2015
THE SANOFI CANADA
HEALTHCARE SURVEY
C A N A D A ’ S
P R E M I E R
S U R V E Y
O N
Benefits 2020:
Shifting gears toward
health management
H E A L T H
B E N E F I T
P L A N S
CONTENTS
THE 2015 EDITION OF THE SANOFI CANADA HEALTHCARE SURVEY
THE SANOFI CANADA
HEALTHCARE SURVEY
CANADA’S PREMIER SURVEY
ON HEALTH BENEFIT PLANS
3
12
SECTION 1
PHILOSOPHY OF
HEALTH BENEFITS
SECTION 2
IMPACT OF
CHRONIC DISEASE
SECTION 3
16
22
31
THE WORKPLACE:
BRIDGE OR BARRIER
TO HEALTH?
SECTION 4
FUTURE FORWARD FOR
HEALTH MANAGEMENT
SECTION 5
RETIREMENT
CONUNDRUM
33
METHODOLOGY
34
ADVISORY BOARD
35
SANOFI GROUP
IN CANADA
Benefits 2020:
Shifting gears toward
health management
we approach the year 2020, analogies between time and
As
“20/20” vision come to mind—and when it comes to health
benefit plans, such comparisons are apt. Indeed, we are
especially excited to present the 2015 edition of The Sanofi
Canada Healthcare Survey. One of its key revelations is that
plan members and plan sponsors appear ready to see health
benefits in a new light.
Growing concerns over sustainability certainly spur the need for change. Equally
important is the growing awareness of health-driven solutions that can tackle
barriers to workplace health, such as chronic disease. This year’s survey shows that
more plan sponsors are seeking a deeper, multi-dimensional view of their health
benefit plan, trying to understand the connections between different benefits and,
ultimately, productivity. Employees also want to get involved in this space, stating a
willingness to engage in decision-making and offerings based on personal health.
Members of our advisory board—dedicated opinion leaders in the Canadian
health benefit industry—enthusiastically endorse this broadening of outlooks,
and provide insights for health management strategies. While benefits will always
help attract and retain employees, their greatest value lies in supporting workplace
productivity—and to do that we must refocus attention on health and well-being.
Sanofi is committed to partnering with all stakeholders to be part of a system
that cost-effectively delivers the best possible health outcomes while also improving
employee productivity. Our goal with The Sanofi Canada Healthcare Survey’s
18th edition is to convey the latest opinions around health benefit plans and offer
perspectives and practical tips that help plan sponsors and providers embrace
the tenets of health management—which is as much about the well-being of the
organization as it is about the well-being of the employee.
Danny Peak
Senior Manager, Private Markets – National
SANOFI CANADA
THANK YOU TO OUR 2015 SPONSORS !
DIAMOND SPONSORS
GOLD SPONSORS
P H I LO S O P H Y O F H E A LT H B E N E F I T S
Plan members are
satisfied … sort of
Plan members value their
health benefits but are
open to plans that are more
responsive to personal needs.
TAKE
AWAY
been consistent since the survey first
posed the question in 2006. Similarly,
93% of respondents believe their
health benefit plan meets their needs,
of whom 56% judge that it does so
extremely or very well. Health benefits
also continue to be an effective means
to attract and retain employees, as
PLAN MEMBERS
42%
35%
36%
44%
38%
42%
38%
41%
40%
42%
37%
37%
38%
n Good
36%
36%
39%
36%
40%
n Very good
39%
36%
n Excellent
43%
Quality of employer-sponsored health benefit plan
10%
0%
2006
2007
2008
2009
2010
2011
2012
16%
16%
11%
14%
17%
17%
21%
20%
19%
30%
20%
V
irtually all plan members are
positive about their current
health benefit plans, yet at
the same time almost two-thirds
prefer a plan design that is significantly
different from what’s typically in place.
What does this apparent contradiction
tell plan sponsors and their providers?
It suggests that member satisfaction
is not as black and white as it first
appears, and it’s time to look more
critically at how health benefit plans
are evolving—or not evolving, say
industry leaders on the advisory board
for the 2015 edition of The Sanofi
Canada Healthcare Survey.
First, the numbers: 94% of plan
members are positive when describing the overall quality of their health
benefits, with 58% describing them as
very good or excellent. This result has
SECTION
13%
SECTION 1
2013
2014
2015
BASE: All plan members (2015 n=1,504)
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
3
S E C T I O N 1 : P H I L O S O P H Y O F H E A LT H B E N E F I T S
77% of respondents say they would
not move to a job that did not include
health benefits (increasing to 85% in
Atlantic Canada and decreasing to
66% in Quebec).
When asked which statement most
closely describes their plan, 77% of
plan members selected “a traditional
plan that defines what is covered
and the levels of coverage” and 23%
selected “a ‘flex’ plan that allows them
to choose levels of coverage.” When
then asked which type of plan they
prefer, 64% of members opted for
the less-prevalent flex plan and 36%
opted for the traditional plan. As well,
almost all respondents (91%) agree
‘
group benefits solutions, at Health
Association Nova Scotia. “The question is, how do we as an industry create
a strategy to redesign plans that are
decades old for many of us?”
Plan members’ high satisfaction
levels can also contribute toward
a sense of complacency in benefits
management, warn members of the
advisory board. As a result, change
is generally a response to “burning
platforms” rather than evolving needs.
“Plan members are telling us there’s a
desire for flexibility and personalization, and the timing is right because
we’re seeing greater differences
between the generations and we have
Susan Belmore-Vermes, HEALTH ASSOCIATION NOVA SCOTIA
Plan members see great value in having a health
benefit plan, but they also want to have a voice in
decisions around what is covered. That’s a huge
challenge for plan sponsors, but perhaps this is an
opportunity and the time is right to make change.
‘
they would like to be able to choose
specific benefits that are best suited
for their current personal situation.
A separate survey of plan sponsors
indicates that 32% offer flex plans.
Larger employers (more than 500
employees) are more likely to do so
at 50%, followed by mid-size (34%,
101–500 employees) and smaller
employers (18%, up to 100 employees).
Plan members, meanwhile, are
consistent no matter the size of their
organization: approximately two-thirds
prefer a flex plan over a traditional plan.
“Plan members see great value in
having a health benefit plan, but they
also want to have a voice in decisions
around what is covered. That’s a
huge challenge for plan sponsors, but
perhaps this is an opportunity and
the time is right to make change,”
says Susan Belmore-Vermes, director,
4
this great ‘bulge’ of baby boomers in
the workforce right now. The ‘one-sizefits-all’ approach of traditional plans
doesn’t really suit this reality,” says
Marilee Mark, vice-president, market
PLAN MEMBERS
Would not move to a job that did
not include a health benefit plan
77%
Total
83%
British Columbia
Alberta
79%
Manitoba/
Saskatchewan
80%
Ontario
79%
66%
Quebec
Atlantic Canada
85%
0%
20%
40%
60%
80% 100%
BASE: All plan members (n=1,504)
development, at Sun Life Financial. As
well, plan members’ changing needs
do not necessarily point to added costs
for the employer. “For example, there’s
a growing interest in getting access to
resources and education,” says Mark.
Board members also point to a
potential sleeping giant: chronic disease. “Chronic disease in the workplace
is very prevalent and employers are not
paying attention to it. We can’t wait
for it to become a burning platform,”
notes Carol Craig, director of human
resources, benefits and pensions at
TELUS. (For more on the impact of
chronic disease, see page 12.) l
PLAN MEMBERS
Current type of health benefit plan versus preferred
n Traditional plan (defines what is covered and the levels of coverage)
n Flex plan (allows plan members to choose levels of coverage)
23%
36%
Current plan
Preferred plan
77%
64%
BASE: All plan members (n=1,504)
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
IT’S ALL CONNECTED
A HEALTHY WORKFORCE MEANS A HEALTHY BUSINESS
Our 360° approach to health management improves healthcare
quality and reduces costs. And we constantly build on it to help
employees live healthier lives.
We connect with your employees to keep them healthy.
Part of your ecosystem.
desjardinslifeinsurance.com
Desjardins Insurance refers to Desjardins
Financial Security Life Assurance Company.
Proud Partner of
S E C T I O N 1 : P H I L O S O P H Y O F H E A LT H B E N E F I T S
SECTION
TAKE
AWAY
The higher purpose of
health benefits
Employee reward, competitiveness or
core strategy—if plan sponsors had
to choose one to explain why they
provide health benefits, which would it
be? Not unexpectedly, they most likely
(at 39%) gravitate to the statement that
describes benefits as a form of reward
or compensation: “Benefits are a way
to reward and support employees and
we know employees appreciate them.”
Another 26% tend to view benefits as
essentially a cost of business: “We have
to offer benefits to be competitive with
other organizations in our industry
and/or region.”
Serafina Morgia, TOWERS WATSON
‘
‘
choose this statement: organizations
with more than 500 employees (43%),
unionized environments (40%), public
sector employers (40%) and organizations with wellness programs (38%).
Members of The Sanofi Canada
Healthcare Survey advisory board are
encouraged that 31% of plan sponsors
take this holistic view, and suggest
that all would be well served by such
an outlook. “Right now there is clearly
a disconnect between traditional
plans and what will be required in the
workplace due to chronic disease. Plan
designs require more strategy along
Managing health becomes as important as
managing turnover, competitive compensation, etc.
And then there are 31% who make
the link between health and the
bottom line: “Healthier employees are
more productive employees; our health
benefit plan is one of our corporate
strategies to grow or improve our core
business.” Several factors characterize
plan sponsors that are more likely to
6
the lines of health and productivity,”
says Nathalie Laporte, vice-president,
product development, marketing and
strategy, at Desjardins. (For more on
the impact of chronic disease, see
page 12.)
The board also cautions that the
31% more likely reflects a desired
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
Plan sponsors want to
understand the connections
between drug, disability
and other claims data.
philosophy than today’s reality. The
current paradigm for plan design is
very traditional and decades old, and
clearly reflects a reward or compensation type model.
For example, recent Green Shield
Canada claims data reveal that
one of the fastest-growing benefits
over the past years is massages for
teenage girls. “Is that what we want
the fastest-growing costs to be if we
say we’re interested in managing
health and doing good things
around productivity? Have we
taught a generation of employees and
dependents that what they ‘need’ from
a benefits program is a regular massage
for everyone in their family, when what
they actually need could be a health
coach to prevent or manage a chronic
disease?” asks David Willows, vicepresident of strategic market solutions
at Green Shield Canada.
“Unless we change what plan designs
look like today, we’re not going to get
the health and productivity results
that we want,” agrees Serafina Morgia,
senior consultant at Towers Watson.
“We can reshape how to use benefits
dollars more effectively—for example, so that dollars can be put toward
health risk screenings. To do that we
would have to evolve the reward and
compensation type of model into more
of a risk management type of model.”
Such an approach addresses not
only the risks to individuals but also
to organizations. “Managing health
becomes as important as managing
turnover, competitive compensation,
etc. Investing in biometric screenings
can seem costly but early detection
of chronic conditions reduces the
risk of more drug costs and absences
down the road. Employers can create a
benefit plan that covers this and other
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
PLAN SPONSORS
Breakdown of those who said healthier
employees are more productive employees:
Plan sponsors’ views on why their organization provides
health benefits
40%
Benefits are a way to reward and support
employees and employees appreciate them.
39%
Healthier employees are more productive employees;
the health benefit plan is one of the corporate
strategies to grow or improve the core business.
31%
Have to offer benefits to be competitive with
other organizations in the industry and/or region.
20%
24%
Union/Non
40%
29%
Sector
40%
28%
27%
10%
26%
0%
types of health services that reduce and
manage health risks,” says Morgia.
Risk management also establishes
a context that’s more relevant for
decision-makers, including CFOs. “This
becomes a business issue, not something
that seems out in left field because it
has to do with healthcare,” says Chris
Bonnett, president of H3 Consulting.
