2012 success benefits strategies symposium.pdf · diabetes: a pandemic • rates in canada almost...
TRANSCRIPT
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2012 Success
• Mobile apps
• Pharmacy Network Value Plan
• ProspectsPlus
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Agenda
• Canadian Diabetes Association Keynote Speech
• Workplace Wellness: Benefits for Any Business
• DrugSolutions: balancing health and cost management needs
• Panel Discussion with program experts
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diabetes.ca | 1-800-BANTING (226-8464)
Diabetes in Canada A disease of pandemic proportions
Presented by Dr. Jan Hux
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Canadian Diabetes Association
• Founded in 1953 by Dr. Charles Best
• Supported by a community-based network
• Creates awareness
• Provides hope and improves people’s lives; and
• Supports promising research towards finding a cure.
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What is diabetes?
• A chronic, often debilitating and sometimes fatal disease, in which the body cannot produce insulin or cannot properly use the insulin it produces.
• Result: Elevated blood glucose levels that can lead to serious complications if not managed properly.
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Diabetes complications
• 80% die from a heart attack or a stroke;
• 35% of new dialysis patients in 2011 had diabetes;
• 30% will become blind;
• 70% of non-traumatic limb amputations;
• 25% suffer from depression; and
• Life expectancy may be shortened by 5-15 years.
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Diabetes: A Pandemic
• Rates in Canada almost doubled over past decade.
• Over 20 people diagnosed every hour.
• 2.7 million Canadians diagnosed with diabetes in 2010.
4.2 million by 2020
• Nearly 1,000,000 people have diabetes & don’t know it.
• 5.4 million have prediabetes.
• 1 in 4 Canadians living with diabetes or prediabetes. If
nothing is done, by 2020, it will be 1 in 3.
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The cost of diabetes in Canada
• $11.7 billion spent in 2010, to rise to $16 billion by 2020.
• Complications from diabetes account for 80% of cost.
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Diabetes management: a daily challenge
• Diabetes management is not just about medications/insulin and supplies
• It is a constant struggle to manage/juggle/plan and adjust medications, physical activity, etc. in order to remain healthy
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The numbers
• Fewer than half of Canadians with type 2
diabetes are at the recommended A1C target
5.6 7.8 12.9 5.4 11.7 6.2
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The personal price of diabetes
• Nearly 60% of Canadians say they do not comply
with their prescribed therapy because they cannot
afford it.
• Less access to public or private insurance means
greater out-of-pocket costs.
• Reaching a breaking point for those living with the
disease.
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Why is diabetes important to consider?
• Among the top 10
causes of disability
worldwide.
• Over 50% of type 2
diabetes could be
prevented or delayed
with healthier diet &
more physical activity.
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Diabetes in the workplace
• Investment into health and wellness programs will reduce sick leave and absenteeism & support strong plan member productivity and retention.
• Support of wellness programs makes good business sense.
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Being part of the solution
• Provide opportunities for employee education and engagement.
• Take a holistic approach to health and wellness and develop workplace policies that promote health.
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Questions? | Connect with us!
• diabetes.ca
• 1-800-Banting (226-8464)
@DiabetesAssoc
Facebook.com/CanadianDiabetesAssociation
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Workplace Wellness Benefits
any Business
Driving the Wellness Agenda for
your Customers
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Agenda
• Why Health & Wellness matters
• Initiating the Health & Wellness conversation
• Information gathering and resource options
• Putting a plan together
• Questions
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Before we get started remember…..
• We are here to help
• Value added = no cost tools and resources
• You don’t have to be an expert
• You don’t have to remember all of this
• Awareness is the key
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Diabetes Obesity
Cardiovascular Disease
Cancer
Mental Health
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Are your customers interested in promoting a culture of wellness in their workplace? Should they be?
Workplace productivity is being impacted by: Absence of key plan members due to illness
Distracted plan members whose family members are ill
Decreased resiliency among those who have to fill in the gaps
Inability to attract and retain skilled plan members
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Do you know what workplace wellness means to your clients?
• Decreased rate of absenteeism
• Fewer sick days
• Decreased amount of health/insurance claims
• Improvement of worker’s performance and productivity
• Lower employee turnover rate
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Why should workplace Health & Wellness be important to you, the Advisor?
