Spotlight on the TELUS Health Annual Conference 2016
Benefit consultants and group insurers discussed Canadian benefit plan data and trends at the 2016 TELUS Health annual conference in Toronto, Québec, Montréal and Vancouver.
The rising cost of drugs, the necessity to drive behavioural change, and the role of technology as an enabler continue to be central issues driving the evolution of health benefit plans. But the 2016 TELUS Health Annual Conference examined critical new parameters that must also be considered to bring about sustainable change: the need for a fundamental shift in the way we, as an industry, define value and measure success.
- What are the challenges?
- What are the solutions?
- How can we drive innovation while maintaining sustainability?
Moving at warp speed
Luc Vilandré, Vice-President and General Manager, Health Benefits and Payment Solutions at TELUS Health, underlined the industry’s need to find creative ways to adapt to new economic realities and the impact of rapidly developing advances such as medical research and personalized medicine.
He highlighted the rising costs of specialty drugs—a concern that is top of mind for everyone, patients, governments, insurers and plan sponsors alike. Using the example of Hepatitis C, he demonstrated how specialty drugs are not only fundamentally changing health outcomes for patients, but are also placing immense pressure on employers and the overall sustainability of drug coverage.
With pharmacogenetics and precision medicine, he illustrated how data, when leveraged effectively, holds infinite potential in providing the right treatment, to the right patient, and at the right time.
Redefining the cost-to-outcomes equation
In 2015, a TELUS Health survey revealed that 70% of plan sponsors (employers) made no changes to their plan design to offset rising costs. Furthermore, only a few had taken steps to implement measurement tools that looked at the return on their investment across all components of the benefit plan. Even though awareness of what is possible is limited, opportunities to generate considerable savings without limiting the value delivered to plan members do exist.
Tools such as prior authorizations, step therapies and coverage information at the moment of prescribing represent opportunities to implement tighter controls around approval for high cost drugs, provide physicians with more visibility and increase fulfillment and therapeutic adherence.
Knowing that specialty drugs represent less than 1% of the claims but are driving close to a quarter of the costs, this still leaves 99% of claims and 75% of costs that employers can address.
In Canada, 40% of the population suffers from a chronic disease. No longer associated with the elderly, today, 45% of new type 2 diabetes cases are in teens, due to obesity and bad lifestyle choices. Employers need to try to get the most out of the existing available strategies but must also consider emerging trends. One trend that is gaining momentum among employers and insurers worldwide lies in prevention and tackling chronic disease. Changing behaviours, engaging people and leveraging the growing desire to self-manage one’s own health can drive sustainable changes that will lead to lasting positive health outcomes. According to a survey by Accenture[i], the number of consumers who use wearables and mobile apps for managing their health has doubled in the past two years. With 40% of consumers planning to buy wearable devices soon, flexible plans and wellness programs should consider the potential associated to the use of other advances in technologies, like apps and connected objects.
What about Innovation?
Sometimes, innovation can reside in small changes or can be found in how we manage relationships with customers or how we share data. Whether it’s technology such as wearables, or the ability for doctors to validate drug insurance coverage prior to issuing a prescription (and to send it directly to the pharmacist) true innovation lies in an ability to work together, in a true collaborative model.
As Dr. Mark Britnell, Chairman and Partner of KPMG’s Global Health Practice mentions in his book titled In Search of the Perfect Health System, “to achieve the level of transformation needed, health systems must focus not just on efficiency – doing things better – but as much on a more fundamental revolution in care – doing better things”.