10%
20%
30%
Private
Public
Non-union
Union
501+
4%
101 to 500
1 to 100
0%
Other
BASE: All plan sponsors (n=504)
30%
Company Size
43%
40%
Plan sponsors and providers can also
look for guidance based on examples
set in other areas, such as occupational
safety and pension funds. “When CAP
[Capital Accumulation Plan] guidelines
were established, plan sponsors had to
sit down and consciously write down the
purpose of their retirement savings plan.
And based on that purpose they built
objectives and methods of evaluation.
We don’t have the same requirements
in the group benefits world. Without a
clearly articulated purpose and objectives it’s difficult to effectively manage
a plan, especially in a rapidly changing landscape,” says Lisa Callaghan,
assistant vice-president of product and
group benefits at Manulife. l
PROFILE: BENEFITS IN MOTION
Flex plan with a twist
As a design and software firm,
and funding for public transportation
Macadamian is all about the “user
or a parking pass. Employees can also
experience.” The company of 100
allocate credits to retirement savings.
employees in Gatineau, Quebec, has
If employees exceed coverage limits,
the system automatically notifies them
(by email, at this point) and the differ-
The fitness allowance starts with $400
ence is deducted from their pay. So
taken that to heart internally as well,
annually for all employees. “The com-
far, plan members have rarely exceed-
with a benefit plan that’s built upon
pany’s founders are into fitness them-
ed their chosen levels of coverage;
personal preferences and the latest
selves, and want to encourage that
instead, Bastien says “they seem happy
in technology. Its ability to do so
in employees,” says Virginie Bastien,
to see that we are so generous. By ask-
demonstrates that plan sponsors of
director of HR.
ing them to make conscious choices,
all sizes can get creative with win-win
benefit offerings.
Struck by the changing needs of its
Enrolment is online, and last year
they really see that they are getting the
the company’s design team worked
most value from their benefits.”
with the benefits provider to build and
An annual employee survey helps eval-
employees, many of whom have been
launch a mobile platform. They are now
uate the plan and Macadamian receives
with the company since its start in 1997
working towards apps that give access
detailed reports on utilization patterns.
and are now raising young families,
to benefit-dollar balances and send
Employees’ satisfaction levels increased
Macadamian decided to replace
texts about benefits and health tips.
from 80% to 87% after just two years, and
its traditional benefit plan with a flex
“Our employees travel a lot so having
last year the company added critical ill-
plan—with a few twists. In addition to
access to group insurance information
ness insurance for all employees. The plan
the usual buckets for prescription drugs,
where and when they need it is very
is “definitely an attraction and retention
extended health, dental and health
important. And mobile access is really
strategy,” adds Bastien. “When we do
spending accounts, Macadamian’s
a necessity considering our core
offers to employees and tell them about
flex plan includes a fitness allowance
business,” says Bastien.
our benefits, they’re always amazed.”
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
l
7
S E C T I O N 1 : P H I L O S O P H Y O F H E A LT H B E N E F I T S
Benefits
outside
the box
Just under half of plan sponsors
(42%) anticipate making changes
to their plan design in the next two
years. Large employers (52%) are more
likely than small employers (34%) to
make changes, as are plan sponsors
with wellness programs (52%).
Interestingly, when asked why
they anticipate making changes, plan
sponsors almost equally pointed to the
need to better reflect the utilization
patterns and needs of employees (51%)
as they did to the need to reduce or
better manage costs (50%). The desire
to add or expand offerings is also a
motivating factor for 38%. As well, 37%
expect to invest more per employee
on health benefits within the next five
years, increasing to 43% among plan
sponsors with wellness programs. Just
5% anticipate spending less (leaving
52% who will spend the same and 5%
who do not know).
On the plus side, the results indicate
that plan sponsors are looking at more
than costs when it comes to chang-
‘
SECTION
results and when you consider the level
of activity today,” says Anne Nicoll,
vice-president of health and disability
management for Medavie Blue Cross.
“Yet it is important that more plan sponsors start making changes to plans now
in anticipation of what’s coming in terms
of chronic disease and other trends.”
“We need to start converting
benefits and health promotion into a
single strategy over the next few years
to protect benefit plan sustainability,”
says Chris Bonnett of H3 Consulting.
It starts by stepping outside the traditional benefits box and looking more
broadly at the costs of chronic health
Ben Harrison, GREAT-WEST LIFE
We need to identify the obstacles before we
can overcome them, and what feeds into this
is deeper data analytics.
‘
ing plan designs. The consideration
of utilization and needs can guide
decision-making toward changes that
address health and productivity, note
members of the advisory board.
On the other hand, not enough plan
sponsors are contemplating change
in the first place. “Overall there is no
sense of urgency when you look at these
8
issues. “Studies suggest these costs are
meaningful and that, more importantly, they’re manageable and preventable. Insurers and consultants can
help change the way employers look
at their benefits and encourage more
active management,” says Bonnett.
Carriers, benefits consultants or
advisors and brokers are vital to that
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
TAKE
AWAY
The potential for benefits to
support health and productivity
is largely untapped; the time is
right to close that gap, urges
the advisory board.
evolution. “We can see a desired shift
toward supporting employees more
on health and wellness, but until the
components are better defined, it’s
hard to move beyond the focus of
traditional plan design. We need to
identify the obstacles before we can
overcome them, and what feeds into
this is deeper data analytics,” says Ben
Harrison, director of group strategic
relationships at Great-West Life.
Perhaps the first obstacle to overcome is a fixation on drug costs only.
“One of the biggest problems is we look
at benefits in silos, and drug benefits
are trapped in perhaps the biggest
silo of all. We make decisions based
on silos instead of taking a strategic
approach,” says John McGrath, senior
vice-president, human capital practice
leader at Willis Canada.
“There are a lot of mixed messages
about drug costs, and people don’t
know what to do with the information.
More needs to be done to interpret
the information in order to make
informed decisions based on the company’s strategies and health outcomes,”
adds Steve Semelman, CEO of
Gemini Pharma Consultants. l
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
A NEW PHARMACY
BENEFITS LANDSCAPE
REQUIRES A
NEW APPROACH
Welcome Dr. Laureen Rance
to the new role: Director of
Pharmaceutical Relations.
With over 20 years of health
care experience, Dr. Rance, in
her role as Manulife’s Director
of Pharmaceutical Relations, will
work directly with pharmaceutical
manufacturers to help ensure your
plan members continue to have
access to valuable and innovative
drugs, with the right support,
at an affordable cost.
Dr. Rance’s appointment is one
more reason you can count on
Manulife to deliver forwardthinking solutions to help you
manage your prescription drug
plan costs.
To learn more about our pharmacy
solutions, contact your Manulife
representative today.
S E C T I O N 1 : P H I L O S O P H Y O F H E A LT H B E N E F I T S
Knowledge, a powerful “benefit”
Marilee Mark, SUN LIFE FINANCIAL
Company size
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
n Somewhat agree
Total
22%
1 to 100
18%
76%
52%
101 to 500
26%
501+
27%
0%
54%
20%
70%
68%
94%
51%
40%
Company size
Company size
How their organization’s health benefit plan
affects health outcomes, productivity and
absenteeism in their workforce.
1t
101 t
78%
60%
80% 100%
Their organization’s claims data.
Total
76%
1 to 100 18%
52%
Canadian
healthcare system,
and70%
in
light of the challenges that are coming
500
26%
due101
totochronic
disease and 68%
an aging 94%
workforce, we know there is much
51%
501+
work still
to be27%
done,” says
David 78%
Willows of Green Shield Canada.
40% 60% 80% 100%
Providers0%that20%
address
plan
sponsors’ growing interest in the
integration—and interpretation—
of data will have a competitive
advantage, adds the board.
“Employers generally think
Total 17%
45%
62%
providers
and consultants
are doing
a pretty good job. We need to take
1 to 100 16%
36%
52%
advantage
of these good
working
relationships to get to the next
15%
60% and 75%
101
500
level
oftoinformation
sharing
understanding how programs work,
68%
18%
50%
and can501+
potentially
be improved
to be more effective,” concludes
0% 20% 40% 60% 80% 100%
Telena Oussoren,
manager of
benefits for Suncor Energy. l
Company size
Company size
10
n Strongly agree
45%
17%
1 to 100 16%
501+
36%
52%
15%
101 to 500
60%
18%
0%
62%
75%
68%
50%
20%
40%
60%
80% 100%
The connections between their organization’s
drug claims, disability claims and utilization
of other services (such as the EAP).
Total
19%
1 to 100 15%
42%
101 to 500
26%
501+
21%
0%
49%
20%
68%
57%
57%
75%
54%
40%
83%
60%
80% 100%
BASE: All plan sponsors (n=504)
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
Company size
‘
100%
Plan sponsors would like to
have a better understanding of…
100%
It’s encouraging that plan sponsors are looking
for more information in these areas. It tells us
there could be an appetite to do more, which
54%
we really haven’t seen before. Total 22%
Yet when questioned about
possible approaches to evaluate the
utilization of benefits, a majority
of plan sponsors or employers
consistently agreed they would like
a better understanding of:
100%
•how their health benefit plan
affects health outcomes,
productivity and absenteeism
(76%);
•the connections between drug
expenditures, disability claims
76%
andTotal
other22%
services54%
such as the
EAP (68%); and
1 to 100 18%
52%
•their
organization’s
claims70%
data in general (62%).
101
to 500
26%
68%
94%
Mid-size
employers (101–500
employees) are especially eager for
27%
78% a
more501+
knowledge:
94%51%
would like
better understanding of the impact
20% 40% 60% 80% 100%
on health0%outcomes,
productivity
and absenteeism; 84% want to
PLAN SPONSORS
Company size
‘
know more about the connections
between claims; and 76% would
like a better general understanding
of claims.
“It’s encouraging that plan
sponsors are looking for more
information in these areas. It tells
us there could be an appetite to
do more, which we really haven’t
seen before,” says Marilee Mark
of Sun Life Financial.
These results also caution against
a false sense of security. “Plan
sponsors say they like their carriers
and their advisors, but if we think
more globally about our role in the
Company size
Plan sponsors say they’re happy
with their providers and not many
are planning to change carriers or
advisors in the near future—yet a
notable majority also want more
from their current relationships.
Nine out of 10 plan sponsors
(92%) indicate they’re satisfied with
their insurance carriers, although
only 29% are very satisfied. Eightyfive percent say the same about
their benefits consultant, advisor
or broker, their employee assistance
program (EAP) provider and their
occupational health provider (if
these are applicable).
1 to
101 to
5
RESEARCH NEWS: IMPACT OF ADHERENCE
short-term disability for depression, as
compared to 3.5% of the nonadherent
claimants. For those adherent claimants
being treated for hypertension, 1.0%
were on short-term disability for
cardiovascular reasons, as compared
to 1.3% of the nonadherent group.
The cost of adherence was calculated
on average to be between $101 and $198
annually for hypertension and depression, respectively. The rates of nonadherence for all conditions were extrapolated
based on the following figures:
•71% of claimants living with one
or more chronic conditions did
not fill their prescriptions at the
correct intervals in order to receive
Breaking down the silos
between drug and disability
the maximum benefits from their
medications;
•23% discontinued their therapy
after the first filling of the
According to an analysis of drug and
For long-term disability claims, these
disability claims for 38,000 Canadian
same conditions, minus pregnancy
employees over a three-year period,
complications, accounted for 64% of
plan members with chronic conditions
spending and 66% of days lost.
who take their medications as
prescription; and,
•4 % discontinued their therapy too
soon after initially being adherent.
Among employees with one or
prescribed may be less likely to take
more chronic conditions, including
disability-related leaves of absence.1
hypertension, high cholesterol, diabetes
with how to address the challenges that
or depression, those who took their
come along with managing the impact
Overview
medications as prescribed (i.e., were
of chronic disease on benefit plans,”
Within drug claims, 10 disease states
adherent) had 17% fewer short-term,
says Ben Harrison, director of group
accounted for 59% of spending:
and 15% fewer long-term, disability
strategic relationships for Great-West
diabetes, hypertension, depression,
claims than employees not taking
Life. “What’s really exciting about this
dyslipidemia (high cholesterol), asthma,
their medications as prescribed
analysis is it has the potential to start
rheumatoid arthritis, ulcers, Crohn’s
(i.e., were nonadherent).
to help employers more effectively
disease/colitis, cancer and bacterial
infections.
