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Green Shield Canada

Episode 21: On air with Stephen Frank, again

In episode 21, producer Sarah Murphy and host David Willows welcome (for the third time) CLHIA’s President and CEO Stephen Frank to talk about industry happenings – pharmacare, CCIR, fraud, and more.
And now for something completely indifferent

And now for something completely indifferent

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Episode Transcript


[0:00:14.9] SM: Hello and welcome to another episode of GSC’s Podcast; And Now For Something Completely Indifferent, where we’ll be discussing the hottest topics and trends in Canadian health benefits. I am the producer and editor, 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 individual 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 upfront.

You can download this podcast from our website at\podcast, or subscribe to it from wherever you get your podcasts. We also encourage you to read our publications, the inside story, follow the script and GSC Talk, which you can also download from our website. Please be sure to follow the conversation on Twitter and LinkedIn.


[0:01:09.9] SM: Now let’s get started. Today’s episode is hosted by David Willows, GSC’s Executive Vice President of Innovation and Marketing. Hello, David.

[0:01:18.1] DW: Hi, Sarah. I’m not going to spend this intro talking about guest, like I normally do, because he’s always on. It’s Stephen Frank, yet again, from CLHIA. We’re lucky to have him on every year and he does his thing and we talk about the year.

[0:01:30.9] SM: He’s solid.

[0:01:31.3] DW: Has all sorts of insights. I don't want to talk about that. There's something I really want to talk about.

[0:01:35.0] SM: Oh, okay.

[0:01:36.7] DW: You know how on a lot of podcasts that are out there in the store, there are real advertisements on them, where the host will read something from a sponsor and it's like a commercial.

[0:01:50.4] SM: Yeah, it helps pay for the podcast. Yeah.

[0:01:52.3] DW: Yeah. Well, you also know that here at Green Shield Canada, we do have a line of business that is marketed directly to the Canadian consumer, its individual health insurance. It's called SureHealth. The group over there has all sorts of different marketing strategies, TV, digital. Most recently, whether you know it or not, they have strayed into the world of podcast. Did you know this?

[0:02:19.3] SM: I may have heard a few things, but I don't know a lot of details.

[0:02:23.0] DW: Well, I've heard more than a few things about it, because it's literally all they talk about –

[0:02:26.9] SM: Do tell.

[0:02:27.5] DW: They are now sponsors/advertisers on the Darren Dreger podcast on TSN. I mean, it's literally all they talk about. If there was a drinking game with Joe Blomeley and Bob Doyle, our colleagues, involving them saying Darren Dreger’s podcast, we would be drunk at 9:00 a.m. and we'd have to take an Uber home. That's how often they talk about being on Darren Dreger’s podcast.

[0:02:52.7] SM: Wow. Really?

[0:02:54.4] DW: It’s awkward, because –

[0:02:56.0] SM: We have one.

[0:02:56.7] DW: We have a podcast. I fear that maybe over the last year or so, I've been virtue signaling, which I didn't want to do, that maybe this is a pristine podcast and we wouldn't do something like that.

[0:03:08.2] SM: We wouldn’t sell out, but we would.

[0:03:10.4] DW: Oh, no. I've been waiting for the opportunity. I will literally read anything put in front of me and not for much. Now we probably can't ask them for money, because it gets complicated with internal accounting and stuff like that, where they would pay for it. I would literally do anything for a lunch at Jack Astor's.

[0:03:26.8] SM: Yes. For sure.

[0:03:27.7] DW: I will read anything they put in front of me, for a drink at Jack Astor's.

[0:03:31.4] SM: Maybe the other podcast, I'm not going to mention it anymore, gets more listeners maybe?

[0:03:36.8] DW: I doubt.

[0:03:38.1] SM: I doubt it too.

[0:03:38.7] DW: Some hockey insider has more listeners than we do for arcane topics of health and dental benefits. I don't believe that for a second.

[0:03:47.0] SM: No, I agree.

[0:03:47.9] DW: I just want them to know we're on to them. Quite frankly, it hurts. Let's talk to Stephen.


[0:03:59.0] DW: Okay, warm welcome back to the studio to our good friend and colleague, Stephen Frank, President and CEO of the CLHIA. This is your third time.

[0:04:07.7] SF: Third time.