• Proactive is much more desirable than reactive
• Clients health and wellness is important to the bottom line
• Increase your ability to engage new business
• Increase your ability to retain existing business
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The Basics: Helping your client develop a simple Health & Wellness program
Assessment Planning Implementation Evaluation
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Key points to remember
• Don’t underestimate what your clients already have
• Help your clients gain an appreciation for where they are and where they want to go
• A comprehensive strategy may not be needed
• Take a practical approach
• Okay to start small
• Little or no budget is not a problem
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Start at the beginning: Gathering the facts…
Utilize value added tools to help clients
Data to help clients analyze and strategize.
• GroupNet reporting
• Organizational Health Risk Assessment
• Industry specific reports
• Health and Wellness Activity Report
• Personal Health Risk Assessment Aggregate Report
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Health & Wellness Resources What’s out there?
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Providing plan members with a reliable Canadian source for health information
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Our Health and Wellness Site
• Community Resources
• Interactive Tools
• Drug, Condition, Test/Procedure databases
• Health Features
• E Newsletter
• Reliable Canadian content built for GWL
• Helps identify health risks and build action plans
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www.workplacestrategiesformentalhealth.com
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Community health resources
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Employee & Family Assistance Plans (EFAP)
Contact: GWL & Shepell-fgi
• First Chat
• Video-counselling
• Manager Consultations
• Proprietary secure network
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We Need to be Serious: Why Does Mental Health Matter?
• 1 in 5 Canadians
• Co-morbidity of mental health conditions is a big issue
• 60% of disability claims have a mental health component
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Mental Health Resources
Great-West Life Centre for Mental Health in the Workplace:
• Public domain
• Increase knowledge and awareness
• Help turn knowledge into action
• Recent accomplishments – Managing Mental Health Matters & National Standard for Psychological Safe and Healthy Workplaces
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www.workplacestrategiesformentalhealth.com
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• 2012 National Ipsos Reid Survey
on psychological health and safety in the workplace
• National Standard of Canada for Psychological Health and Safety in the Workplace
• Centre Resources target survey results and national standards
Supporting Psychological Health and Safety
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Healthy Workplace Month
www.healthyworkplacemonth.ca
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Key Take Aways
• We are here to help
• No cost resources and tools are available
• Communication and education is paramount
• Mental Health issues drive productivity loss, absence and disability
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Addressing Health and Wellness is vital to you and your clients
There are tools and resources to help with:
• Asking the questions
• Gathering the information
• Putting a plan together
Be the “go to” proactive advisor for your clients
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Thank you for your time!
Questions?
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DrugSolutions From yesterday, to today,
to tomorrow…
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Discussion
• Meeting your needs for your clients (Education & Cost Management)
• How is DrugSolutions working?
• What can be expected next? Why?
• Practical tips to help strengthen your advice
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The Basis for DrugSolutions: Our Dual Bottom Line
Balancing the health needs of plan members
and
the cost management needs of plan sponsors
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Better savings than expected
• New amendment factors, April 2013
• Conversion opportunity
LOW request for brand forms
End Result
• Material savings for plan sponsor
• Very small impacts to plan
members
Enhanced Generic Substitution
4% savings
0.4% impact
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Health Case Management
• Savings on new claims
• Collaboration with doctors and patients on lower cost therapies
• Follow-up vs. one and done decision
25% savings
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Average Savings from Designated Pharmacy
• Have only begun rolling out
to existing claimants
• <40% of pharmacies
manage specialty drugs
• Expanding to Prior
Authorization drugs
5% savings
Health Case Management
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Health Case Management
Overall satisfaction with Health Case Management team “Extremely satisfied”
Personal touch makes a difference
“Overall they seem genuinely
concerned …they are sympathetic
and helping with my condition”
– A Thankful Wife:
88% “Extremely satisfied”
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Pharmacy Network Value Plan
• Over 800 Sales as of March 2013
• Maximum Value Pricing available June 2013
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800+ sales
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Acute/Maintenance/Specialty Formulary
• Efficient use of healthcare dollars (true insurance)
• One size doesn’t fit all
• Specialty drugs aren’t a problem if there are no claims
• Problem comes with an 80% coinsurance on a $50,000 claim
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$10K Out of Pocket
$0
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Therapeutic Class Pricing
• Picking up where Health Canada left off
• Reimbursement limits for specific therapeutic classes
• Additional cost management
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2.5% savings
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Maximum Savings, Maximum Value
• 4% Enhanced Generic Substitution
• 25% Health Case Management
• Up to 15% Pharmacy Network Value Plan (Costco)
• Up to 23% Acute/Maintenance/Specialty Formulary
• 2.5% Therapeutic Class Pricing
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Cost management is a necessity. Health management remains an opportunity.