Within short-term disability claims,
“Many employers are concerned
direct their limited resources to services
Adherence vs. nonadherence
like adherence or chronic disease
Unfortunately, rates of adherence
management programs, because
six conditions accounted for 61%
among employees living with one
they’re able to see the value these
of spending and 63% of days lost
or more chronic conditions are
programs can have on real-world
due to disability claims: muscle or
poor, ranging from a low of 45% for
claims data.”
bone inflammation/spasm, cancer,
depression to a relative high of 58%,
depression, bone fractures, neurologic
for hypertension.
pain or nervous system disorders, and
pregnancy complications.
Of those adherent claimants being
treated for depression, 2.6% were on
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
l
1.Integrated Analytics Initiative: Summary of Key
Findings. Cubic Health, Great-West Life, Sanofi
Canada. Analysis of drug, short-term disability
and long-term disability data sets for 38,000
Canadian employee claimants, 2010-2012.
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
11
SECTION 2
I M PAC T O F C H R O N I C D I S E AS E
Sicker than we seem
12
for the 2015 edition of The Sanofi
Canada Healthcare Survey.
“If an employer discovered that
almost 80% of their older workforce
had these conditions, would they
PLAN SPONSORS
Plan sponsors who know the “top”
disease states in their workforce
n Strongly agree
n Somewhat agree
Total 14%
Company size
F
orty-five percent of plan
members report being told
by a physician that they have
one or more chronic diseases such
as diabetes, arthritis or depression.
When high blood pressure and high
cholesterol are added to the list—two
chronic conditions that often lead
to or are associated with certain
diseases—the number of employees
living with chronic health conditions
climbs to 56%.
Not unexpectedly, age is a contributing factor. Seventy-eight percent
of plan members aged 55 and older
say they have at least one chronic
condition, dropping to 52% among
those aged 35 to 54, and 42% among
employees who are 18 to 34 years old.
Nonetheless, the rates of prevalence
across all ages are high enough to
warrant closer attention from plan
sponsors, stresses the advisory board
1 to 100 6%
31%
101 to 500 11%
34%
27%
501+
0%
37%
45%
38%
25%
BASE: All plan sponsors (n=504)
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
48%
34%
50%
65%
75%
not be compelled to act?” asks Chris
Bonnett, president of H3 Consulting.
“Insurers and advisors can help
employers better understand the
health and workplace conditions that
affect their workforce. We can help
employers understand the magnitude
of the problem.”
“Employers underestimate the
prevalence of chronic disease in their
workplaces and they underestimate
the positive impact they can have on
employee health,” notes David Willows,
vice-president of strategic market
solutions at Green Shield Canada.
For their part, plan sponsors
estimate that 26% of their workforce
have a chronic disease or condition
such as high blood pressure, diabetes
or depression. While these numbers
fall short of employees’ reports, they
reflect an important perceptual reality.
Among employers, 26% may actually
seem high because the perception is
that the majority of employees are at
work and appear to be healthy, notes
the board. Yet many chronic diseases
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
claims to see that,” adds Ben Harrison,
director of group strategic relationships
at Great-West Life.
‘
Currently, not quite half of plan
sponsors (48%) know the top disease
states in their workforce and only 14%
Dr. Alain Sotto, TORONTO TRANSIT COMMISSION & MEDCAN WELLNESS CLINIC
Right now, there is this big disconnect between health
benefits, wellness and chronic disease management.
How does the workplace offer programming in all
three of these areas? We have to look at all three in
combination because they’re intertwined.
‘
are “silent” and as a result employers
underestimate their impact on productivity over time.
Mental illness, such as depression or
anxiety, is the most prevalent chronic
disease according to surveyed plan
members (18%), followed by arthritis
(14%), and asthma or other chronic
lung conditions (9%). Respondents
who are 55 and older are more likely to
have arthritis (27%) and diabetes (12%
versus 8% across all ages), and far more
likely to have the related conditions
of high cholesterol (34%, compared
with 19% for all ages) and hypertension (33% versus 16%). (For more on
prevalence rates, see “Sobering reality
of chronic disease,” page 14.)
“In the last couple of years, we’ve
been seeing the need for more chronic
disease management coming to the
forefront, but our industry has been
almost singularly focused on highercost specialty drugs such as biologics.
Now the numbers on chronic disease
are starting to stare us in the face and
we as providers have to move that
conversation forward,” says Willows.
“Chronic disease is not a contained
issue, it is an organizational issue.
You only have to look at your drug
By making the connection between
an organization’s claims data and
its top disease states, providers can
help plan sponsors understand the
unintended consequences that costcutting can have on health outcomes,
stresses Dr. Alain Sotto, occupational
medical consultant at Toronto Transit
Commission (TTC) and director of
Medcan Wellness Clinic. “Right now,
there is this big disconnect between
health benefits, wellness and chronic
disease management. How does the
workplace offer programming in all
three of these areas? We have to look
at all three in combination because
they’re intertwined.”
strongly agree with this statement.
Employers with more than 500
employees are far more likely to know
(64%) than those with up to 100
employees (37%). “Providers should
be able to supply reports that tell
plan sponsors their drug utilization
SECTION
TAKE
AWAY
Plan sponsors underestimate
the prevalence, and hence the
possible impact of chronic
health issues in the workplace.
profiles and top disease states
while still protecting plan member
confidentiality,” notes Pierre Marion,
senior director of sales and business
relations at Medavie Blue Cross. l
TM
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
13
S E C T I O N 2 : I M PAC T O F C H R O N I C D I S E A S E
RESEARCH NEWS: PREVALENCE RATES
among those aged 18 to 39. Among
those who are aware they have the
condition, 30% have brought their cholesterol levels under control and 21%
continue to have unhealthy levels. 4
Diabetes
Ten percent of Canadians aged 20 and
older have diabetes5 and another 22%
have prediabetes. If current trends continue, one in three Canadians will have
diabetes, prediabetes or undiagnosed
diabetes by the end of this decade.6
Mental illness
Eleven percent of Canadians aged
20 and older have mood disorders
and/or anxiety.7 One in five will experience a mental illness in his or her
Sobering reality of chronic disease
lifetime, and approximately half of
those who feel they have suffered
from depression or anxiety have not
Fifty-eight percent of adult Canadians
take drugs to treat hypertension or
have at least one chronic disease
high cholesterol, you are less likely to
or condition, according to a 2013
have a stroke or heart disease.”
consumer survey by the Canadian
seen a doctor for treatment.8
Additional research reports the
Foundation for Healthcare Improve-
following details on some of the most
ment. 2 That’s up from 37% reported in
common chronic conditions.
2007. Respondents were most likely to
indicate they have arthritis (22%) and/
High blood pressure
or heart disease (including high blood
It’s estimated that 52% of Canadians
pressure, 22%), followed by a mental
aged 60 to 79 and 24% aged 40 to 59
health condition (16%), a respiratory
have hypertension. Among them, 68%
condition such as asthma (14%) and
take medication and their blood pres-
diabetes (11%).
sure is controlled, 12% take medication
Forty-eight per cent of plan
sponsors know the top disease
states in their workforce,
underlining the need for better
interpretation of claims data.
SECTION
TAKE
AWAY
As prevalence rates climb, drugs are
but their blood pressure is not controlled, 4% do not treat their hypertension and 16% are unaware they have
the condition.3
High cholesterol
increasingly important components
Fifty-nine percent of Canadians aged
of treatment. “We have better drugs
60 to 79, 40% aged 40 to 59 and 23%
today to control chronic diseases and
aged 18 to 39 have unhealthy cho-
risk factors, so more people are able
lesterol levels, or dyslipidemia. It’s
to stay in the workplace,” says Dr. Alain
estimated that half are unaware they
Sotto of TTC and Medcan. “When you
have the condition—jumping to 86%
14
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
l
2.Canadian Foundation for Healthcare Improvement. 2013 Health Care in Canada Survey.
POLLARA, December 2013–January 2014.
3.Statistics Canada Health Fact Sheets.
“Blood Pressure of Adults, 2012 to 2013.”
Canadian Health Measures Survey, 2012 to
2013. Catalogue no. 82-625-X. Accessible at
www.statcan.gc.ca/pub/82-625-x/2014001/
article/14101-eng.htm.
4.Statistics Canada Health Fact Sheets.
“Cholesterol Levels of Adults, 2012 to 2013.”
Canadian Health Measures Survey, 2012 to
2013. Catalogue no. 82-625-X. Accessible at
www.statcan.gc.ca/pub/82-625-x/2014001/
article/14122-eng.htm.
5.Public Health Agency of Canada. Chronic
Disease and Injury Indicator Framework Quick
Stats. Chronic Diseases and Injuries in Canada
2014:34(4). Accessible at www.phac-aspc.gc.ca/
publicat/cdic-mcbc/34-4/assets/pdf/CDIC_
MCC_Vol34_4_12_CDIIF_eng.pdf.
6.Canadian Diabetes Association. Canadian
Diabetes Cost Model. Toronto, May
2014. Accessible at www.diabetes.ca/
getmedia/513a0f6c-b1c9-4e56-a77c6a492bf7350f/diabetes-charter-backgroundernational-english.pdf.aspx.
7.Public Health Agency of Canada. Chronic
Disease and Injury Indicator Framework Quick
Stats. Chronic Diseases and Injuries in Canada
2014:34(4). Accessible at www.phac-aspc.gc.ca/
publicat/cdic-mcbc/34-4/assets/pdf/CDIC_
MCC_Vol34_4_12_CDIIF_eng.pdf.
8.Canadian Mental Health Association. “Fast
Facts about Mental Illness.” Accessible at
www.cmha.ca/media/fast-facts-about-mentalillness/#.VQ2y2mTF-V8.
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
Almost half of plan members (44%)
with chronic conditions told their
immediate managers or supervisors,
and 82% report their managers
were supportive afterwards. In fact,
43% describe their managers as very
supportive. “It’s extremely positive that
eight in 10 managers were supportive
of the individual when personal
health information was shared. That’s
something that should be leveraged,”
says Ben Harrison of Great-West
Life. “These results suggest that
people don’t have to deal with their
health challenges alone, and given
the opportunity, managers can be an
important part of the support system.”
The high level of support may be
an indicator of trust levels, says Anne
Nicoll, vice-president of health and
disability management for Medavie
Blue Cross. “Perhaps employees choose
to tell their managers because they
already know they will get the support.
If they don’t feel the support is there,
they’re not going to tell.”
Results differ based on the
condition. While plan members with
a mental illness are likely to disclose
their condition (42%), they report
a somewhat lower level of support
(76%, with 37% saying managers
are very supportive). Plan members
with heart disease are somewhat
more likely to disclose their condition
(54%) but, as with mental health
conditions, describe a somewhat lower
level of support (76%, although they
also report a higher level of managers
being very supportive, at 52%).
Plan members with high cholesterol
are less likely to disclose their
‘
SECTION
TAKE
AWAY
Management training may
be beneficial to appropriately
support employees with
chronic conditions.
Medcan. Indeed, the World Health
Organization estimates that 60%
of all cases of heart disease and
40% of strokes are due to elevated
cholesterol levels.9
Among those who did not disclose
their condition, most did not do so
because they feel their condition does
not impact performance (49%) or it is a
Anne Nicoll, MEDAVIE BLUE CROSS
Perhaps employees choose to tell their managers
because they already know they will get the
support. If they don’t feel the support is there,
they’re not going to tell.
‘
Employees
willing to share
health status
condition (38%). Those that do,
however, report the highest level
of support (88%, with 51% of
managers being very supportive).