[0:04:08.5] DW: This is becoming an annual event. Every year, I suspect he's finally going to get the nerve to say no, but he's just too polite. Here he is at the end of 2019. I think people know probably what we're going to lead with and what topic we're going to start off with my questions. Let me ask you, you've had the role for how long now?

[0:04:26.4] SF: We'll be coming up to four years this spring. About three and a half years.

[0:04:29.7] DW: The pharmacare issue has been out there a few years, probably a major one that you’ve had to tackle.

[0:04:34.2] SF: Pharmacare predates me as president for sure. This is I would say five to 10 years we've been talking about this and we've probably got another five to 10 to go. We’ve got a lot of clarity.

[0:04:44.7] DW: For you, was this the most pressure-packed, or interesting year given this was the election year, sort of culminating all of that talk?

[0:04:53.0] SF: Well, I think we had hoped the election would clarify things.

[0:04:57.0] DW: It didn’t.

[0:04:57.8] SF: It probably has not, right? I mean, well we can talk a bit about the environment we see in Canada and federally, but there's been important changes in the provinces, there have been important changes federally. The environment changes.

What hasn't changed and I think this is across the board and even within our industry. I think the belief that the system is not working as well as it should and that there are things we can do better to make sure particularly those that are struggling to get their needed medications that we address that, I don't think that's changed. Smart reform, well-thought-out reform would be welcomed by everybody. That agenda is not going to go away.

[0:05:34.7] DW: Okay. Walk us through this year a bit, knowing that election is coming, how does your work, your organization's work change in that environment, as opposed to some of the advocacy that you did in the years past?

[0:05:47.5] SF: A couple things happen in the lead-up to an election period. In normal course, we would be in speaking with officials at the Department of Finance, or the Health Department, or Treasury Board, or the Privy Council office, things like that.

We would be having some pretty, almost technical discussions around how does the system work? Sometimes we provide them with some modelling and some numbers to help them look at various options. All of that work stops. Our efforts then turn towards really understanding and monitoring what political parties are saying.

You try to gain insights into their party platform and then you watch what they're saying on the election campaign. It's a bit more passive in the sense that we're not engaging with politicians during a campaign. They've got other things to do though.

[0:06:39.1] DW: Yes, they’re not interested in setting up a meeting.

[0:06:40.1] SF: We’re on the sidelines and you end up watching really intently and trying to see what the cues are. What you're really looking for is the direction of travel on these things changing, is it gaining a lot of momentum? What we are watching for with pharmacare was was this going to potentially become the election issue? In the end, I don't think it did. This was about climate change, about affordability, about the middle class. That was front and center and pharmacare was mentioned periodically, but it never really came to the forefront.

For us, we were just watching that and trying to see okay, what environment will we be in right out of the election? As an advocate on behalf of the industry, that's what you end up doing for those maybe two, three months. Then now they we’re out of it, we'll start engaging in a different way again.

[0:07:26.5] DW: Let me ask you this, as the party platforms rolled out, when I looked at this and I've asked you this before, was it expected okay, we've got two parties where probably the ideological roots of them dictate what their position will be on pharmacare. We've got a smaller government party with the conservatives and a party that probably doesn't like the profit mode of being engaged in healthcare and that's the mantra of the NDP. You've got the one sitting in the middle. Really at the end of the day, did you focus on that's the one party that is influenceable and we have to hope that they come out more along the lines of what we want to see?

[0:08:04.8] SF: Well, for sure. We didn't do that in the month leading up to the election, right? That was a many year process of engaging with them, explaining to them how the system works. The message we were trying to get across to them and we can talk a little bit about what we're hoping for is a reform, but what we're trying to help them understand is that for the vast majority of Canadians, their coverage works extremely well. In fact, for the majority of Canadians with private plans, they're getting probably better coverage than they would get on a public program.

We wanted them to understand the facts and that there's some real risk there. There's some risk for people's health and there's some political risk for them. If they're taking things away from people and they're getting back, what may be perceived as lower quality going forward that that's – they better think really carefully about that.

A lot of time was spent explaining how our industry works, who the payers are, the types of coverages we provide, that it's broader than just drugs; it's the dental and it's all the paramedicals. All those things are bundled together and there's impacts on all of that if you do something without thinking it through. Building that in.

Then of course on the other hand and this was more discussions you may have with the finance department and some other more fiscal folks within the Liberal Party. It's around okay boy, there's a big dollar symbol on this and there’s a lot of priorities in Canada and a lot of priorities in the health system and is that really the best use of those dollars?

