Plan sponsors are facing a chronic disease “tsunami” that is leading to higher benefits and drug plan spend and increasing disability claims.
But the three root causes of this growing problem — undiagnosed health issues, the availability of primary and preventative health care and challenges navigating the health-care system — are issues plan sponsors are well-positioned to address, said Peter Nord, chief medical officer at Medcan, speaking during Benefits Canada’s 2024 Healthy Outcomes Conference.
“Historically, employers would say, ‘That’s not us, that’s the health-care system.’ But increasingly, it’s going to be falling on the shoulders of employers to take on more accountability for these [health] issues” such as chronic illness.
Read: Chronic disease, drug claims driving benefits plan costs: report
According to the 2024 Benefits Canada Healthcare Survey, 58 per cent of plan members currently live with at least one chronic condition, with the share higher — at 72 per cent — among plan members aged 55 and older. Mental-health conditions, cardiac disease and diabetes were among the most common chronic illnesses.
While the coronavirus pandemic certainly had an impact on employees’ health, Nord noted the trend had started well before then. In the period between 2016 and 2019, disability claims associated with mental health and other chronic conditions increased 17 per cent.
The over-taxed public health-care system has made it much more challenging for plan members to get support, he said, noting 6.5 million Canadians don’t have a family doctor and many have to turn to urgent care centres when they’re ill, overwhelming emergency rooms and driving up wait times. In addition, hospitals are having to cut back services to balance their budgets and often the first things to go are outpatient therapy programs.
Navigation is also a significant issue for people seeking care, said Nord. “We have a very fragmented system and it’s very difficult to manage — even for those of us that are pretty knowledgeable. It’s also really hard to navigate our own patients or our loved ones through the system.”
Read: A deep dive into health-care navigation guides
For employers, offering a combination of a “robust primary care system” that includes preventative health services and some supports for mental health will offer the highest return on investment, said Nord. Prevention comes in two layers: the first is proactive screening for health issues and adjusting lifestyle behaviours to reduce the risk of illness and the second is the management of any existing diseases early and aggressively to improve plan members’ quality of life.
He also suggested engaging employees with targeted interventions through their benefits plan, including mental health and well-being benefits, nutrition and weight management, perimenopause and menopause support, sports therapy and rehabilitation and more.
For ongoing support, said Nord, plan sponsors can negotiate preferred rates for access to primary care physicians when employees have urgent or episodic needs. These costs could be covered by a health-care spending account or wellness spending account, he added.
Read more coverage of the 2024 Healthy Outcomes Conference.