What’s new in health benefits in 2019? TELUS Health spoke with industry thought leaders, including our own Shawn O’Brien, principal, business intelligence, to learn more about what we can expect as the year unfolds.
Many insurers have established partnerships with providers of telemedicine, and are actively promoting it as an optional benefit, or for plan sponsors, to promote it as an eligible expense under healthcare spending accounts (HCSAs).
Plan members can use their computer, phone or smartphone app to get 24/7 access to nurse practitioners or physicians, who can immediately diagnose and prescribe for common ailments. Employers that derive most of their revenue from hourly billings, for example, will likely find the service especially appealing.
“It certainly provides value to private plans because it gives very timely and efficient access to care, so that employees are more productive and do not have to take time off work to go to walk-in clinics,” summarizes O’Brien.
“It won’t be a majority of plans that will cover telemedicine immediately, but certainly more are looking at it and we will see a movement toward it in 2019,” says Tim Clarke, President, tc Health Consulting, Inc.
2. Virtual care
Virtual care takes telemedicine a step further by providing an alternative way to access ongoing care (for example, for plan members already diagnosed with chronic conditions). Members consult with specialists and other allied healthcare professionals by phone, computer or smart app.
Virtual care for mental health, and more specifically for cognitive behavior therapy (CBT), is leading the way. Indeed, the long-term aim is to promote the use of virtual CBT as an early intervention, while employees are still at work, to prevent disability claims.
“A lot of pilots are out there now for virtual CBT. The important thing to note is that it doesn’t necessarily mean additional costs for the plan sponsor, or new out-of-pocket costs for the plan member. This is about diverting some of the traditional benefit dollars to deliver services in a different way, and more cost effectively,” says Marilee Mark, Group Benefits Strategist, Marilee Mark Consulting.
“Canadians are ready to embrace the digital future of health,” agrees Christine Potvin, Vice-president, Group Life and Disability, Sun Life Financial. “We are seeing increasing interest from employers who want to add virtual care to their plans and these employers cite demand from their employees as well as the potential to increase employee health and productivity, with the potential to reduce time off work for doctor visits.”
3. Healthcare apps
Along the lines of virtual care, healthcare apps will likely be eligible as a medical expense by the end of this year or in early 2020, predicts Clarke. “We are definitely closer to a few months away from that, rather than a few years away.”
Recently, we have seen a number of healthcare apps, from both start-up vendors and traditional healthcare innovators. Insurers will soon be vetting the options to determine which are medically valid and financially viable as benefit offerings.
These apps will complement existing benefits and can reduce costs. “For example, an employee may go to a psychologist every six weeks, at a cost to the plan of $150 per visit. Between visits, he uses an app that costs $10 a month that helps him manage his anxiety day-to-day. Today, that $150 visit is an eligible expense, but the $10 app is not. If the $10 app saved one or more psychologist visits per year, it would save money and cover its own cost,” explains Clarke.
As with many new benefits, coverage for healthcare apps will likely initially be promoted as an eligible expense under HCSAs. “But I see them being covered by medical plans within the next couple of years for sure,” says Clarke.
4. Targeted health messaging
This year could mark a pivotal year for wellness supports from the workplace, due to insurers’ growing capabilities in analytics and artificial intelligence to send targeted, action-oriented health information to plan members.
“We can identify plan members who are at risk for chronic conditions, or who may be at risk for disability leave. We can reach out to them, with their consent, with helpful information and suggestions for care,” says Matthew Gaudry, Director, Product Support and Management, Great-West Life. “There are no huge barriers to delivery here, it’s just a matter of time and resources.”
Personalized, regular health messaging could be the missing link to help prevent and manage chronic disease. While past pilot projects consistently showed the value of coaching from allied health professionals (such as pharmacists and dietitians) for members with health risk factors or chronic diseases, member enrollment was a challenge and ongoing costs a concern. The incorporation of targeted messaging from insurers, with automated “nudges” that can be delivered digitally, may help with both engagement and cost-effectiveness.
5. Medical cannabis
The most popular conversation come renewal time this year will likely be about coverage for medical cannabis. Now that most insurers have put together offerings for optional coverage, plan sponsors will be able to address a topic that continues to steadily garner media attention—which in turn stokes consumer interest.
“Certainly, the number of inquiries has significantly increased now that insurers’ options are available,” confirms Gaudry, which released its coverage offering for medical cannabis on January 1 this year. He also confirms that employee demand has helped put this item on the agenda. “We are now seeing large clients that report having populations of employees who have been asking them to find a way to cover it.”
“This year could be the start of a big trend in coverage, for sure,” agrees Suzanne Lepage, Private Health Plan Strategist, Suzanne Lepage Consulting, Inc., adding that coverage may eventually, in turn, “be the tipping point for accelerated consumer uptake.”
Currently, Health Canada reports that more than 300,000 Canadians take medical cannabis, presumably paying out of pocket (or possibly using funds from healthcare spending accounts).
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Cost containment: reviews for higher-cost drugs
While not a new trend for 2019, insurers’ review processes for new, higher-cost drugs will likely capture more of plan sponsors’ attention this year due to the growing number of higher-cost drugs coming out of the pipeline.
“The biggest and most important thing that many in the industry are doing is changing how we evaluate new drugs for inclusion in our plan,” says Barb Martinez, Practice Leader, Benefits Solutions, Group Benefits, Great-West Life. “For so many years we followed what I would call a Health Canada approach, whereby once a drug was approved it was automatically added to the plan. Today we will generally only add new, high-cost drugs when our evaluation shows they represent sustainability to the plan, and a reasonable treatment for the condition.”
More than a year has passed since insurers launched pilot projects for pharmacogenomics testing in disability management and as a standard health benefit, with a focus on drugs to treat mental illness (depression and anxiety) and pain. Click here for an update.