Then you can go in with that messaging, but what we really try to do is to back that up with some proactive, thoughtful solutions, right? So that we're not just saying, defend the status quo, everything's fine and walking away. We're trying to go in and present some options for them, so that we're seen as a partner and then we can be influencing the direction. Like I started from right at the beginning, I think we do agree there are changes that could be made and there are some cracks in the system and it would serve us all well to try and fix those.

[0:09:53.2] DW: When the liberal platform came out, it was clear that they had not embraced all of the ideas flowing from the Hoskins report. Did you view that as somewhat of a victory for your work, and that they had not gone full bore towards a single-payer, government-run pharmacare?

[0:10:12.6] SF: Yeah. I mean, I think I do believe our advocacy and education efforts have made a difference for sure. We had a bit of an inkling that that's the direction they were going when the budget last year, or in the budget you may recall they talked about pharmacare, but that pulled down to three things; the creation of a Canadian drug agency, some orphan drug or rare disease strategy and then some idea of a bit of a more standardized formula for Canadians, right?

Those are three pretty tactical things that if done in a big way could be very profound and could result in structural change. That's not a single-payer, right?

Out of the budget, we thought okay, that seems to be where their head’s at. We were watching as okay, is there any change in that messaging in the platform? Of course, there wasn't. We continue to think that that's still where they're at, coming out of the election that their preference would be to address prices, to address some degree of standardization and then real focus on rare diseases. Of course, all those things would be boxes and we can really get behind, right?

There is a path forward here, where pretty well all the stakeholders can get aligned and can move forward together with some pace, which could be very I think good. The signal seems to continue to be that's where the liberals are leaning towards. Clearly, conservatives would be more in that bucket than not. Then the NDP and Green Party and whatnot would be pushing for a different model.

[0:11:40.1] DW: I should tell everybody that's listening to this podcast, we are taping this the afternoon of Friday November 29th. We have the throne speech next week and then probably the first critical vote coming after that. Now the NDP had come out in the last number of weeks escalating their interest in pharmacare. Some of us thought okay, they're going to go climate change. They seem to go pharmacare. What's your sense of that?

[0:12:02.4] SF: Well, maybe we can step back and just take stock of how the election landed, right? We have what is generally described as a strong minority. What people mean by that is that the liberals don't need two parties to stay in power. They just need one. On any bill, they just have to find one of the other major three parties and they'll be able to get the bill passed. That's what's considered a strong minority. You would anticipate that the liberals aren't feeling a ton of pressure to bend too much to any of the party's agendas. They'll be thinking to themselves, “We'll find a path forward where we'll get someone to support what we want to do.”

You've seen there's been no formal alignment or arrangements between the liberals and anyone else. That's really how this is going to play out. You can think of how it worked with Prime Minister Harper for the first couple of terms, right? Where strong minority and he just – on different bills, he could rely on different party supports.

The NDP are going to look to communicate to their supporters, they're going to look to try and push the government as hard as they can, but their influence in this environment isn't as large as it would have been had the liberals fell 20 seats short of where they did, in which case we'd be thinking well, maybe the liberals could be dragged into a direction they don't want to go.

Next week will be the next milestone and we are watching. It'll be the throne speech. We'll watch what they say. They will almost certainly say that they want to implement pharmacare, and so we shouldn't read too much of –

[0:13:29.3] SM: That word is not going away.

[0:13:30.2] SF: That word doesn't mean anything, right? You got to then figure out what they are talking. It'll be interesting, right?

[0:13:36.2] DW: If it's the pharmacare as described in their policy platform, then we would be interested partners.

[0:13:42.5] SF: Absolutely. We'd be heading in there and saying, “Can we work with you on this? I think we could have some really good alignment.” Now the other element we haven't talked about in all this is that healthcare is a provincial thing. The federal government can propose anything it wants. At the end of the day if the provinces aren't interested, it's not going to go anywhere. We've seen a lot of changes provincially in the last year, so you've got – there are three provinces that have come out publicly saying not interested in any form of national program –

[0:14:13.5] DW: Pretty big ones, right?

[0:14:14.3] SF: Yeah, the big ones. Quebec and Ontario and Alberta have all stated, “We've got good coverage. We're not interested.” You've got one province that's actually banging the drums to say, “We'll be a pilot province and we're really keen on this and that's Newfoundland.” Then the rest when we talked to them and when you look at what they're saying, they're in a wait-and-see mode.

