Get creative in making space for new technologies in benefits plans

Rapid changes in Health, (digital health) in the U.S. are mirrored around the globe. Canada is making a uniform change and analysis of additions to their health system and adjusting benefits accordingly, using the hard test of time prior to funding.

It’s an exciting time for group benefits in Canada. That’s not a phrase you hear every day, but it’s one that’s coming up more and more often.

Terms like “digital health” and “disruption” are new words to the Canadian benefits vernacular. All of a sudden, it seems like a new digital health startup launches every day and incubators, accelerators and labs are popping up everywhere.

Over the past decade, health plans at all levels in Canada have become much better at managing costs. Employer health plans increasingly require proof of value before covering a new medical service or pharmaceutical product. The challenge, however, arises when the item under consideration is genuinely new and innovative. As difficult as it is to assess a new prescription drug, evaluating a service unlike anything currently offered can be nearly impossible. By definition, a service that has only existed for two years can’t have demonstrated a long-term return on investment. As a result, good ideas and new technologies face implementation delays.

But what does it all mean for group insurance? What will these new services, startups, innovation labs and disruptors really do to change how plan sponsors and employees manage their health and insurance?

Where to find help?

Consultants seeking solutions amid disruption, competition . Printable pdf

Pharmacogenetics: Personalized medicine is one of the great developments in health care. It has begun to arrive, and pharmacogenetics represent one of the first ways in which we see personalized medicine becoming available to group insurance plans.

Read: Pharmacogenetic testing a growing area as pilot projects, research get underway

Telemedicine: Access to prompt medical advice is one of the most commonly cited shortcomings of the Canadian health-care system. Due to an apparent gap in the definitions under the Canada Health Act, provincial plans generally don’t cover remote or virtual access to physicians. There are now multiple providers of the service on a per-visit or annual subscription basis. For employers, the potential time savings to their employees are significant. Is covering an on-demand video call with a doctor or nurse not more cost-effective than an employee taking time off work to wait at a clinic or in an emergency room?

Pharmacists: The idea of pharmacists doing more than simply dispensing pills by providing value-added services, such as coaching for patients with chronic disease, has been a solution waiting to happen. After years of discussion, the idea has yet to take hold. Why is that? Pharmacists will offer the services if employer benefits plans provide reimbursement. Employer benefits plans, in turn, are open to covering those services once there’s a proven track record of added value.

Read: Pharmacists’ role evolving to help plans manage costs

Gene therapy: The ability to alter someone’s genes to cure a disease (or eliminate the risk of developing one) will soon be a reality. How will benefits plans handle a genetic treatment for a disease, such as cancer, that someone is at risk for but doesn’t yet suffer from?

Health coaching and navigation:Unfortunately, most Canadians don’t get enough time with public health professionals either to stay healthy or get help, when they fall sick, in navigating the system efficiently. As a result, wellness, coaching and navigation alternatives are growing fast, often using technology to personalize and automate the services and thus drive down the cost and improve employee health at the same time.

Virtual care: In-person care has historically been the default way to see a health practitioner. But what if, instead of seeing a psychologist in person for $150 per hour, plan members could treat their mental-health issue by using a cognitive behavioural therapy app on their phone? Is that not worth paying the $60 annual subscription to access it? Despite the potential, most benefits plans haven’t developed a framework to assess the value of or reimburse virtual care.

Read: A look at video health-care visits as an option for plan sponsors

Health-care spending accounts: New entrants into the group insurance market have sparked a growing debate recently about the role health-care spending accounts could and should play in benefits plans. Given the predictability of many kinds of expenses covered (such as paramedical services, dental recall exams and vision care), the concept of a health-care spending account as the primary source of coverage, with adequate real insurance for catastrophic expenses, is a valid structure to consider.

Medical marijuana: For a variety of reasons, information on both the therapeutic value and cost effectiveness of marijuana in a benefits plan is often still anecdotal. Would a plan that covers medical marijuana see an increase or a decrease in overall costs? For whom and under what circumstances could it be a benefit that outweighs the cost?

When looking at whether to add a new plan feature, employers don’t need to offer it at 100 per cent coverage or to all employees and under all circumstances. Being creative in merging new solutions with established ones will differentiate those plan sponsors that are willing to embrace change and use technology to engage employees in their health.Get creative in making space for new technologies in benefits plans | Benefits Canada