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The advantage - November issue

the advantage

WHAT’S NEW

Upcoming Inkblot webinar

Back in March 2021, the Green Shield group of companies announced its acquisition of Inkblot Technologies (Inkblot), Canada’s fastest growing virtual mental health platform. The acquisition allows us to provide you with access to best-in-class services delivered through one of Canada’s most comprehensive digital health ecosystems.

On November 30 at 1 p.m. EST, the Inkblot team will:

  • Share information about their advisory services, GSC’s preferred iCBT program – Tranquility
  • Demonstrate the value and uniqueness of GSC’s preferred employee assistance program
  • Share details about their Access product – a low-cost option for plan sponsors that provides plan members with a mental health hub for rapid counselling support, plus reduced rates to stretch their benefit maximums across more sessions

Register here.

Promote the final 2022 Change4Life® challenge and get access to valuable wellness data!

The current health risk assessment (HRA) challenge started on October 1 and will end on December 31. When a plan member completes their HRA, they’ll be automatically entered into a draw for a chance to win a $200 gift-card prize pack. Eight winners will be selected.

Remember – as more plan members complete their HRA, you are better able to identify key organizational risk factors through detailed behaviour-change analytics and reporting insights – as long as you meet minimum reporting thresholds – at no cost to you. The report is easy to read, displays the data using various visualization tools, and helps you gain a true understanding about where plan members are most motivated to make changes. It also shows how behaviour has changed over time, and which tools, education modules, and content your plan members are using the most. This report is more than just a summary of the HRA results.

Please share this promotional poster about this awesome HRA challenge with your plan members to help spread the word!

And if you want to take the Change4Life experience to the next level via enhancements that range from adding your company name/logo to providing a co-branded experience, running a custom HRA challenge, or even creating a custom reward store, you can learn more about the available options in this Enhancement Guide.

Contact your account team if you have any questions.

Travel coverage enhancements coming to all Group plans as of January 1, 2023

As Canadians begin to travel again, it’s never been more important to offer a travel product that includes the protection that plan sponsors and plan members want and deserve.

Effective January 1, 2023, we will be enhancing our standard travel product to provide additional support for plan members experiencing an unforeseen medical emergency while travelling. This new enhanced travel product will replace the current standard travel product for all Group plans and will not impact our pooled travel rates. For plan sponsors with unique/non-standard travel plans, there will be no impact to your plan on January 1, 2023.

The enhancements include increases to reimbursement levels for existing eligible expenses along with the inclusion of expenses that were previously excluded. Booklet language will be updated to reflect the enhancements.

GSC’s Specialty Care Program expands to Alberta

Managing drug plan costs to ensure long-term benefit plan sustainability is at the forefront of GSC’s commitment to our customers. Since 2015, our preferred pharmacy network (PPN) for specialty drugs has been a key initiative to help manage the ever-increasing cost of specialty medications and to provide adherence-focused patient support that helps plan members stay on track with their prescribed treatment. The drug PPN is now known as our Specialty Care Program, and with a new name comes expansion of the program into Alberta.

Following the acquisition of NKS Health by the Green Shield group of companies earlier this year, our pharmacy team assumed full responsibility for managing the Specialty Care Program. In April, we announced the transition of care navigation services to NKS Assist, the care coordination arm of NKS Health. And we are now pleased to announce that effective November 14, we will be broadening our national footprint to support plan members living in Alberta via Innomar Pharmacy and Sentrex Health Solutions.

Through its home-delivery pharmacy, the most common service model employed by specialty network providers across Canada, Innomar and Sentrex Health will offer your plan members in Alberta the same level of service available to plan members in other provinces, including delivery of their medication to their home or designated treatment centre.

How will this impact plan members living in Alberta?

There is no impact to existing specialty drug claimants at this time. The transition for Alberta plan members who are currently taking a specialty drug is planned for the end of March 2023.

As of November 14, plan members in Alberta who are newly approved for a specialty drug and belong to a group with the specialty drug PPN requirement on their plans will be automatically enrolled in GSC’s Specialty Care Program and contacted by an NKS Assist care coordinator. In line with how the program works in other provinces, plan members in Alberta will be required to obtain their medication from a participating network pharmacy to receive eligible reimbursement under their drug plan. If a plan member chooses to go to a pharmacy that’s not in the network, their claim won’t be reimbursed.

Our pharmacy team continues to work with the NKS Health team to leverage their expertise in managing specialty drugs, while collaborating to create enhancements to the program that will better support patients with complex diseases. This commitment to holistic, patient-centered care is the driving force behind GSC’s Specialty Care Program.

Anti-obesity drug coverage coming to all Group plans as of March 1, 2023

In the August GSC Update, we dispelled the misunderstanding of obesity as a lifestyle choice with the recognition of obesity as a complex chronic disease. Similar to managing high blood pressure or diabetes, obesity management requires a multidisciplinary approach, including pharmacological and non-pharmacological interventions. However, weight bias and stigma continue to result in obesity-related health disparities and can prevent people living with obesity from receiving adequate coverage for life-enhancing medications and other related interventions.

A proactive and supportive approach is needed…

Obesity is the leading risk factor for type 2 diabetes. Diabetes continues to be top of mind for many plan sponsors due to an increasing number of claimants paired with the escalating cost of treatment. Once diagnosed with diabetes, these individuals are at an increased risk for other complications which further increases their overall health expenditures. In 2021, each diabetic claimant spent $1,558 on non-diabetic medications on average, which was 86 per cent higher than their non-diabetic counterparts.* By eliminating just five to seven per cent of body weight, adults with obesity can reduce the risk of developing type 2 diabetes by 58 per cent.** Through this ripple effect, disease prevention plays an ever-important role in managing drug spend and plan sustainability.

