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Ask the Canadian Expert

Cherri Burdeyny, CEBSManager, Information Management & Plan Administration

Alberta School Employees Benefit PlanEdmonton, Alberta

12D-1

Agenda

• Benefits Past and Present

• Plan Challenges

• Reshaping the Future

• Interactive Discussion

12D-2

Benefits Past and Present

12D-3

Tools and Support

PAST:• Paper-based communication• Limited interaction• Telephone, face-to-face

PRESENT:• Mobile apps, online claims access• Internet, live chat• Mobile devices

(gamification, contact lenses)

12D-4

Plan Member Relationship

PAST:• Parental: “we know best”• Benefit plans were costs• Challenged to cover everything

PRESENT:• Partner in health: benefit plan is an investment• Shared responsibility• Optimal health is key

12D-5

Health Provider Relationship

PAST:• Interaction left to TPA• Front-line communicator of our coverage details• Unsympathetic to providers’ realities• Transaction-based

PRESENT:• Spokesperson for our collective vision• Value-added services, integral to our success • Allies…if interested

12D-6

Plan Challenges

12D-7

Benefit Plan Pressures

Dental Costs

New Drug Costs

Formulary Creep

LowInterestRates

Employees Living Longer

Medical Inflation

Weak Audit Controls

Medication Non-Adherence

Generic Pricing

Reductions

Special Authorization

Process

Increased Employee

Engagement

Patent Cliff

ENVIRONMENTAL FACTORS

12D-8

Industry Environment

• Working in silos

• Stagnant engagement

• Technological and chemical advancements

• Reluctance to change

• Legal and regulatory requirements

• Government need to offset

12D-9

Demographic Environment

• Multigenerational– Differing health needs

– Meaningful communication

• Family structure• Higher education• Instant gratification

12D-10

Reshaping the Future

12D-11

Leaving the past behind in order to reshape the future…

12D-12

Benefit Plan Philosophy

PAST:• Thirty year journey• Prescriptive plan design approach• “Fire-proof” the plan

PRESENT:• More strategic• Various lenses: health impact, risk of not covering• Outcome-focused• Investment vs. cost

12D-13

Plan Management Readiness

DoNothing

Provide Nothing

Absorb Shift Contain Eliminate

How much? Where?Strategy? What?

12D-14

Data and Analytics

• Embrace “big data”– Cross sectional

– Adherence levels

– Disease states

• Know your VOI– High Cost/Questionable Therapeutic Value?

• Offer mobile health, drug and dental apps– Dual purpose (gather data; share knowledge)

12D-15

More Creative Plan Solutions

• Preventative dental• Therapeutic drug pricing

substitution• Enhanced special authorization• Step therapy solutions• Tiered Coinsurance• Maintenance medication

strategy• Product pricing agreements

Los Algodones: Dental Centre of Mexico!

12D-16

Strategies for Sustainability

• Managed health care plans

• Adherence focus

• Compensation for value-added services

• Abandon ”one size fits all”

• New responsibility matrix

• Redefined Strategic Partnerships

12D-17

Interactive Discussion

12D-18

OPPORTUNITYEN

GA

GE

COLLABORATEPLAN CHARTER

STRATEGY

PHILOSOPHY

WHOWHAT

KNOW YOUR PLAN

WHERE

HOW

12D-19

Thank you!

12D-20