There's so many layers to this. On the ground, there'll be the political descriptions of what they're doing, pharmacare and da, da, da. Then the substance is going to be a debate between the federal and provincial governments. Then even that, they're going to figure out what they do. That's why I said earlier, we've been talking about this for five years. We have a long way to go yet before there's a ton of clarity on this. Probably a little more uncertainty now than before and we're still at the beginning of this discussion, would be the way I'd characterize it.

[0:15:05.1] DW: Okay. Good. I can’t believe we're going to talk about something other than pharmacare now. I know there's been a lot of talk in our industry around, I guess what CCIR is calling fair treatment of customers. This was another pivotal year of dialogue around that for our industry. First, can you tell us a bit about CCIRs, the Canadian Council of Insurance Regulators? Who are they? How do they exist? Who do they report to? What is your relationship with them, back and forth?

[0:15:36.3] SF: Well, I'm glad you did a little homework because you knew what CCIR stood for. There’s a lot of acronyms in this industry.

[0:15:41.4] DW: I went on the interweb to find that out.

[0:15:45.0] SF: Yeah, we just need another acronym like a hole in the head. Yeah. CCIR, it's a grouping of the various provincial regulators.

[0:15:53.0] DW: Got it.

[0:15:53.5] SF: In and of itself, it does not have any authority to make any changes. It's a forum where the provinces can get together and they can try and align and come to agreement on what they want to do. CCIR can put out guidance and notices and they can do communications and stuff.

At the end of the day, each province then has to take that and go do something with it.

Overtime, I would say the CCIR is becoming a more of an effective organization than it would have been 10, 15 years ago. That's I think a recognition by all the provinces that they – we’re in a new world now where the business is pan-Canadian at a minimum, if not global. They just simply have to be coordinating, or their jurisdictions get out of alignment and that would be bad for the industry and bad for them.

CCIR we see is becoming a more robust place for dialogue than it's been in the past. Still at the end of the day, you got to remember each province then needs to go and make the changes. It's a very interesting environment right now. The CCIR is getting more I guess strategic and organized.

At the same time in a number of important provinces, we're seeing new regulators. In Ontario, we've got FSRA, which has been up and running since early November. It's a much more empowered regulatory body than we had with FSCO. It has rulemaking power, it can raise funds directly from the industry, their pay grades for their staff or outside of the civil service grades now so they can theory, attract better talent and more talent.

We would anticipate over time that they will become a more and more robust regulator. You're seeing exactly the same thing in BC with the BC Financial Services Authority, which replaced FICOM. That has just started in the last month as well. It has the same rulemaking authority as Ontario, same pay grid outside the civil service. They've modeled themselves very much in Ontario. You've got the AMF and Quebec continuing to be a very active regulator. Potentially some change coming in Alberta down the road.

What's happening and it's a slow evolution, but it's very clear, the regulators are getting muscle they will be more engaged going forward than they have in the past. What we're hearing from them and we will have some documentation on this shortly, but the CCIR is redoing its three-year plan, so their previous one ran from 2018 to 2020, or whatever. 2017 to 2019. Their next one will start this year and roll forward three years.

They're in dialogue with a bunch of stakeholders on what they should be focusing on. It's a continuation of what they've been talking about the last number of years, but probably a little bit more energy and more pace behind it. We're seeing the same here in Ontario, where FSRA is rolling out a new three-year plan, and so they're starting to talk publicly about where their priority is going to be.

At the CLHIA, we're watching that closely. We're talking to them as much as we can. There are certainly some trends and some themes are starting to emerge, which we're trying to make sure we're staying ahead of.

[0:19:00.5] DW: What do you think that next three years looks like in terms of your dialogue with our industry and by connection, the advisory industry?

[0:19:12.4] SF: The themes that are coming out crystal clear for us in all of our discussions with FSRA, with BC Financial Services, with the CCIR, with the AMF is that – and you mentioned this earlier, the fair treatment of customers is the thing, right? It's a principle that's being rolled out in Canada. It's a change from where we've been traditionally. It will result in some change of practice in the industry.

We've made a good case to the CCIR and regulators that we're already treating customers fairly. I don't anticipate that we're going to identify big areas for change. Where the regulators come back to us in discussion as they say, “Okay, we get it, but there's a couple areas in particular we want to talk to you about.” One of them is what they call incentive management and the other is advisor oversight. Those are two areas that come up over and over and over again.