“Plan members and employers often
overlook high cholesterol because it
doesn’t impact performance. But it
is a major risk factor that can lead
to heart disease and stroke, which
are very costly for plan sponsors,”
says Dr. Alain Sotto of TTC and
personal matter (45%). Far fewer were
concerned about general perceptions in
the organization (14%) and the impact
on advancement (10%); however,
these numbers jump to 26% and 20%,
respectively, for plan members with a
mental illness, and 29% and 19% for
those with heart disease. l
9.World Health Organization. The World Health
Report 2002. Reducing Risks, Promoting Healthy
Life. Geneva: WHO, 2002:97.
PLAN MEMBERS
Did plan members tell their immediate manager/supervisor about their chronic health condition(s)?
Plan members who told their manager/supervisor about their chronic condition had:
66%
Cancer
61%
Diabetes
n Yes
n No
Heart disease/heart attack
44%
54%
49%
Arthritis
Asthma or chronic lung disease
56%
46%
Hypertension/high blood pressure
43%
Depression, anxiety or other mental health problems
42%
High cholesterol
BASE: Plan members who have chronic condition (n=822)
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
38%
0%
25%
50%
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
75%
15
SECTION 3
T H E WO R K P L AC E : B R I D G E O R BA R R I E R TO H E A LT H ?
Universal quest for better health
I
n the 2015 edition of The
Sanofi Canada Healthcare
Survey, a clear majority of
plan members (85%) state having one
or more health or fitness goals—and
21% feel the workplace is a barrier to
reaching those goals.
Eating healthier foods is the number 1
goal of respondents (57%), followed by
achieving a certain weight (43%), getting
more sleep (41%) and reaching a certain
fitness level (30%). Employers should
make special note of how important
sleep is to employees, states Dr. Alain
Sotto, occupational medical consultant
at Toronto Transit Commission (TTC)
and director of Medcan Wellness Clinic.
“Sleep is a big determinant of health and
wellness, and we’re not just talking about
feeling well rested so you can put in a
good day’s work. Sleep apnea is linked
with obesity, hypertension, diabetes,
coronary artery disease and strokes.”
When asked how their workplace
affects their ability to reach their goals,
16
38% of respondents described their
workplace as supportive, 41% said it
is “neutral” and 21% described it as a
barrier. Not unexpectedly, employees
who describe themselves as overwhelmed or overcommitted during
PLAN MEMBERS
Plan members with personal
goals for their health or fitness
85%
Any goals (NET)
Eat healthier foods
57%
Achieve a
certain weight
43%
41%
Get more sleep
Reach a certain
fitness level or goal
Reach a certain
body fat percentage
Reach a certain
BMI number
Other
No such goals
30%
13%
11%
2%
15%
0% 20% 40% 60% 80% 100%
BASE: All plan members (n=1,504)
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
most days are more likely to indicate
their workplace is a barrier (33%).
Among those who describe their
workplace as supportive, the reasons
are roughly split between work site
programs (23%), an on-site gym or
membership discount (20%), and
the availability of time due to flexible hours or adequate breaks (17%).
Interestingly, although eating healthier
is the most common goal for employees, only 5% spontaneously cite the
availability of healthier foods as a way
in which their workplace is supportive.
Lack of time, including long or
inflexible work hours, is by far the
biggest reason given by plan members
who describe their workplace as a
barrier to personal health and fitness
goals (46%), followed by a heavy or
stressful workload (26%). Ten percent
of all respondents also blame their
desk job or too much sitting, a result
that increases to 16% among those in
administrative positions. l
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
SECTION
TAKE
Wellness programs in a rut?
Organizational wellness offerings,
such as programs for weight loss
and stress management, are a
tangible way for employers to support
the health and overall well-being of
employees—yet their availability and
use appear to have plateaued.
Forty-five percent of plan sponsors indicate offering such programs,
virtually unchanged from when the
question was first asked in 2012 (47%).
Meanwhile, 30% of plan members say
their employers offer wellness programs, a finding that has see-sawed
between 23% and 43% since the
question was first posed in 1999 (38%).
This year’s gap between plan sponsors
and plan members is likely due in part
to a lack of awareness—22% of plan
members say they do not know if their
employers are active in this area.
Large, unionized and public sector
employers do, however, appear to be
more active. Seventy-two percent of
plan sponsors with more than 500
employees report offering wellness
programs, compared with 52% of
mid-size employers and just 23% of
small employers (up to 100 employees). Sixty-four percent of unionized
environments and 61% of public
sector employers provide wellness
programs, versus 35% and 39% among
non-unionized and private sector
work sites.
When it comes to participation, only
11% of employees say they definitely do
so on a regular basis, and another 23%
“kind of” or somewhat regularly participate. These levels have been generally
consistent since the question was first
asked in 2008 (when 13% definitely and
27% somewhat regularly participated).
Interestingly, the greater availability
of programs in large, unionized and/
or public sector sites does not translate
into greater participation:
AWAY
•Only 8% of plan members working for
large employers say they definitely
participate, compared with a high of
21% among employees working for
mid-size organizations.
•Those working for large employers
are most likely not to participate at all
(31%), compared with a low of 15%
among those in mid-size organizations.
•Unionized or public sector plan members
are also more likely not to participate
at all (36% and 32%, respectively).
Age and health status also play
their part. Forty-five percent of 18to 34-year-olds definitely or somewhat
regularly participate, versus 30% of
those aged 35 to 54 and 31% of those
aged 55 and older. Unfortunately,
less than a third (30%) of employees
with poor or very poor health
The workplace can clearly
help—or hinder—the
achievement of employees’
health and fitness goals.
participate—even worse, 39% do
not participate at all.
When asked to choose from a series
of statements to describe how they
feel about their workplace wellness
programs, 51% agreed they are
“great” whether or not they personally
participate, and 33% indicated they
try to participate in things of personal
interest and are happy with their
participation rates. Sixteen percent
said they would like to participate
but their job or workload prevents
them from doing so. Only 12%
reported they are not interested
in the programs, 5% said they are
uncomfortable participating, and
almost none (3%) indicated that the
attitudes or behaviours of managers or
co-workers discourage participation.
(For more on the future of wellness
programs, see “Step back to move
forward on wellness,” page 22.) l
Feeling better not quite its own reward
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
Eighty-one percent of plan sponsors agree they need to offer incentives
to encourage employee participation in programs or activities related
to health, and 30% actually do so. Size is definitely a factor, with results
climbing from 14% among small employers to 39% among mid-size and 47%
among large employers.
When asked to select from a list of possible incentives offered, plan sponsors
most often selected financial incentives (33%), awards or recognitions (32%),
and prizes such as tickets to sporting events (25%). Nineteen percent also tie
incentives directly to increased benefits coverage, such as contributions to
health spending accounts. Social incentives—for example, team competitions
or fundraising for charities—can also be powerful motivators, suggest members
of The Sanofi Canada Healthcare Survey advisory board.
Personal digital or online tools are a growing opportunity to incentivize
employees, the board adds. Currently, 32% of plan members say they’ve used
at least one such tool—such as personal fitness tracking devices (12%), smartphone apps (11%) or websites that track personal progress (10%)—in the past
year. On the employer side, 16% indicate offering the use of free or loaned personal tracking devices. “This is an area to expand upon because use of these
tools will only go up,” says Ben Harrison of Great-West Life.
l
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
17
S E C T I O N 3 : T H E W O R K P L AC E : B R I D G E O R B A R R I E R T O H E A LT H ?
Many feel overwhelmed—and health suffers
Forty-one percent of plan members
report feeling overwhelmed or
overcommitted on most days due to
work, personal lives or a combination
of the two. A number of telling
variations emerge:
•Employees who describe their health
as poor or very poor are far more likely
to feel overwhelmed (58%) than those
who say their health is excellent or
very good (29%).
•Regionally, employees in Ontario are
most likely to feel overstressed (46%),
compared with 31% in Atlantic Canada.
•Younger (18- to 34-year-olds, 48%) and
middle-aged (35- to 54-year-olds, 46%)
plan members are much more likely than
their older counterparts (55 and older,
26%) to feel overwhelmed.
Now let’s consider that the plan sponsor survey reveals that 87% of employers
believe their overall culture promotes
wellness. In answering this question,
are plan sponsors speaking to wellness
programs such as fitness challenges or
sessions on stress management? If so, the
availability of such programs—45%—
falls far short of what one would expect
based on 87% of plan sponsors indicating that their culture promotes wellness.
(For more on the availability and use
of wellness programs, see “Wellness
programs in a rut?” page 17). Does this
result therefore also speak to strategies
or policies that address the day-to-day
work environment? According to this
year’s survey of plan members, the
answer is, at best, “maybe”—and more
likely “no” among those who feel overwhelmed or who are in poor health.
For example, keeping in mind that
good health includes taking breaks
to eat proper meals and recharge the
mind, the survey found that almost
half of employees (47%) continue to
work while eating their lunch. This
jumps to 66% among employees who
feel overwhelmed. Men (51%) are
more likely to work while eating than
women (43%), and again employees
under 55 are far more likely to do so
(52%) than those 55 and older (35%).
Twenty percent also report that their
current job or workload has caused
them to regularly eat unhealthy foods
or snacks—increasing to 43% among
SECTION
TAKE
AWAY
Employees in poorer health require
more targeted supports, since
they are less likely to participate
in traditional wellness programs.
those in poor or very poor health, and
to 33% among employees who feel
overwhelmed.
These numbers should be a cause
for concern, notes the advisory board.
“Employers believe they are doing
really good things, whether in wellness
programming or by offering flex
time to promote work-life balance,
but when you look at that against
the number of people eating lunch
at their desk and who report being
overwhelmed, employers may want
to consider whether there could be a
disconnect,” says Telena Oussoren,
manager of benefits for Suncor Energy.
What about the ability to keep
appointments directly related to health,
or meet personal commitments for recreation or physical activities? Nineteen
percent of plan members report that
their current job or workload has caused
them to cancel or reschedule appointments with healthcare professionals,
climbing to 31% among those in poor or
PRO FILE : HEALTH CULTURE
Wellness in three parts
important are the results that are more
difficult to quantify. “You can see employees feel better about themselves, and
“I started with the wellness program three years ago and have benefited in many
ways. [My coach gave me] an exercise program and diet that helped me lose
approximately 25 pounds. I had also taken on a new job that was filled with new
challenges. I have learned how to [manage stress and] maintain a healthy work
and personal life. I am truly appreciative!” —Employee testimonial
this benefits our culture. It creates a family
feeling at work.”
When asked what advice he would
give to other employers, Harrison boiled
the wellness equation down to three
components:
Six years after launching its wellness
seen a 30% reduction in sick leave,” says
program, London Hydro couldn’t be
Jeff Harrison, manager of health and
1. Bring in the experts
happier with the results—and momen-
safety for the London, Ontario-based
From the get-go, London Hydro hired an
tum continues to build. “Since 2009, we’ve
company of 330 employees. Equally
independent wellness firm, which works
18
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
Employers can
take better
measures
PLAN MEMBERS
Plan members feeling
overwhelmed most days
n Strongly agree
n Somewhat agree
Total 10%
31%
Sixty-one percent of plan sponsors
41%
with wellness programs create or
British Columbia 8%
29%
Alberta 8%
27%
Region
Manitoba/
Saskatchewan 3%
Ontario
34%
13%
32%
23%
43%
31%
12%
36%
35-54 11%
35%
18-34
55+ 6%
20%
Excellent/Very
Good/Good 8%
Poor/Very Poor
29%
18%
0%
45%
34%
Atlantic Canada 8%
Age
35%
31%
Quebec 9%
Personal
Health/Fitness
37%
48%
46%
26%
20%
40%
58%
60%
BASE: All plan members (n=1,504)
very poor health and 30% among those
who feel overwhelmed.
Employees who feel overwhelmed are
also more likely to be late for or miss
personal recreational activities (23%,
compared with 13% overall) and to
reschedule or cancel plans for physical
activities (19% versus 12%). l
your workforce and measure, measure, measure to make sure you get
what you’re paying for,” says Steve
Semelman, CEO of Gemini Pharma
Consultants.
