Chronic conditions such as depression, cancer, heart disease, stroke and diabetes cost employers big dollars in declining productivity due to increased absenteeism and presenteeism rates, as well as soaring drug costs and claims for short- and long-term disability. Speakers at the 12th annual Solutions in Drug Plan Management conference held on October 11, in Mississauga, Ont., acknowledged the challenges and shared ideas on how to better manage the impact of chronic diseases by improving the health and wellness of their employees.
Chris Bonnett, president of H3 Consulting, opened the discussion with a few hard facts and figures. One-third of Canadians are diagnosed with one of seven chronic diseases, many of which occur together, he said. Today, cancer, heart disease, stroke and diabetes account for 70% of deaths. And, since older people are more likely to have a chronic disease, the aging workforce implies that the impact of chronic disease on the workplace will continue to grow.
“Chronic disease is expensive for employers, but there are opportunities to make a difference,” said Bonnett. “Studies estimate that 40% to 70% of the cost of chronic disease can be avoided through lifestyle change, and, as you peel away the health risks, the costs come down.” Citing Seven More Years, a 2012 study published by the Institute for Clinical Evaluative Studies (ICES) and Public Health Ontario, Bonnett said that by managing five risk factors (smoking, alcohol, diet, physical activity and stress), Canadians could add 7.5 years, on average, to their lifespan and gain almost 10 years of better quality of life.
A properly implemented workplace health promotion program can make a positive difference, Bonnett said. “Demographic and competitive pressures, combined with rising chronic disease rates, mean that a healthy and productive workforce is a strategic business issue worthy of executive attention. Health is a performance driver, and we need to push the silos together.”
New ideas
Although new and innovative drugs may offer more effective treatments for chronic diseases, many employers wonder how they can afford the expense. An expert panel—Marilee Mark, vice-president, marketing, group benefits, Manulife Financial; Suzanne Lepage, private health plan strategist; Peter Zawadzki, pharmacist and professional affairs executive, Pharmasave National; and Bernie Manente, managing partner, Strategic Answers Inc.—looked at the issue from several different angles.
One of the “elephants in the room” during any discussion about managing drug costs is whether employees share a sense of responsibility for controlling drug spending. Mark, a member of the Sanofi Canada advisory board, highlighted several findings from the 2012 Sanofi Canada Healthcare Survey that suggest employees may take their obligation more seriously than employers think they do.
For one, nearly two-thirds of employees responding to the survey indicated they view coverage for higher-cost drugs as a very high priority, and the majority say they feel an obligation to help their employer control plan costs. When it comes down to what employees would be willing to do to assist with those costs, opinions varied: 62% said they would “shop around” when purchasing their drugs, 21% would pay for additional coverage, and 15% said they would be willing to pay higher premiums. Most respondents (92%) also said they would likely participate in on-site health risk screenings, and 91% indicated a willingness to participate in disease education in order to ensure coverage of higher-cost drugs. But only 33% of employers believe that employees share this sense of obligation.
Lepage said a disability claims management approach could similarly apply to drug claims. “Disability case management provides a single point of contact to co-ordinate the claim, ensures consistency of treatment and provides referrals to appropriate healthcare professionals,” she said. “Drug claims case management is not that different.”
But there may be a downside to drug claims case management. Lepage said that plan members may benefit from education on alternative therapies, have better health outcomes and have better access to needed medications, but they may be dismayed when case managers limit medication choice or alter treatment plans, for example. For plan sponsors, the case management approach could better manage drug costs, provide greater returns on drug spending and result in reduced absenteeism and disability rates.
Adopting a case management approach could help keep drug plans sustainable by ensuring that drugs are used appropriately. However, Lepage emphasized the need to evaluate the impact on patients, health outcomes, satisfaction levels and perceptions.
Partnering with healthcare professionals is another way for plan sponsors to get the best value for their investment in employee health, said Zawadzki. Pharmaceuticals are often considered the most cost-effective treatment for chronic diseases—but only if used correctly. With newly expanded scopes of practice, pharmacists are more prepared to engage patients in their drug therapy and improve adherence, Zawadzki said. Pharmacists can now adapt prescriptions to improve adherence and extend prescriptions so that patients don’t have to take time off work to see their doctor for a refill. Plan sponsors in various provinces can also leverage a range of government-paid pharmacy services such as medication reviews or diabetes care to reduce health- and disability-related costs.
To deal with the reality of higher-cost drugs, Manente advised plan sponsors to take a broad approach that includes four essential elements: innovation in plan design, measurement and response, encouragement of employee consumerism and challenging/lobbying government.
By combining elements of consumer-directed health plans, allowing accumula-tion and rollover, and seeking tax-advantaged treatment of premiums for high-cost areas, sponsors can help to boost employee consumerism.
Good reasons to tackle chronic disease
The prevalence and complexity of mental health have received much attention in recent years, and today there is greater acceptance of the need to promote psychological well-being in the workplace. Dr. Merv Gilbert, occupational health consultant with Gilbert Acton Ltd. and adjunct professor at Simon Fraser University, emphasized the strong business case for improving psychological health and safety at work:
- mental health is now viewed as a chronic condition and a big driver of disability claims;
- mental health issues cost employers an estimated $20 billion a year; and
- there are legal and regulatory issues that require employers to pay attention to psychological health in the workplace.
“Doing nothing is not a viable option,” said Gilbert. “But many employers aren’t sure how to go about managing psychological health and safety.” He pointed to the free guide Psychological Health & Safety, An Action Guide for Employers, commissioned by the Mental Health Commission of Canada in anticipation of the release of the National Standard of Canada for Psychological Health and Safety in the Workplace, as a good place to start.
Dr. Alain Sotto, chief physician at Ontario Power Generation (OPG), presented a case study of how his organization is managing the impact of chronic disease. With 12,000 employees across the province, five major disease states—mental health disorders, cardiovascular-related disorders, diabetes/metabolic syndrome/obesity, cancer and musculoskeletal disorders—have contributed to rising rates of absenteeism and higher drug costs at OPG.
“Safety is enshrined at OPG: it’s who we are and part of our corporate culture,” said Sotto. “However, the emphasis now also includes a health and safety policy that includes the mental and physical well-being of employees.”
A four-pronged employee wellness program implemented in 2010 tackles chronic disease through education; engagement (readiness to make changes, determining risk factors and early diagnosis and treatment); enablement (facilitation of programs, early intervention and screening methods); and empowerment of employees. Between 2010 and 2011, sick days from mental health dropped by 16%, those related to cancer fell 9%, and sick days related to diabetes/metabolic syndrome/obesity increased by 4%, likely because more new diabetics were diagnosed with OPG’s biometric screening programs. The wellness initiative also had an impact on drug spending, with total drug cost reductions equalling $323,437. Further savings are expected as OPG’s wellness program continues and expands.
The impact of chronic disease is a huge challenge, but by getting employees involved in cost management, adopting new drug plan strategies, partnering with healthcare professionals and promoting wellness, employers can better manage costs—and have healthier employees. Says Sotto, “If we can save one life, it is worth the cost of prevention.”
Sonya Felix is a freelance writer based in St. Catharines, Ont. sfelix@cogeco.ca