What they mean by incentives is how do you pay your advisors? Is that compensation fair and are you creating undue incentives for bad behavior? We would argue no, but these questions are asking. They ask things about disclosure. How does the customer know what they're paying? The question around how we pay, what we pay, what customers, or where they're paying, those things are gaining in momentum, they're not anticipating. Those are discussions we're going to have to have with the regulators and we're going to need to bring advisors really, really early and closely into those discussions.

Then in Ontario in particular, we're hearing a lot of questions around how do you oversee, particularly the MGA channel? How do you know what an advisor is doing is placing business with you and who's accountable for the behavior of that advisor? What are the processes in the industry to be monitoring that? Questions. Again, we're not positioning that there's big, big problems here, but these are issues the regulators, when we go into a meeting, they're coming with those questions.

That environment, it's something we talked a lot about over the last couple years in the context of G19. It was an effort on the insurer’s part to try and get ahead of a lot of that. I think we learned a couple really important lessons there, which is that we won't be successful and the industry won't be successful for not bringing everybody along together.

Advisors have a critical role in all of those discussions and should be part of the solution right from the beginning. That nobody should be trying to get too far ahead of the others. That's the model we're going to be using going forward and it's the right one. That environment and those questions are still the same and we're going to have to find solutions, or ways to explain what we do and give comfort to the regulators on all those elements. That discussion will be with us for a while.

[0:21:54.7] DW: In a bit of a breather after G19, but it's coming back.

[0:21:57.3] SF: Yeah, it's coming back. We saw it a couple years ago. We knew. I think, like I said, we know and the regulators know and everyone knows this has to be a collaborative approach. We will not get there if one group of stakeholders is rushing out ahead of the other. It has to be a march where we're working together. It will probably be more of a regulatory-led discussion in the future than in the past. That's probably appropriate. There's some difficult issues that we'll have to grapple with in the coming years.

[0:22:27.9] DW: Okay. Let's go to our last major topics and try to pick up the energy in the room. It's the holiday season. Let's talk about benefits fraud. I got an interesting e-mail from actually, a fairly renowned healthcare company in Canada just in the last couple weeks, which surprisingly to me did remind me that the year is coming to an end and I should really be looking to use up those benefits. Had a little chat with them offline, about my surprise with that messaging and they were quite chagrined about it.

Obviously, the issues that we've talked about for many years are still there. We haven't cracked the code on this. Why don't you talk about the industry's focus on this and what is new? What is coming down the pike?

[0:23:10.3] SF: Well, it's been an interesting couple of years for me, because the interest in an industry-led approach to dealing with claims fraud has been rising every year. Four or five years ago, I would have guessed based on the feedback from companies that many viewed their anti-fraud efforts and their educational efforts as a bit of a competitive differentiator. I'm just not sensing that anymore. I think we've all collectively said we have a collective problem and we need some collective approaches to try and address it. And we are all doing more and more in this area than we've ever done. Your comment around getting to that time of year where the use or lose it mentality kicks in is an interesting one, because we've just – and for the listeners who are in around the GTA, you may have seen some of our fraud equals fraud billboards on the Gardiner in various parts of town and online and may have been – we may have been chasing you around your Facebook account and stuff like that. We've rolled out an educational awareness campaign this fall.

The reason we did it now is for exactly the reason you outlined, David. We know that coming up to year end, there's a lot of misinformation in the system around people should be using their benefits. You can get it a – on the best case, you get abuse of plans when that happens. Then sometimes, people cross the line into outright fraud. What we learned a couple of years ago is that almost no one understood that what they were doing was fraud.

There were some tough cases where you'd have some of these organized criminal groups and the majority that people that get caught up in it just didn't understand what they were doing was wrong. When we did a poll in 2018, 75% of Canadians thought that the worst thing that would happen to them if they are caught committing claims fraud was they have to repay the amounts to the employer. It would cost them $75. Well, no. You're going to lose your job, your reputation is going to be impacted, you could go to jail. I mean, these are crimes.

Our campaign has been targeted at areas where times of year in certain areas where we know we can reach people and it's to try and get that message out that this is a crime, it's a real crime, there are real consequences. To provide some educational opportunities to help people identify what a misuse of a plan is. We've got a new webpage called Fraud is Fraud, all of our collateral directs people through that. There's lots of great resources on it.