“Metrics are key to determining the
run the programs themselves, while
return on investment of any wellness
equal numbers work with their insur-
program, specifically linking health
ance carrier (28%) and/or a wellness
and disability data to health risk
provider (28%). Seventeen per cent
assessments and wellness initiatives,”
work with their benefits consultant,
adds Douglas Yep, senior director,
advisor or broker, and 5% draw support
total rewards, at Air Canada. “Achiev-
from their employee assistance pro-
ing such measurable metrics would
gram provider. As well, 20% indicate
encourage companies to include well-
their consultant, advisor or broker and/
ness at the core of their benefit plans,
or insurance carrier helped coordinate
for the benefit of both employees and
a wellness-based program in the past
the bottom line.” (For more on wellness
year, such as on-site flu shots or an
as a core benefit, see “Step back to
initiative tied to chronic disease.
move forward on wellness,” page 22.)
Only 25% of plan sponsors formally
The fact that the majority of
measure participation or outcomes of
employers create or run their pro-
wellness programs; another 55% “infor-
grams internally is likely a key reason
mally” do so. Among those that do,
why the measurement is not there,
whether formally or informally, tracking
notes the advisory board. Indeed, 72%
participation levels is by far the most
of respondents agree they would like
common measure (77%), followed by
better reporting or evaluation of the
the frequency of participation and
ROI of health and wellness programs.
participant surveys (both at 48%).
“Perhaps for carriers the opportunity
Twenty-five percent seek to determine
is to provide tools for plan sponsors to
the impact on absenteeism.
measure these programs that are run
37%
40%
You need to tailor your program for
internally,” says Ben Harrison, director
“The most important measures
of outcome are not there, and that
of group strategic relationships at
includes the impact on absenteeism.
Great-West Life.
l
based on health risk screenings, and
3. Take internal stock
committee of employees. “We could
aggregate results so far include reduc-
London Hydro also assessed its
not be at this level without them,” says
tions in cancer risk from 71% in 2009 to
work environment. “We are always
Harrison. The provider organizes events,
45% in 2014, and in high stress levels
looking for ways to improve our
employs health coaches and supplies
from 34% to 19%. Group programs and
culture,” says Harrison. Changes over
detailed reports to management.
events help employees reach personal
the last year include the renovation
goals. For employees working in the
of the cafeteria into an internet
2. Make it personal
field, the health coaches give presen-
café, with Chromebook computers,
In 2014, 97% of the company’s office
tations at health and safety meetings
televisions and, of course, a range
employees regularly participated
and regularly reach out with more of a
of healthy foods, a quiet room
in the monthly, one-on-one health
personal touch—for example, serving
where employees can relax and
coaching sessions. The coaches
fresh porridge with berries prior to the
an updated fitness centre that’s
develop individual wellness goals
start of the work day.
open 24/7.
with management and a volunteer
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
l
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
19
S E C T I O N 3 : T H E W O R K P L AC E : B R I D G E O R B A R R I E R T O H E A LT H ?
ADDED PERSPECTIVE: ACCOMMODATIONS
Workplace
supports
for chronic
disease
When 56% of the workforce report
having chronic health conditions—
increasing to 78% among employees
55 and older (see “Sicker than we
seem,” page 12)—what steps can
employers take to ensure their work
environment is not a barrier to personal health? Plenty, according to some
of Canada’s largest patient groups.*
Healthy foods, flexible hours
and alternate work arrangements
top the list of accommodations for
employees with chronic conditions.
To help employers provide the first
objective, Hypertension Canada
recently launched the 4 STAR
Food Environment program
(www.4starfood.ca), a step-by-step
guide to implement a healthy food
SECTION
TAKE
AWAY
Better measures are
needed to connect wellness
initiatives with benefits and
disability data.
policy (including, for example, the
renegotiation of vendor contracts).
Healthy foods are one thing; healthy
eating habits are another. Senior managers can walk the talk by taking regular
lunch and coffee breaks away from their
workspace. Dietitians caution that people who work while they eat tend to eat
more and enjoy food less, and are more
likely to crave unhealthy snacks later.
Flexible work hours, more frequent,
shorter breaks and the ability to
work at home can be important to
accommodate self-care routines,
the use of medications and medical
appointments. As well, a “quiet
room” in the workplace, with private
areas for those who need to rest, take
medication or use medical devices can
boost employees’ ability to manage
their conditions. l
* Hypertension Canada, Canadian Mental
Health Association, Canadian Diabetes
Association, The Arthritis Society
Additional suggestions to support chronic disease management:
•Raising general awareness of the growing
prevalence of chronic conditions and the
importance of lifestyle behaviours for
prevention and treatment.
•Stairwells that are well-lit, clean and
spruced up with artwork or greenery.
•Disposal receptacles for testing lancets and
injection needles used to treat diabetes.
•Stress management training for all employees.
20
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
•An ambulatory blood pressure monitoring
machine in on-site gyms or wellness areas.
•Heightened consideration of employees who work
shifts, since eating and sleeping at different times
affect hunger, fatigue and blood-sugar levels.
•For employees with arthritis, individualized
ergonomic workspaces and more frequent breaks.
•Implementation of the Canadian Standard for
Psychological Health and Safety in the Workplace
(www.mentalhealthcommission.ca/English/issues/
workplace/national-standard).
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SECTION 4
F U T U R E F O RWA R D F O R H E A LT H M A N AG E M E N T
Step back to move
forward on wellness
ith ongoing lack of awareness and lukewarm participation levels, especially
among people most in need—what’s
an employer with wellness programs
to do? Step back and start fresh, urge
members of the advisory board for
The Sanofi Canada Healthcare Survey.
“Employers and the industry have
been talking about the wellness
concept for 25 years,” says Susan
Belmore-Vermes, director, group
benefits solutions, at Health
Association Nova Scotia. “We believe
it’s important, but we continue to
struggle with putting programs in
place and increasing participation.”
Results reveal that younger, healthier people are more likely to participate in the programs currently
available (see “Wellness programs in
a rut?” page 17.) How do we reshape
wellness so it also motivates those who
likely need it more? Members of the
advisory board agree it’s time to view
wellness from a different perspective.
“We need to find out how to make
more employees part of the decision
to change their own behaviour,” says
Nathalie Laporte, vice-president,
product development, marketing and
strategy, at Desjardins.
A large part of the problem,
observes David Willows, vice-president
of strategic market solutions at Green
Shield Canada, is that “we have set up
What about
specialty drugs?
their carriers to provide more options
specialty pharmaceuticals, increasing
for coverage. As well, 64% feel they
to 42% among small employers (and
do not have enough information to
dropping to 22% among large employ-
understand the benefits of covering
ers). Among those that do, the most
Plan sponsors appear to be some-
these medications. Small employ-
common programs involve stop-loss
what ambivalent about the man-
ers (69%) are more likely than large
insurance (19%), annual drug plan
agement of claims for higher-cost
employers (58%) to feel they do not
caps (17%) or case management (16%).
specialty pharmaceuticals: 79%
have enough information.
As well, 17% of large employers use a
W
are satisfied with how their carrier
As well, 33% of plan sponsors indicate
preferred provider network for specialty
responds to these claims, yet virtually
they do not have a program in place
pharmaceuticals, versus 9% of small
the same number (78%) would like
to respond to claims for higher-cost
employers.
22
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
l
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
and address personal health risks
(see “What’s my risk? Members want
to know,” page 26).
“Companies already do risk management in other areas, such as occupational safety. If wellness were framed
in this way, perhaps it would get more
attention,” says Chris Bonnett, president
of H3 Consulting. Then, he adds,
‘
have a very important influence on both
risk and health.”
Providers can also collectively play
a stronger role. “It’s difficult to get to a
place where we can educate employers
on the right programs to offer and how
to be more strategic if there continues
to be a lack of clarity amongst industry stakeholders. As providers, we can
Nathalie Laporte, DESJARDINS
‘
a system where wellness is developed
outside of health benefits. It’s this
‘extra thing.’ If we were to start from
scratch today for plan design, I think
many of us would agree that things
like health coaching and adherence
programs should be right there with
reimbursing drugs and paramedicals.”
As with health benefits (see “The
higher purpose of health benefits,”
page 6), “the time is right to reframe
wellness into a health risk management strategy to engage employees’
participation,” suggests Art Babcock,
vice-president of Aon Hewitt. “As an
industry, we’re not having a strategy
discussion in general with employers, let
alone connecting the dots to personal
health risks and chronic disease.”
Past surveys consistently show plan
members’ high level of willingness to
participate in programs that identify
We need to find out how to make more employees
part of the decision to change their own behaviour.
“wellness becomes an organizational
responsibility that affects productivity.
Employers will see their role in improving the work environment and culture
as a foundation for a healthy and productive business. It’s not about blaming
‘unmotivated’ employees—employers
see this as an opportunity to lead the
charge to better define wellness and the
objectives that need to be in place in
order to determine strategy,” says Lori
Casselman, assistant vice-president,
practice excellence and innovation, at
Sun Life Financial. l
ADDED PERSPECTIVE: DEFINING WELLNESS
The right
benchmark for
wellness at work
from an employer’s goals and inter-
come across: “. . . one whose culture,
ests. So, wellness is often reduced to a
climate, and practices create an envi-
series of fitness and health education
ronment that promotes both employee
programs that are typically sporadic,
health and safety as well as organi-
not evaluated for need or impact, and
zational effectiveness.”11 This is short,
Wellness has been defined in many
not integrated with each other or with
simple, integrative and adaptable.
ways, but a general understanding
the organization’s strategy. Sometimes
Beyond a program or a slogan or the
is that wellness (sometimes called
wellness programs simply focus on the
best of intentions, this should become
well-being) is broader than health and
individual’s lifestyle—exercise, diet,
our benchmark for wellness at work.
usually includes a state of balance in
weight, smoking, alcohol, stress—and
Inherently then, wellness should
body, mind (emotional and intellec-
overlook the employer’s ability to influ-
be strategic and therefore sustained.
tual), spirit and social domains, with an
ence health through leadership and
It ought to focus on education and
emphasis on prevention and resilience.
management policies, programs, and
behaviour at all levels of the organiza-
It incorporates the quality of a person’s
practices. These latter factors create a
tion, and aim to improve the worker,
life as well as general life satisfaction. It
culture that employees interpret in order
the workplace and the employer. How
often means having a sense of purpose
to gauge levels of trust, fairness, respect,
does your workplace measure up?
and mastery over life. Importantly,
recognition and support. Lifestyle is
wellness is not the same for everyone:
certainly important but it is not sufficient
it includes subjective, perceptual and
to determine health and it does not exist
relative elements. Wellness is seen as a
in a vacuum. Beyond work, wellness is
continuum measured in degrees, rather
influenced at home, in the community
than a discrete condition.10
and by the broader environment.
In the workplace, that description
Based on many years of experience
probably seems ethereal and unattain-
in this field, the following definition of
able and may appear disconnected
a healthy organization is the best I’ve
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
l
—Chris Bonnett, president,
H3 Consulting
10.These key dimensions have been extracted from
the British Columbia Atlas of Wellness, First
(2007) and Second (2011) editions. Accessible at
www.geog.uvic.ca/wellness.
11.Lim S-Y, LR Murphy. The Relationship of
Organizational Factors to Employee Health
and Overall Effectiveness. American Journal of
Industrial Medicine 1999;36(Suppl):64–65.
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
23
S E C T I O N 4 : F U T U R E F O R WA R D F O R H E A LT H M A N AG E M E N T
Getting value for paramedicals
Plan members submitted at least
one claim for prescription drugs
(89%), basic dental care (82%) and
vision care (61%) in the past year—no
surprises there. When it comes to
frequency of claims, however, paramedical services come second after
prescription drugs—and while the
number 1 ranking for medications
is again no surprise, the high use of
paramedicals generates growing debate
over value and the need for controls.
Based on all respondents (including
those who did not submit a claim), the
average number of claims in the past
year was 8.6 for prescription drugs, 3.8
for paramedical services, 3.2 for basic
dental care and 1.5 for vision care.