Cost & Health – Our Dual Bottom Line
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Diabetes Drug & Supply annual Cost = $275M*
Diabetes related cost due to lost productivity = $9.6B**
*Telus block of business **Canadian Diabetes Association, “Get Check Now” , March 2011
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Employer Perspective – Health Outcomes
• Your clients understand the value of promoting and supporting health outcomes BUT
• Do they have the time?
• Do they have the expertise?
• Do they have the money?
• Do they know where to begin?
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• Top group carrier
• Innovation leader
• Dual bottom line focus
• Top retail pharmacy brand
• Convenient & national
• Clinical service programs in Pharmacy
Supporting healthier outcomes together
Together “helping plan sponsors and plan members manage costs and improve health outcomes”
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Two unique programs. One unique approach.
1. Diabetes Support Program
2. Medication Counselling Program
One Approach:
• Proactive plan member outreach
• Turn-key solution for the average plan sponsor
• NO cost
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Diabetes Support Program
1. GWL writes to plan member
2. Plan member books appointment
3. Dedicated call centre team
4. Plan member visits pharmacist
5. Plan member feedback
6. Reporting
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The plan member experience
• A1C testing
• Lifestyle counselling
• Information kit
• Follow up appts booked, as required
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Program Goals:
• Access
• Adherence
• Education
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Medication Counselling Program
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• NOT generic substitution
• Call centre pharmacist will counsel patients on medication alternatives
• Plan member and plan sponsor savings
• Lower out of pocket cost can improve adherence
**Program only applies to existing Shoppers Drug Mart patients
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Cost
• Generic substitution
• Maximize days supply dispensing
• Support medication reviews
Health
• Adherence management
• Lifestyle counselling
• Minor ailment assessment
Pharmacist & Benefit plan management
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What you can tell your clients
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Medical costs: two to three times higher than those without diabetes. Direct plan sponsor costs : $1,000 to $15,000 a year.
More than claims management: working to support plan members living with diabetes. Managing costs while improving health – Our dual bottom line in action!
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Drug Plan Performance Report
• Putting solutions into action
• Created to present detailed drug information to clients
• Fast, easy and free
• Allows you to focus on advice
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Drug Plan Performance Report
• Annual drug claims experience – 3 years
• Claims statistics by age
• Claims cost breakdown – ingredient cost and dispensing fee
• Brand vs. Generic drug claims
• Top therapeutic class spending
• Acute, maintenance and specialty drug spending
• Overview of drug plan design
• Plan savings – enhanced generic, dispensing fee limits, etc.
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2013 DrugSolutions
• Diabetes Support Program – Shoppers Drug Mart
• Enhanced Prior Authorization
• Designated Pharmacy for prior authorization drugs
• Acute / Maintenance / Specialty Formulary
• Therapeutic Class Pricing Feature
• Pharmacy Network Value Plan
• Maximum Value Pricing (Costco Option 3)
• Drug Plan Performance Report
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In Closing
• Today’s drug plans are not sustainable
• New management techniques are needed
• We support you in providing solutions to your clients
• Together we’re balancing health needs of plan members and cost needs of plan sponsors
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Panel
• Barbara Martinez, Practice Leader, Benefits Solutions
• Tara Besant, Director, Pharmacy Benefits
• Ben Harrison, Manager, Group Strategic Relationships
• Dr. Dorian Lo, Executive Vice President, Pharmacy & Healthcare, Shoppers Drug Mart
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