The click throughs on that have blown through every metric we set for ourselves. We've been really surprised actually at how much it's resonated, how many people are visiting the webpage, how much interaction we're getting with them.

[0:25:45.7] DW: Is that because it's been in the news more? I would say the last few years was big high-profile cases?

[0:25:51.7] DW: Possibly. I think collectively, we're not afraid to talk about it when it happens. Many years ago, if a carrier had a big fraud and the employer had a big fraud, that the temptation not to talk about was pretty high. You're seeing a little bit more of it now. Frankly, I think abusive plans and – I think it's rampant, frankly. I think everybody who sees those ads questions themselves a little bit like, “Oh, boy. I better – Hmm. If this is really that serious, maybe I better think about this a little bit more.”

It has really surprised us how engaged people have been. When we do exit polls, not quite the right word, but when we go back out in the market and test people who've been exposed to these ads, it really does move their understanding. We're encouraged by that. This is a multi-year program. We will be doing at least a couple more years of these kinds of outreaches in the fall every year. We're really going to try and raise awareness. We're focusing right now on the plan members.

We know there's a big role for the providers and the paramedicals and others in this too. Eventually, the plan is to start to reach into those stakeholders as well and try and get the whole system talking about this and doing things to raise awareness and also to get people to change their behavior. That's ultimately the goal here. It’s a long way to go, but it's been really interesting how big an impact for the relatively small spend we’ve put on it, that we've been able to have.

We've been doing a lot around the education piece, but there is within the industry a real desire to actually provide some tools that could help people. We are looking at piloting some approaches that would let the industry pool claim data and do some very sophisticated analytics on that, to identify trends that you don't necessarily see if you're just looking in your own block of business. The other industries, like the PNC industry and the bankers and others have been down that road already, so we know what works. I would suspect it's going to work for us too and I suspect there'll be a lot of interesting takeaways from that. A lot of work going in there.

A lot more collaboration between the fraud investigators within the industry and we're talking a lot more than we ever have. There's just a lot of energy around that now. It's interesting time. Very interesting time, but it's being driven. I don't see the data. I'm not in the companies, but the level of interest in this and the demands on us to do more are rising every year, which tells me there's a real issue here.

[0:28:20.0] DW: Yeah. I would say just on the side, this company – I mean, we're all talking about AI and things like that. Our largest focus with AI has been on this particular topic. It's just fascinating that our capabilities have grown by leaps and bounds, even in 18, 24 months.

Sarah, you were telling us about people you knew that are talking about this. Tell us your story – this gets to Stephen’s point around people seem interested in talking about this too. It's a topic that people really relate to.

[0:28:46.9] SM: Our marketing team had gone to an event earlier this week, where your team was sharing some of their successes from the Fraud is Fraud marketing campaign. The room is filled with other marketers who are expecting that all the folks in the room, if they're going to have questions or dialogue, it's going to be about the marketing tactics.

[0:29:05.8] DW: Strategy.

[0:29:06.6] SM: How were your digital ads? How did they perform? How was your search engine optimization? That stuff. All the marketers in the room, though, all they wanted to talk about was their specific scenarios, their experiences. Like, “Oh, so my dentist has called me and asked me to book an appointment before the end of the year. Should I be doing that? Is that fraud? Oh, I got a kickback from my orthotics. That's a problem, right?” It was like a therapy session, yeah, among the marketers.

[0:29:28.9] DW: The big confessional.

[0:29:30.0] SM: Yeah, yeah. It really does have impact.

[0:29:32.3] DW: Maybe one of the key issues, or the demographic we should be looking at are marketing people.

[0:29:36.4] SF: Marketing people. Yeah.

[0:29:37.5] SM: They seem to have more of a –

[0:29:38.4] SF: There’s got to be some ethical rules that they have to follow, right?

[0:29:40.6] SM: Anyway, the team thought that was such a kick, because they were – obviously, our team has been engaged with CLHIA on that campaign as well and cross-promoting materials, so they were like, “This is fantastic. It’s great.”

[0:29:50.7] DW: Okay, good. That's the dialogue we need.

[0:29:51.6] SM: Yeah, that’s great.