When you remove those respondents
who did not submit any claims, the
averages increase to 9.5 for drugs, 7.3
for paramedicals (a much bigger jump
since 47% of respondents did not make
a single claim), 3.7 for basic dental care
and 2.2 for vision care.
Plan members in poor or very poor
health on average submitted 8.8 claims
for paramedical services, compared
with 6.8 from those in excellent or
very good health.
Massage therapy is the most popular
paramedical service (57%). Women
are more likely to use massage therapy (62% versus 52% for men), and
68% of claimants aged 18 to 34 receive
massage therapy compared with 45%
of those 55 and older.
These results for paramedical services,
and in particular massage therapy, generated much discussion among members
of the advisory board. For one thing,
their level of use signals the need for
greater scrutiny. It also brings questions
around philosophy back to the surface.
On the one hand, employees who are
light users of traditional benefits and
have few or no health issues perceive
paramedicals as “lifestyle” offerings
24
that help communicate that benefits are
a form of compensation or reward. On
the other hand, paramedical services
help make the connection to health and
productivity by being an effective part
of treatment for those with injuries or
chronic pain, for example. As well, carriers have begun to explore the role of new
paramedical offerings in chronic disease
management: Medavie Blue Cross, for
PLAN MEMBERS
Paramedical services used
in the last year
Massage therapy
57%
Physiotherapy
41%
Chiropractic
37%
Acupuncture
15%
Naturopathy
10%
Osteopathy
Other
0%
9%
3%
20%
40%
60%
BASE: Used paramedical services as a health benefit (n=769)
example, recently added asthma coaches
to its list of eligible providers.
No matter how plan members regard
paramedical services, the fact remains
that the frequency of use is coming
close to rivalling that of prescription
drugs among those who made at least
one claim. The time has come to
consider establishing criteria based
on objective, clinical measures (such
as proof of an injury) rather than
plan members’ self-perceived needs,
suggests the advisory board.
“If you want benefits to be
evidence-based, then why would you
give access to paramedicals to everyone? We have a lot of barriers to drugs
but we have almost zero barriers to
massage and other paramedicals,”
notes Steve Semelman, CEO of
Gemini Pharma Consultants.
“When you consider disability issues
and issues around specialty pharmaceuticals, which can be life-changing
for members, the cost and use of some
paramedicals just don’t seem to make
sense,” says Paula Allen, vice-president
of research and integrative solutions
at Morneau Shepell. “Perhaps it makes
more sense to first align investments to
the health supports that are most critical. Medications are at the top of plan
members’ lists for both utilization and
need. Mental health underlies all health
and productivity. Both are great examples of what needs to be well supported.
The more discretionary services within
the paramedical group are really more
aligned with the intent of a healthcare
spending account, and may be better
addressed there.” l
PLAN MEMBERS
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
One in five is a “heavy user” of benefits
Twenty percent of plan members
Number of annual claims
can be described as heavy users
of health benefits, submitting 31
or more claims annually across all
types of benefits. Almost half (48%)
make moderate use of their benefit
plan, submitting 11 to 30 claims,
and the remaining 31% submit no
1%
20%
31%
n Non-User (0)
n Light User (1-10)
n Medium User (11-30)
n Heavy User (31+)
more than 10 claims a year.
48%
Combined uses of any benefits; BASE: All plan members (n=1,504)
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
SECTION
Low uptake for health spending
“We have sessions on how to use
the HSA and what it can be used for,
but at the end of the day the people
who go to the sessions are those who
are already interested,” says Carol
Craig, director of human resources,
benefits and pensions at TELUS.
‘
AWAY
members’ expressed desire for
more flexibility and personalization
of benefits (see “Plan members
are satisfied . . . sort of,” page 3).
To that end, the advisory board
notes a growing trend to offer
taxable spending accounts that
John McGrath, WILLIS CANADA
At the end of the year, employers look at all of these
defaults for HSAs and ask what’s going on, but
what they probably haven’t done throughout the
year is continuously communicated to employees
what the benefit is all about.
‘
More than half of plan members
(57%) with health spending accounts
(HSAs) did not use them at all in
the past year, and those who did
used 50% on average of the funds
available. This level of use is not
unusual and some plans will see
levels closer to 40%, note members
of The Sanofi Canada Healthcare
Survey advisory board. Are the
results telling us that plan members
are uninterested in their HSAs?
Should plan sponsors reallocate
some of the unused funds to wellness
and health management initiatives?
What’s the right level of control or
management by employers?
Lack of awareness is a key factor.
“At the end of the year, employers
look at all of these defaults for
HSAs and ask what’s going on, but
what they probably haven’t done
throughout the year is continuously
communicated to employees what
the benefit is all about,” says John
McGrath, senior vice-president,
human capital practice leader at
Willis Canada. As well, eligible
claims can be restricted and plan
members can find the process
of using the fund too complicated.
TAKE
To reach higher-risk plan members,
plan designs can incorporate new,
wellness-oriented benefits such as
health coaching.
“We have to be cognizant of the
fact that everybody has so much
thrown at them and they’ll only
pay attention when it’s important
and relevant to them.”
Technology should eventually
improve utilization, as carriers will be
able to directly remind plan members of the funds available and the
deadline for submitting claims, note
members of the advisory board.
Employers are also exploring the
evolution of HSAs to address plan
plan members can use for products
and services not always covered
under HSAs, so long as they are
health-related.
Based on the survey of plan
sponsors, 32% of employers
offer HSAs, ranging from 19%
among small employers (up to 100
employees) to 25% among midsize (101–500) and 53% among
large (more than 500) employers.
Unionized environments are also
more likely (41%) to offer HSAs. l
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C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
25
S E C T I O N 4 : F U T U R E F O R WA R D F O R H E A LT H M A N AG E M E N T
What’s my risk? Members want to know
Year after year, plan members indicate a strong preference for health
risk screenings as a benefit offering.
When one considers the growing
prevalence of chronic disease, early
detection—and the possibility of
prevention—appears to be a logical
first step toward managing long-term
benefit costs (see “Impact of chronic
disease,” page 12).
Two years ago, 88% of respondents
to The Sanofi Canada Healthcare Survey
stated they would participate in on-site
screenings with healthcare professionals. Last year, the survey broke down
plan members’ willingness based on
disease state: 91% would likely participate in screenings for cancer risk, 89%
for heart disease, 84% for diabetes, and
75% for stress or mental health issues.
This year, health risk screenings
were one of seven possible new benefit
offerings related to health, fitness or
work-life balance. On-site screenings ranked first (45%) as the benefit
respondents would most likely use,
followed by on-site immunizations for
infectious diseases (40%) and fitness/
yoga classes (34%).
Seeking support
for elder care
arranging for medical or other services,
off for caregiving (62%), flexible work
and taking over regular tasks.
hours or compressed work weeks (59%)
possible new benefit offerings, employ-
Coverage for the costs of assisted-living
Employees with elder care responsi-
ees with elder care responsibilities put
services (45%) and coverage of mobility
bilities would appreciate assistance
“assistance with day-to-day care of
equipment (25%) came next on their
through their health benefits, yet plan
elderly parents” at the top of the list
wish list.
sponsors appear less inclined to expand
(49%), ahead of the number 1 pick for
their plans in this way.
total respondents (on-site health risk
paid days off for elder caregiving; on
screenings, 45%). Plan sponsors, mean-
the other hand, 44% say they already
and Caregiving, which surveyed more
while, are not very likely to consider
offer flexible hours or compressed work
than 25,000 employees, found that
expanding their benefit plan to accom-
weeks and 42% offer compassionate
9% of men and 15% of women provide
modate elder care—only 6% ranked it
care leave. Only 6% and 4% provide
elder care. The incidence is slightly
as their first consideration for expanded
coverage for mobility equipment and
higher in the 2015 edition of The Sanofi
benefits, well behind screenings (19%).
assisted living, respectively.
The 2012 National Study on Work, Life
PLAN MEMBERS
Plan sponsors appear to be aligned
with plan members. When presented
with the same list of possible additions
to their health benefit plan, employers
most likely rank on-site screenings
as their first consideration (19%),
PLAN SPONSORS
Future benefits: which ones would members/sponsors likely use/consider?
n Plan members (likely use)
n Plan sponsors (top 3 choices)
Health risk screenings with a healthcare professional to determine
personal risks for certain diseases on-site in the workplace
45%
50%
40%
35%
Immunizations for infectious diseases on-site in the workplace
34%
38%
Coverage for a series of fitness classes/yoga classes
29%
27%
Coverage for a personal fitness trainer
26%
25%
Coverage for assistance with day-to-day care of elderly parents
25%
Coverage for one-on-one health/wellness coaching
23%
For those with a chronic condition, one-on-one education sessions with a
pharmacist or nurse to better understand their medicines and health condition
None of these
0%
BASE: All plan members (n=1,504); All plan sponsors (n=504)
When asked to choose from seven
Canada Healthcare Survey, with 15% of
8%
10%
32%
31%
14%
20%
30%
40%
50%
and compassionate care leave (52%).
Employees providing elder care
Among plan sponsors, 18% provide
While plan sponsors may not wish to
plan members indicating they pro-
mainly seek more time rather than
change plan designs to accommodate
vide care for elderly family members,
financial assistance. When asked which
elder care, that does not mean they
climbing to 20% among those between
benefits would be most helpful, based
do not want to support employees,
the ages of 55 and 64. Care activi-
on a list of eight options, their top-three
state members of the advisory board.
ties include driving to appointments,
rankings most often went to paid days
For older workforces in particular, elder
26
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
Jury out on preferred providers
Will preferred provider networks (PPNs)
the end of the day, what matters to
play an important role in future plan
employees is how they benefit from
designs, or does experience show
the preferred provider arrangement,
they don’t deliver on expectations?
as opposed to how they can save their
Twenty-four percent of plan sponsors
organization money as a whole,” says
indicate their prescription medication
Godfrey Mau, pharmacy consultant,
plan includes a PPN of pharmacies,
group benefits, at Manulife.
ranging from 13% of mid-size employ-
Almost one in five (19%) states that
ers to 21% of small and 34% of large
their current provider needs to be part
employers. Pharmacy PPNs have been
of the network. Interestingly, those with
around for years, but low participa-
a chronic condition (22%) and those
tion rates have generally limited their
who describe themselves as being
‘
Godfrey Mau, MANULIFE
There’s an opportunity to look at PPNs from a
broader perspective—as more than just a cost-saving
measure, but also as an opportunity to establish
a stronger connection between plan members and
practitioners such as pharmacists and nurses for
health management purposes.
‘
followed by fitness/yoga classes
(13%) and immunizations (13%).
Screenings are ideal benefits
because “they reduce the risk of
much higher benefit costs down the
road through the early detection of
chronic diseases and risk factors,”
says Dr. Alain Sotto, occupational
medical consultant at Toronto
Transit Commission (TTC) and
director of Medcan Wellness
Clinic. He adds that today’s screening devices are also better suited for
on-site assessments.
Currently, 46% of large employers
indicate they partially (29%) or fully
(17%) cover health risk screenings
with healthcare professionals,
compared with 32% of mid-size
employers (10% fully, 22% partially)
and 29% of small employers (12%
fully, 17% partially). For immunizations, 62% of large and 63% of
mid-size employers already provide
full or partial coverage, compared
with 39% of small employers. l
ability to reduce costs through lower
in poor health (25%) are not that much
mark-ups and dispensing fees.
more likely to want to keep their
Some caution against mandatory
current provider.
PPNs because plan members could lose
“There’s an opportunity to look at
care support can be a point of
long-term relationships with pharmacists,
PPNs from a broader perspective—as
differentiation—and reduces the
which are important for health outcomes
more than just a cost-saving measure,
risk of losing valued employees.
and reduce the risk of medication errors
but also as an opportunity to establish
Community supports and other ser-
and drug-related adverse events. A sin-
vices are not always readily avail-
gle pharmacy also increases medication
able, and if the parent becomes
adherence because the pharmacy can
a safety risk then employees may
monitor refill rates.
be forced to quit their jobs or retire
SECTION
TAKE
AWAY
Plan sponsors can play a major role
in prevention and detection based
on employees’ strong support for
on-site health risk screenings.
