TORONTO, ONTARIO (THURSDAY, OCTOBER 4, 2018) – Over the past year, employee health benefits plans administered by Green Shield Canada (GSC) spent four times more dollars on massage than mental health services.
“To give some background, for decades, the majority of Canadian full-time employees have had access to employer-sponsored health benefits plans, typically with a standard design – drug and dental coverage and a host of miscellaneous health services and devices,” explains David Willows, GSC’s Chief Innovation and Marketing Officer. “But these plans have evolved very little over that time.”
As Canadian health markers have steadily worsened, and health care costs have consistently increased above the rate of inflation, little attention has been paid to examining and changing our health benefits plans to address broader, systemic health challenges. The rise of chronic diseases, the spotlight on mental health conditions and the impact of new expensive drugs (some that cost tens of thousands of dollars a year and occasionally hundreds of thousands) have all generated momentum for a health benefits re-think.
“Yet the response to these challenges in the world of health benefits has been muted,” says Willows. “The few attempts at change have fallen short, including capping the annual drug spend per employee, potentially cutting off employee access to expensive, but potentially life sustaining or saving drugs. What we have not seen is a holistic look at all the costs contained in employer-sponsored plans, and a measurement of the ultimate value they provide by looking at the best available evidence from scientific literature.”
In response, GSC is launching its SMARTspend™ health benefits plan design as of October 2018, providing much-needed options for employers seeking more tangible employee health outcomes from their health benefits investment.
Examples of what is in GSC’s SMARTspend plan design:
- A managed drug formulary for smart pharmaceutical options, with 100% coverage, and no dollar caps that cut off those in the greatest need.
- Digital mental health support options for easier access and consistency of care.
- Health coaching by pharmacists and dietitians to stem the tide of chronic disease.
- Vision benefits that recognize those with greater vision challenges, not just a small, flat bi-annual benefit for all.
- Dental benefits that reflect the needs of different generations, based on research and the best available evidence.
Examples of what is not in GSC’s SMARTspend plan design:
- Massage. GSC’s most popular and costly paramedical service is removed as a core benefit in order to re-invest significant funds in the more serious health challenges noted above.
- The popular six and nine month dentist recall for adults, unsupported by any research or evidence of need, is pushed to 12 months.
- Access to expensive new drugs that do not provide demonstrated advantages over established, effective ones will be slowed by a step therapy process that requires evidence of the clinical need for reimbursement of those higher cost drugs.
- Copayments or deductibles, because we know that out-of-pocket expenses can act as a barrier to getting access to things that employees need to improve their long-term health.
Options exist for employers to add both personal and health spending accounts for employees that provide additional dollars for the purchase of services and medical devices of their own choice, including massage therapy.
And in an interesting first in Canadian health plan design, additional dollars can be earned and deposited in those personal and health spending accounts by participating in healthy activities – including step-tracking, setting medication reminders, and tracking blood pressure – on GSC’s online health management portal, Change4Life®.
“Real change requires meaningful movement away from traditional plan designs and the courage to explain the reasons why to employees who have become accustomed to freely accessing a host of benefits that they definitely like but do not necessarily need,” explains Willows.
“It is GSC’s hope that this new SMARTspend plan design, and the conversations it spurs, will provide a host of ideas for employers, benefits consultants and insurers to start a collective journey towards health benefits plans that better embrace concepts of health research and evidence, clinical outcomes and ultimately, value.”
For more information:
Green Shield Canada
Click Here to Listen to the PODCAST Episode on SMARTspend.
Click Here to Read the Edition of THE INSIDE STORY® on SMARTspend
About Green Shield Canada:
GSC is Canada’s only national not-for-profit health and dental specialist, and their reason for being is the enhancement of the common good. GSC seeks innovative ways to improve access to better health for Canadians. From coast-to-coast, their service delivery includes drug, dental, extended health care, vision, hospital and travel benefits for groups and individuals, as well as administration services. Supported by cost containment strategies, advanced technology and exceptional customer service, they create customized programs for over two and a half million plan participants nationwide. greenshield.ca