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Benefits 2019 – Is your plan stuck in a time warp?

Benefits 2019 – Is your plan stuck in a time warp?

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There have been amazing advances in technology that go well beyond asking Alexa for the date the plan will cover your next dental check- up or pair of glasses. Technology has changed the best practices for the treatment of many diseases and the accommodation for many disabilities and reduced costs of the best-in-class solutions. But even though these new practices can significantly improve the quality of life for Canadians, insurers – in the name of cost containment or protecting the tax status – aren’t moving quickly to embrace them.

Recently I assisted with a claim for a plan member who required an artificial limb. The plan was happy to cover the cost of the prosthesis that was in excess of the amount the government would pay — up to the limit of the cost of a hook! Does that really enhance their quality of life? In this age of electronic limbs that can assist with the activities of everyday life while making an individual feel less stigmatized, is it reasonable to cover only the most antiquated piece of equipment available?

Experimental treatments
As another example of putting progress on hold, benefit plans specifically exclude coverage for “experimental treatments” or “off-labelling”, which is the use of a drug that has been approved by Health Canada to treat a condition not approved by Health Canada. This seems short-sighted to me. Seriously ill plan members could elect to participate in those “experiments” which are usually already funded in part by drug companies, sharing some of the cost with insurer plans. In some cases this may lead to a return to health, avoiding a death claim. Members of plans who refuse to cover such treatments have to turn to options like GoFundMe as an alternative to benefit plans – often with financially positive results.

New treatment protocols
McMaster University announced in 2016 that with their protocol (using a combination of oral medications, insulin and lifestyle therapies to treat patients intensively for two to four months) they were able to put Type 2 diabetes in remission. As Type 2 diabetes is at the top of medical conditions driving health costs today, shouldn’t insurers have been lined up to have this protocol introduced to all their Type 2 claimants? Insurers could probably cover the expense of bringing the patient to the treatment or the treatment to the patient and still come out ahead in the longer term.

Stem cells
In other countries, stem cell transplants are being explored as treatments for illnesses such as Parkinson and MS, two seriously disabling illnesses. Although successful trials have been completed with stem cell transplants, I have not yet heard of an insurer suggesting stem cell transplants as a way to avoid a Long Term Disability claim. In addition to saving claims dollars, these amazing medical advances are impacting quality of life for disabled individuals and their families. Maybe this is just another experimental treatment opportunity (see above) however, support from insurers for treatments of this type might not only avoid LTD claims, but could also reduce drug claims as current treatments for MS for example are in excess of $30,000 per year.

Canada is struggling in many locations with a shortage of physicians. We are a small population spread over a giant territory, so it shouldn’t surprise anyone. The urban centres where the doctors tend to congregate have high demand for services, resulting in long wait times in doctors’ offices and emergency rooms. As well, several barriers contribute to the difficulty rural and remote areas have in retaining physicians, including a heavy workload, professional isolation, and limited career options. The advancement of on-line doctors is an amazing breakthrough for many, such as parents dealing with sick children. With stress being a top driver of illness and absence from work, a service such as this that brings peace of mind should be of great value to insurers and plan sponsors alike. On-line doctors’ visits are available under a subscription model on an optional basis, but the cost is not covered under benefit plans.

Mental illness
The doctor shortage is not limited to physicians who treat physical illnesses. Mental health specialists are also overwhelmed by the potential case load. CAMH (the Center for Addiction and Mental Health) reports 1 in 5 Canadians are struggling with mental illness. This is an area where innovation has moved quickly. Apps have been developed to support individuals with a variety of psychological illness and several insurers have advanced telemedicine for early intervention including it in the benefit plan coverage. This is a great application of innovation. As these services will help mitigate disability claims and contribute to employee wellbeing, more plans should include coverage for, and promote awareness of, these tools.

Marijuana products
Marijuana in various forms is already being used successfully to treat multiple conditions, including MS, epilepsy and Crohn’s Disease. As few benefit plans cover medical marijuana, people are paying out of pocket. The insured treatments for these diseases on the other hand, cost thousands of dollars and are contributing to the poor experience of the insurer pools. According to “Medical marijuana in Canada – Statistics & Facts” on the Statistics Portal, the average amount of dried medical marijuana authorized per client in Canada between April 2018 and June 2018 was 2.1 grams per day. The same site indicates the price of medical marijuana is $6 to $13 per gram, depending on the strain. Given this, the cost of medical marijuana on average is less than $10,000 per year. Insurers are unwilling to add coverage for marijuana to plans, when it may be a cost effective alternative to approved pharmaceuticals and it may contribute to a better quality of life for patients.

Missed opportunities
Innovation is an incredible means to an end. The items cited above are just a brief summary of how innovation can contribute to the wellbeing of mankind. However, unless we are able to reconcile the options of today with benefit plan coverage we will miss opportunities to engage employees and shorten periods of absence and we will continue to contribute to negative attitudes toward benefit plans and insurers in general.

Make 2019 the year you consider what your plan can really do to support plan members in this century. Then message me to share the changes you’ve made!

Until then, stay healthy!