On the other hand, plan members
early. Whether it’s the employer
themselves appear to be willing to
a stronger connection between plan
who should help address this of
join PPNs. Eighty-five percent say
members and practitioners such as
the government, the reality is that
they would use a PPN of, for example,
pharmacists and nurses for health man-
employees are facing this and we
pharmacies or physiotherapists, if it
agement purposes,” suggests Mau.
should not wait for it to become a
were part of their health benefit plan.
“The initial financial incentive still needs
bigger issue, stresses the board.
However, more than half (54%) qualify
to be there, for both plan members and
their participation by stating they
plan sponsors. But let’s say, for example,
assistance programs can also pro-
would personally have to save money,
plan members start to take medications
mote their existing navigation and
a result that climbs to 61% among
for complex or chronic conditions—the
support services. “These supports
those aged 18 to 34.
preferred provider network of health
Plan sponsors with employee
are not being used enough when
“These results speak to the need
professionals is already in place to pro-
you consider the level of need,” says
to develop PPNs that provide incen-
vide additional case management
Paula Allen of Morneau Shepell.
tives for employees to participate. At
and adherence support.”
l
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
l
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
27
S E C T I O N 4 : F U T U R E F O R WA R D F O R H E A LT H M A N AG E M E N T
SECTION
TAKE
AWAY
Uncertainty over cost-sharing
Year after year, plan members would
rather pay more themselves than
experience reduced levels of coverage
due to increased costs—yet this year
almost an equal number are not sure
what they would do.
Since 1999, The Sanofi Canada
Healthcare Survey has asked plan members what they would do if health benefit costs increased and their employer
was unable or unwilling to pay the
increase. Would they pay higher premiums to maintain the same levels of
coverage? Would they rather opt for less
coverage so that they would not have to
pay more in premiums? Or would they
prefer to pay a higher portion of the
cost (or higher co-pays) when they use
the covered products or services?
‘
the move to online data collection,
respondents saw a fourth option that
was previously recorded only when
volunteered as a response: that they
do not know. Since then, the strength
of opinion has steadily shifted
(although reduced coverage remains
the least-preferred option):
•In 2009, 43% preferred higher premiums, 23% preferred higher co-pays,
20% did not know and 14% were willing
to accept lower levels of coverage.
•In 2015, 31% prefer higher premiums,
30% do not know, 20% opt for higher
co-pays and 19% would consider
reduced levels of coverage rather than
having to pay more themselves.
Pierre Marion, MEDAVIE BLUE CROSS
While cost-sharing has its role in terms of
accountability, it can backfire when pushed too far.
Instead we need to consider strategies that ensure
everyone is getting full value from their benefits.
‘
Employees have consistently opted
for higher premiums first, higher
co-pays second and, at a distant
third, reduced benefits. In 2009, in
28
“The number of people who don’t
know what they would do keeps
growing and now it’s at 30%,” says
Jacques L’Espérance, president of
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
Getting better value must come
ahead of cost-cutting measures
that could have unintended
consequences.
J. L’Espérance Actuariat Conseil Inc.
And while the situation is hypothetical,
the perceptual trending over a 16-year
time frame indicates a growing sense
of uncertainty—a trend that could
reflect a growing awareness and use of
higher-cost specialty pharmaceuticals
(see “What about specialty drugs?”
page 22). “A lot of people do not know
what they would do and I believe many
employers are in the same boat. There
are no easy answers,” he says.
“The increased cost of healthcare is
a great concern for many employers,”
says Douglas Yep, senior director, total
rewards, at Air Canada. “Cost-sharing
fosters a more consumer-minded
thought process among employees and
moves them away from an entitlement
mentality.”
However, while 72% of plan
sponsors indicate they would like
their insurer to suggest additional
cost-sharing options for health
benefits, the advisory board cautions
against exploring this area without a
greater understanding of the possible
unintended consequences on health.
For example, higher out-of-pocket
costs directly correlate to rates of nonadherence to medications, which can
in turn lead to more costs to treat the
complications of unmanaged disease.
“While cost-sharing has its role
in terms of accountability, it can
backfire when pushed too far,” says
Pierre Marion, senior director of sales
and business relations at Medavie
Blue Cross. “Instead we need to
consider strategies that ensure
everyone is getting full value from
their benefits. Full value equals
positive outcomes, which means
you’re less likely to have to spend
more down the road. That’s where
we’re going to see the savings.” l
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
Workplace wellness programs can
save $251 per employee, per year.
(Sun Life-Ivey Canadian Wellness
Return on Investment (ROI) Study, Phase one)
Making Wellness Count
At Sun Life, health and wellness is about more than fu clinics
and ftness challenges. It’s a business strategy that keeps
healthy employees healthy and helps those at risk.
Our in-house wellness experts help you understand the
health issues facing your organization and implement targeted
programs to address identifed risks. And we take on the heavy
lifting, providing you with dedicated guidance and support every step of the way.
To learn more about Sun Life’s Health and
Wellness solutions, contact your
Sun Life group benefts representative or
visit sunlife.ca/healthandwellness.
Life’s brighter under the sun
Group Benefts are offered by Sun Life Assurance Company of Canada,
a member of the Sun Life Financial group of companies.
Our targeted solutions address:
• Mental Health
• Diabetes
• Heart Disease
• Weight Management
• General health and wellbeing
With Sun Life by your side, you’ll
be empowered to set and achieve
measurable healthy workplace
objectives. Your employees and
your organization will be all the
healthier for it.
S E C T I O N 4 : F U T U R E F O R WA R D F O R H E A LT H M A N AG E M E N T
Education part of cost management
Cost management continues to drive
changes to health benefit plans, yet
not all changes have to do with cutting
costs. That’s welcome news, say members of The Sanofi Canada Healthcare
Survey advisory board.
“When considering change, there
will always be some trepidation or
uneasiness about what to do, which
is why plan sponsors’ requests for
more information and data that is not
limited to a singular view are really
important,” says Lisa Callaghan,
assistant vice-president of product and
group benefits at Manulife. “Employers
are making new connections and providers would do well to keep moving
the conversation forward beyond cost
containment only.”
Sixty percent of plan sponsors say
benefit costs increased in the past
three years, of whom 12% describe the
increase as significant. When asked,
69% of plan sponsors reported making
at least one change to their plan in
the past two years—and their biggest
reason for making the change was to
reduce or better manage costs (47%).
Yet four of the five top changes did not
directly pertain to cost-containment:
1.Efforts to improve employees’ understanding and use of their plan (31%)
2.New communication methods (29%)
3.New wellness program or information on health (23%)
4.Mandatory generic substitution (22%)
5.Higher levels of coverage for nondrug benefits (13%)
Plan sponsors could be looking for
better management of costs rather than
reduced costs, notes the advisory board.
Health management may also be emerging as a common theme when you consider that the reasons for change include
the need to better reflect the utilization
patterns or needs of members (31%) and
a desire to add or expand offerings (24%).
Large employers appear far more
likely to take this broader view. While
all sizes had similar experiences with
increased costs, a relatively low 56% of
small employers made any changes to
their health benefits, compared with
82% of large employers. As well, large
employers were far more likely than
small employers to increase education
(44% versus 19%), expand communications (43% versus 15%) and launch
wellness programs (43% versus 8%). l
P R O F I L E : DATA A N A LY T I C S
Treating the patient, not the plan
years. A data analytics firm also began to
analyze drug, disability and other health
What do two physicians, two pharma-
dental problems. Hygienists would rec-
claims by disease state, starting with
cists, one dentist, one dental hygienist
ommend more frequent preventative
diabetes. Among the findings:
and representatives for the Alberta
scalings and fluoride treatments, but
School Employee Benefit Plan (ASEBP)
plan members would usually decline
have in common? A commitment to
after learning coverage is not available.
the sustainability of health benefits—by
“We were treating the benefit plan, not
•A plan member with reasonably
well-managed diabetes costs the plan
about $30,000 over 20 years, versus
turning traditional plan designs on their
the patient,” says Carson. In January this
more than $550,000 for a plan mem-
heads. “These healthcare professionals
year, ASEBP removed dollar maximums
ber with poorly managed diabetes.
are taking us to next levels we could
on basic dental services as the first step
never have achieved on our own. It’s
toward “oral care plans” that focus on pre-
•Thirteen percent of plan members
heaven!” exclaims Jennifer Carson, CEO
ventative measures and health outcomes
under age 25 (excluding depen-
of ASEBP, which administers health ben-
support. Similarly, ASEBP is exploring how to
dents) were already being treated
efits for 58 school boards (or 110,000 plan
build upon Alberta’s government-funded
for diabetes, and 42% across all ages
members, including dependents).
care plans provided by pharmacists to
were not adherent to medications.
ASEBP’s health benefit advisory panel
has met four times since its inception
in June 2014. Its task: “to tear our plan
people with chronic conditions and/or risk
factors (such as tobacco use).
“Intuitively we knew that health ben-
Such out-of-the-box thinking is fuelled
efits are an investment, not a cost, but
apart and tell us what we’re doing well
by a deeper understanding of the links
the predictive modelling and analytics
and what we can do differently, based
between health and benefits. The process
really spelled this out,” says Carson. “The
on best professional practices,” says
began in 2012, when ASEBP worked with
question then became, ‘How do we get
Carson. For example, the panel pointed
its benefits consultant to apply predictive
in front of this?’ Working with the panel,
out that certain medications can cause
modelling to determine what its present
we’re convinced we’ll see improved
dry mouth, which increases the risk of
plan would cost per employee in 10
overall health as costs come down.”
30
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
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C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
SECTION 5
RETIREMENT CONUNDRUM
Boomers make noise;
are we listening?
P
lan sponsors underestimate
the impending impact of
aging baby boomers on health
benefits, warn members of the advisory board for the 2015 edition of The
Sanofi Canada Healthcare Survey.
Surveyed employers calculate that
42% of their workforce falls into the
baby boomer generation, currently
aged between 51 and 69 years. This
is consistent with Statistics Canada’s
most recent census data for 2011,
which estimated that 42% of the working population is between the ages of
45 and 64—a record high.12 Research
by the Public Health Agency of Canada
also shows that the rate of diagnosis
of chronic disease is climbing faster
among people below the age of 65 than
it is among people older than 65.13
When asked to select from a
list of statements to reflect their
SECTION
TAKE
AWAY
organization’s perceptions of baby
boomers, 44% indicated they had
no concerns about the issue of baby
boomers in their workforce and their
health benefits, and 18% said they
have not considered the issue at all.
Meanwhile, 19% are concerned that
too many of their baby boomers will
not be in good health in the years
before they retire (increasing to 31%
among large and 30% among unionized employers).
“Too many employers have no
concerns or have not considered the
impact of baby boomers on their
health benefits. This goes back to the
gap in awareness of the prevalence
and impact of chronic disease in the
workplace. There is a real disconnect
here,” says Carol Craig, director
of human resources, benefits and
pensions at TELUS.
Plan sponsors may underestimate
the impact of aging baby boomers
on health benefits, suggests the
advisory board.
“We know that drug costs per
individual tend to increase as we
age and with 42% of baby boomers
in the working population, that’s a
significant risk to the future sustainability of drug plans,” agrees Susan
Belmore-Vermes, director, group
benefits solutions, at Health Association Nova Scotia. To lower that risk,
members of the board urge plan sponsors and providers to facilitate the
early detection of chronic conditions
through screenings in the workplace
for cancers and cardiometabolic diseases. (See “What’s my risk? Members
want to know,” page 26.) l
12.Statistics Canada. “The Canadian Population in 2011: Age and Sex.” Statistics Canada
Catalogue no. 98-311-X2011001.
13.Elmslie K. “Against the Growing Burden of
Disease: Protecting Canadians from Illness.”
Public Health Agency of Canada. Accessible at
www.ccgh-csih.ca/assets/Elmslie.pdf.
