean it all really comes back to which list of practitioners this area that deemed to be vetted and benefit plans have hung their head on that and we’ve actually discussed internally and there’s practitioners that do provide more value that aren’t on that list right now. So something like a diabetes health coach is not considered a covered practitioner by the CRA standard and it is too bad because I think those would provide a lot more value in plan designs and we’ve talked about how do we talk to the CRA because do we want the CRA be responsible for innovation and benefits clients?

I don’t think that’s the best route to go but yeah, they are on that list and so no one is really questioned it, right?

[0:27:19.1] DW: Okay, I think what you said is true. This is meant to be a conversation starter for industry and we hope to have a very interesting dialogue with the advisory community with plan sponsors and I think we’re also saying that this is just the first stroke of what we’re going to try to do here. That overtime, we are going to certainly talk to the paramedical community and ask them to probably invest more in that research so we can make better determinations and some things may stay and some things may go.

[0:27:48.6] EC: Just one more thing, one more thought to add as we went through all of this, it was always trying to strike that balance as well between designing a plan that we thought really would pay for the right things at the right time and balancing that with employees actually understanding their benefits, right? You could so easily make it so complex that people would be going to their optometrist, their dentists having absolutely no clue what they’re covered for and so it is always difficult to strike that balance.

[0:28:14.8] DW: Yeah, so as we move towards the end of 2018, the proof will be in the pudding and we are looking forward to the response to the work that has been done over the last 12 or 18 months here in our incubator and I want to thank both of you for walking us down this path today and I am sure we’ll be back talking about how it is going, thanks.

[0:28:32.6] NP: Thank you.

[0:28:33.2] EC: Thanks.


[0:28:38.1] SM: Thank you to our listeners for tuning into another episode of And Now For Something Completely Indifferent, a Canadian health benefits industry podcast. To be sure to get future episodes, please subscribe to this podcast wherever you get your podcast or visit our website at to download. As a reminder, we talk about these issues consistently in our publications, which are available on our website as well as on social media. So be sure to follow the conversation. For this specific episode, you can check out our September issue of the Inside Story.

Thanks for listening and we’ll talk again soon.