[0:29:52.5] SF: Yeah, that's what's been interesting. Yeah, you do hear some horror stories  that you try not to bias your thinking on those extremes. That will always be the people that are just so far out and off cross the line and we have to address those. It's the more like, the things you were talking about those questions where that's going to drive a ton of cost and inappropriate cost and that impacts the sustainability plans. That's the messages this stuff will may not be there if we're not careful with how we use it and judicious.

It's a subtler message, but we want to try and get that across. It really does seem to hit people pretty hard and there's a ton of interest. I get so many media calls when this campaign’s on, like the media love it, everyone loves talking about it.

[0:30:36.3] DW: It’sa juicier story.

[0:30:37.3] SF: Juicy story. Yeah.

[0:30:38.3] DW: Usually, insurance companies don't generate those. No offense, Stephen.

[0:30:42.7] SF: No. None taken. None taken.

[0:30:44.7] DW: Let me round back to not pharmacare, but just you mentioned sustainability there. There's certainly all sorts of policies and approaches that our industry can take and alliances that we can make and other policy pieces we can get involved in around rising drug costs. Have you seen any progress absent from the debate that we have and then the lobbying with governments and stuff like that, is there progress being made out there on different fronts?

[0:31:08.2] SF: Yeah. It's a great, great point. I'll have to give the liberals, federal liberals a lot of credit on this. They've pushed forward with their planned reforms of patented medicines prices review board and all how familiar people are with that. It's a federal agency. It's a traditionally pretty quiet one, but it sets maximum prices for drugs in Canada.

The way they've done that – the cost no version is the way they've done that in the past has led to quite a bit of inflation and prices. There's some big changes have been proposed that will almost certainly drive prices down across the board in Canada. They've been really strongly resisted by the drug manufacturers. It was a tough political battle. You give them a lot of credit that they got that over the line.

I think it does signal that they are pretty serious about doing something around reforming the system. The good news for anyone who's a payer is that the things are suggesting will most certainly come into effect sometime next year or two, no longer they consulting on what they're going to do, but it's around how. They're getting into some of the guidelines and the real meat and potatoes of what they're proposing to do.

For the listeners, I would say it's very positive direction. We should see some relief on prices in Canada, which right now are in the top two, or three, or four in the world. We will start to become more of an average priced country of other wealthy countries. The goal is not to make Canada the lowest-cost country in the world. None of us would support that. It's to make us a little bit more representative of a typical western OECD country.

It will, I do believe meaningfully move us in that direction. Great news there. We continue to talk to the provinces about can we work more closely with them on negotiations of lower prices and continue to think there's lots of opportunity for public and private payers to be more aligned and collaborative on how we're dealing with manufacturers when we're negotiating. Those discussions, we hope will pick up and we'll get to end the job there at some point. There's no news on that, but that's another area where we continue as an industry to say competing with government, competing with each other on the price of drugs is not in our customers’ interests. It’s not in the plan sponsor’s interest. We should be doing this more collaboratively and let's look for ways to do that. There's other things going on, but the PMPRB reforms are big and we're really pleased that they're moving forward.

[0:33:35.9] DW: Okay, good. Well, we'll end our meaty discussion on that high note. I think it's a tradition now that we talk a little bit about sports. You're from Ottawa and your beloved senators have had not a great run the last few years. Now as a Torontonian, I was pleased to see we're trying to help you out by sending you a coach and some key players. Are things looking up for you? Are things any better now that we’ve done some charity for you?

[0:34:00.3] SF: What I would say David, the key to life is setting expectations you're likely to hit. That's the problem with the Leafs. Every year, they start – they're going to be the team to beat and every year they underperform. I think we’ve got more of the sense over the expectations –

[0:34:13.1] DW: Seems like we got demand of good things at the last few weeks. I expect you will not lose another game this year.

[0:34:18.3] SF: There you go. Spoken like a true Leafs fan. Well, in Ottawa they set expectations a little more realistic. We're in a building phase. It's all good. All good. I still think the Oilers are the team to watch this year though.

[0:34:29.8] DW: Yes. Yes. Connor is very exciting. Okay, we're going to head off into the holidays. Thank you, Stephen, for coming yet again. I'm crossing my fingers that we'll make this four years next year, we'll see how the next year goes, but good luck in everything you have to do this year.

[0:34:41.7] SF: I'm always pleased to come do this and thanks for the opportunity.

[0:34:44.5] DW: Great.


[0:34:48.9] SM: Thank you to your listeners for tuning in to 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 podcasts, or visit our website at\podcast to download.

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