Retirement benefits, sooner than later
Twenty-six percent of plan members
do not know what will happen to their
health benefit plans when they retire,
a finding that is consistent across breakdowns for size, labour environment and
public versus private sectors. Gender
and age, however, influence results:
32% of women and 38% of younger
employees (aged 18 to 34) do not know
what will happen (versus 21% of men
and 14% of those aged 55 to 64).
Among remaining employees, 25%
expect their current workplace benefit
plan to continue—jumping to 40%
among employees closest to the age of
retirement (aged 55 to 64). Another
39% know their provincial healthcare
plan will cover some of their healthcare costs, though not to the extent
of their workplace plan, while only
9% believe the provincial plan will
take over from the workplace plan
with similar levels of coverage.
Thirty-five percent of plan sponsors, meanwhile, indicate health
benefit plans are available after retirement—but only 6% do so at no cost
to the retired plan member (increasing to 12% among large employers
and 10% in unionized environments).
Most offer a separate plan for a price
(16%) and the remaining 13% offer a
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
continuation of the workplace plan,
again for a price. As well, only 16% of
plan sponsors are concerned that the
baby boomers in their workforce do
not understand their health benefit
options upon retirement.
“Plan members are generally not
prepared for the change in benefits
after retirement,” says Telena Oussoren,
manager of benefits for Suncor Energy.
“Employers need to add this to their
retirement communications around
benefits so that employees give themselves enough time to plan for benefit
needs in retirement before they retire. If
decisions are made only at retirement, it
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
31
SECTION 5 : RETIREMENT CONUNDRUM
may be too late to qualify for or be able
to afford private insurance.”
Twenty-eight percent of plan members will most likely purchase private
insurance for health benefits if their
workplace plan ends at retirement,
and another 19% will definitely do
so. Twenty-eight percent may do so,
15% are uncertain and 10% say they
will not purchase private insurance.
“There can be more activity among
providers in post-retirement products,”
says Nathalie Laporte, vice-president,
product development, marketing and
strategy, at Desjardins. “It’s an opportunity for carriers to make a stronger
PLAN SPONSORS
Benefit options for plan
members in retirement
29%
n Yes, they can continue with current
13%
plan at a price
n Yes, there is a separate plan
available at a price
35%
38%
16%
n Yes, they can continue with current
plan at no cost
n We provide contact information for
our plan provider if they are interested
in purchasing a plan privately
6%
n No, we do not provide a plan or
Plan at a price (net)
contact information
27%
BASE: All plan sponsors (n=504)
connection between health and wealth,”
agrees Lori Casselman, assistant
There is a plan available (net)
vice-president, practice excellence and
innovation, at Sun Life Financial. l
Retirement “cliff” casts large shadow
Plan sponsors anticipate that 22%
of their current workforce will retire
within the next five years. Twenty-one
percent are concerned that too
many employees in the baby boomer
generation will want to work past
retirement, a number that jumps to 31%
among large and unionized employers,
and to 30% within the public sector.
One in five (19%) plan members
expects to continue working
beyond the traditional retirement
age of 65; are we ready ?
SECTION
TAKE
AWAY
For their part, one in five (19%) plan
members expects to continue working
beyond the traditional retirement age
of 65, with a somewhat lower likelihood
among unionized members (14%)
and a higher likelihood among those
working for small employers (28%).
Most say they plan to work longer
because they need the money (65%),
while 22% indicate needing the health
benefits. Almost half (48%) plan to
continue because they enjoy the work.
On the other hand, far more plan
members, 46%, plan to retire before
65—jumping to 57% of unionized plan
32
members and 59% in the public sector.
The higher rates of early retirement
for unionized and public sector plan
members likely demonstrate the
influence of defined benefit pension
plans (versus defined contribution
plans that are more typical in
non-unionized and private sector
environments). When considered by
age, 47% of employees aged 18 to 34
plan to retire early, increasing to 57%
in the 55- to 64-year-old age group.
That leaves 19% of plan members
who plan to retire at the traditional
age of 65, with no significant variations by size, labour environment,
sector or age.
The plans for early retirement
appear to be somewhat overly
optimistic when compared with
actual retirement data. According to Statistics Canada, in 2009 a
50-year-old worker could expect to
work another 16 years, resulting in
an average age of 66 for voluntary
retirements—up from an average of
63 in the late 1990s.14 When involuntary retirements (due to personal
or economic reasons, such as illness
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
or layoff) are factored in, the average
expected retirement age for 50-yearold employees in 2009 was 64.5 years.
It also appears that plan sponsors
can induce employees to work past
their planned retirement age. Among
employees aged 55 and older, continued
coverage for prescription drugs would
likely encourage them to work longer
(72%), followed closely by a flexible
work schedule (71%). Other possible
motivators, all scoring well, are: dental
coverage (67%), disability insurance
(61%), life insurance (59%) and the
ability to work from home (56%).
“Despite the fact that there are
provincial drug plans after retirement
at age 65, plan members still place
an extraordinarily strong value on
additional prescription drug coverage. People understand the importance of access to the right medications for them,” notes Paula Allen,
vice-president of research and integrative solutions at Morneau Shepell. l
14.Carriere Y, D Galarneau. “How Many Years to
Retirement?” Statistics Canada, Catalogue no.
75-006-X. Dec. 2012. Accessible at www.statcan.
gc.ca/pub/75-006-x/2012001/article/11750-eng.pdf.
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
T H E 2 015 E D I T I O N O F TH E SAN O F I CANADA H EALTH CAR E S U RVEY
Methodology
Ipsos Reid fielded the plan member survey on behalf of
Rogers Insights Custom Research group using an online
(Internet) survey methodology from January 5-8, 2015.
In total, a national sample of 1,504 primary holders of group
health benefit plans completed the study. At the time of
each interview, these adults were the primary holders of
employee plans with a health benefit portion. The online
completes were conducted using a random sample drawn
from the 200,000+ members of the Ipsos Reid Canadian
i-Say Panel. The total results of a probability sample of this
size would be considered accurate to within +/- 2.5%, with
95% certainty of what they would have been had the entire
population of Canadian plan members been polled. It is
important to note, though, that the margin of error would be
larger among sub-sample respondent groups. The data has
been statistically weighted to ensure that the age, gender and
regional composition of the sample reflect those of the adult
population according to the 2011 census data. Additionally,
some response categories in this report do not add up to
100%—this is due either to the rounding of numbers or
questions that allowed plan members to provide multiple
responses. In addition, Rogers Media Inc. conducted separate
online surveys with 504 benefit plan sponsors from across the
country from January 5-15, 2015. The data was statistically
weighted to accurately reflect the geographic distribution of
business and business size according to Statistics Canada.
PLAN MEMBER DEMOGRAPHICS
ORGANIZATION SIZE
EDUCATION
10%
11%
36%
11%
15%
17%
n 10% Fewer than 50 employees
n1
1%50 to fewer than 250
employees
n 11%250 to fewer than
1,000 employees
n 15%1,000 to fewer than
5,000 employees
n 17% 5,000 or more employees
n 36%Did not know the size of
their organization
POSITION
16%
44%
32%
n 44%University degree or
post-graduate degree
n 8% Some university
n 32%College education
(some college or diploma)
n 16%High school education
or less
8%
INCOME
5%
21%
10%
11%
18%
13%
17%
n 21% Professional positions
n 18%Administrative/clerical/
secretarial positions
n 17% Technical/trade positions
n 13%Managerial/supervisory/
executive positions
n 11% Retired/not currently working
n 10% Sales/service positions
n 5% Teaching/academic positions
n 1% Self-employed
4%
26%
27%
n 4% Household incomes of
less than $30,000
n 27%Household incomes of between
$30,000 and $59,999
n 33%Household incomes of between
$60,000 and $99,999
n 26%Household incomes of
$100,000 or more
33%
AGE
LOCATION
LANGUAGE
GENDER
n3
3% Aged 18 to 34
n2
0% Aged 35 to 44
n1
9% Aged 45 to 54
n 20% Aged 55 to 64
n 8% Aged 65 and older
n 12% Live in British Columbia
n 11%Live in Alberta
n 7%Live in Saskatchewan/
Manitoba
n 36%Live in Ontario
n 26%Live in Quebec
n 9%Live in Atlantic Canada
n7
4%Most frequently speak
English at home
n 25%Most frequently speak
French at home
n 2%Most frequently speak
a language other than
English or French at home
n 47% Female
n 53% Male
Note: Due to rounding, response categories may not add up to 100%
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H BEN EF I T P L A N S
THE SANOFI CANADA HEALTHCARE SURVEY | 2015
33
T H E 2 015 E D I T I O N O F TH E SAN O F I CANADA H EALTH CAR E S U RVEY
Advisory Board
The Sanofi Canada Healthcare Survey is shaped through the guidance and expertise of the advisory board. The members of
the advisory board tapped into the concerns of today’s plan members and plan sponsors. Throughout the year, they took time
out of their schedules—as key stakeholders in the Canadian health benefits industry—to participate in every stage of The Sanofi
Canada Healthcare Survey, from reviewing the questions asked of Canadian plan members and employers to promoting the
report and answering questions about the findings. Their continuing support of this important project is essential.
Paula Allen
Vice-president,
research and
integrative solutions
Art Babcock
Vice-president
AON HEWITT
MORNEAU SHEPELL
Carol Craig
Director, human
resources, benefits
and pensions
Susan
Belmore-Vermes
Director, group
benefits solutions
Chris Bonnett
President
H3 CONSULTING
HEALTH ASSOCIATION
NOVA SCOTIA
Ben Harrison
Director, group
strategic relationships
GREAT-WEST LIFE
TELUS
Nathalie Laporte
Vice-president,
product development,
marketing and
strategy
Lisa Callaghan
Assistant vicepresident, product
and group benefits
MANULIFE
Lori Casselman
Assistant vicepresident, practice
excellence and
innovation
SUN LIFE FINANCIAL
Jacques
L’Espérance
Pierre Marion
Marilee Mark
Senior director, sales
and business relations
Vice-president,
market development
J. L’ESPÉRANCE
ACTUARIAT CONSEIL INC.
MEDAVIE BLUE CROSS
SUN LIFE FINANCIAL
Anne Nicoll
Telena Oussoren
Steve Semelman
SUNCOR ENERGY
GEMINI PHARMA
CONSULTANTS
President
DESJARDINS
Godfrey Mau
Pharmacy consultant,
group benefits
MANULIFE
John McGrath
Senior vice-president,
human capital
practice leader
Serafina Morgia
Senior consultant
TOWERS WATSON
WILLIS CANADA
Dr. Alain Sotto
David Willows
TORONTO TRANSIT
COMMISSION/MEDCAN
WELLNESS CLINIC
GREEN SHIELD CANADA
Occupational medical
consultant/director
34
Vice-president,
strategic market
solutions
T HE SANOFI CANADA HEALTHCARE SURVEY | 2015
Vice-president,
health and disability
management
Manager, benefits
CEO
MEDAVIE BLUE CROSS
Douglas Yep
Senior director,
total rewards
AIR CANADA
C A N A DA’ S P R EM I E R S U R V E Y O N H E A LT H B EN EF I T P L A N S
THE BENEFITS OF HEALTHY
For decades, Sanofi has been committed to providing valuable healthcare solutions in Canada and
around the globe, a cause made possible by our greatest strength: our people. That’s why we’re
passionate about health and wellness within our own walls.
We know that healthy, happy individuals are more satisfied in their personal lives, more inclined to be
socially engaged, and more productive in the workplace. The benefits of good health go beyond
reducing costs. It’s great for people – and for business. To learn more about us, visit sanofi.com or sanofi.ca.
PEOPLE-FOCUSED. PASSION-DRIVEN.
SANOFI CANADA
SANOFI PASTEUR
SANOFI CONSUMER HEALTH
GENZYME CANADA
MERIAL CANADA
The Sanofi Canada Healthcare Survey
is published by Rogers Media Inc.
For an electronic version of
The Sanofi Canada Healthcare Survey
and the Survey at a Glance,
visit sanofi.ca
© 2015, sanofi-aventis Canada Inc.
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