To complement the most up-to-date understanding of obesity as a complex chronic disease, GSC is excited to announce that:

  • Effective January 1, 2023, anti-obesity drug coverage will be added to the standard drug benefit for all new groups (ASO and non-refund).
  • For existing groups, anti-obesity drug coverage will be added to benefit plans (ASO and non-refund) effective March 1, 2023.

While our thorough product development process confirmed the value of making this plan enhancement, should you need to opt out, please advise your account team by January 15, 2023.

For existing groups that currently offer anti-obesity drug coverage, any unique reimbursement limitations that apply only to these drugs will be removed as of March 1, 2023. When coverage is converted to the new standard, the anti-obesity drugs will still be subject to any prescription drug co-pay and overall health maximums that apply to the plan. You can maintain your current coverage limitations by sending a request to your account team by January 15, 2023.

This change also applies to any new anti-obesity medications added to the GSC formularies by our pharmacy experts, and new medications may be subjected to other clinically informed controls (i.e., frequency limitations, renewal criteria, etc.).

Cost impacts of this plan enhancement will flow through your drug claims experience, and any changes will be applied at renewal. To provide additional context on what this could mean for benefit plans, we estimate that the impact will be less than 0.25 per cent of total health costs across GSC’s entire book of business. However, a few factors could impact the degree of uptake related to this change, such as the prevalence of obesity in a plan member population and whether anti-obesity medications were previously covered by the plan.

A holistic approach to obesity management…

Obesity management is more than just reducing numbers on a scale – it’s about improving overall plan member health and well-being. Understanding this, all GSC plan members who are newly approved on certain anti-obesity medications may be eligible for optional one-on-one chronic disease management support. Based on an initial health assessment, a care coordinator will work with the plan member to identify their individual needs and provide personalized navigation support to seamlessly connect them with timely and appropriate care:

  • This may include one-on-one medication support with a pharmacist (i.e., a medication review with an emphasis on optimal weight management), nutritional education with a registered dietitian, physical activity coaching, and/or mental health services. Referrals are made based on a clinical assessment.
  • Even better, most services (i.e., registered dietitian and mental health services) would be available to plan members at no cost or a reduced out-of-pocket cost – where full or partial coverage exists within benefit plans. And where there’s no coverage, plan members will have access to discounted rates.
  • Existing groups that currently offer anti-obesity drug coverage but opt out of the new coverage standard as described above, will still have the option to add comprehensive chronic disease management as an added benefit for their plan members.

Diverse, equitable, and inclusive…

GSC continues to make diversity, equity, and inclusion (DE&I) a priority, and it is part of our ongoing commitment to helping plan members live their healthiest lives. This plan enhancement – another important step in delivering inclusive benefits – also enables plan sponsors to better align their benefits plan coverage with their own DE&I commitments through a comprehensive chronic disease management program.

* 2022 HBM+ Drug Trends & Strategic Insights Report.

** Diabetes Prevention Program (DPP). Available at: https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp 

Coming soon! Monthly reports to assist with life & disability benefit management

Good news for plan sponsors where GSC is administering life and disability benefits through a strategic arrangement with preferred life and disability carrier partners! Beginning with your December billing statement, if any of your plan members reach a non-evidence maximum (NEM) that is less than the overall maximum for a particular life and/or disability benefit, a report will be included with your monthly statement, identifying these plan members and the new benefit amounts that they are eligible for. Plan members can complete the carrier’s health evidence form, send directly to the carrier for review, and upon approval GSC will process the new benefit amount(s), if applicable. This allows you to quickly alert the plan member to their eligibility for a greater benefit amount, expediting the application and review process.

Didn’t know that GSC offers joint arrangements to administer and bill for pooled benefits? If you are still entering plan member information into the systems of two different carriers (GSC, for health and dental, and another carrier for life and disability benefits), GSC works with select pooled benefit carriers so that you can work in one system and receive and pay one bill (GSC will handle the remittance to the pooled benefit carrier on your behalf), simplifying your benefit administration. Contact your GSC account team for more information. 

ICYMI

GSC’s partnership with HALEO and their Healthy Sleep Program

Through our partnership with HALEO Preventive Health Solutions Inc. (HALEO), a centre of expertise in virtual sleep therapy, we are able to offer you HALEO’s Healthy Sleep Program – a clinically proven solution to effectively screen, diagnose, and treat sleep disorders. It’s designed to help you improve the health and productivity of your workforce.

Some startling statistics…

Approximately 1.8 million Canadians work shifts between midnight and 5 a.m. This represents around 12 per cent of working Canadians. And 28 per cent (4.1 million) of the 14.6 million employed Canadians work something other than a regular day shift.* 50 per cent of Canadians are living with symptoms of insomnia – regardless of their work schedule, and while shift workers are more likely to be struggling with poor sleep and the impacts of it, HALEO works with plan sponsors in all sectors.

Developed in collaboration with a distinguished team of researchers and clinicians, HALEO is a virtual sleep clinic accessible through a telemedicine platform. Its national team of experienced, registered therapists has specific training in treating chronic insomnia using cognitive behavioural therapy for insomnia (CBT-I), offering real-time tailored support through video and text. The only product of its kind, their five-week program offers one-on-one sessions with a registered professional, with 94 per cent of patients with moderate-to-severe sleep disorders no longer experiencing clinically significant symptoms following completion of the program. 

There is a direct correlation between poor sleep and reduced productivity, and HALEO’s programs are bringing plan members back to healthy sleep, and ultimately, healthy living.

Reach out to your account team if you are interested in learning more about what HALEO offers or for a quote.

 

* CAREX Canada