Business Health Volume 3:3 – July/August 2007
Benefits: The Line is Drawn
In recent weeks, three surveys have reflected dramatically different needs and
expectations among employees and employers.
First, a poll of 69 generally large Canadian employers found that about half
(55%) were considering eliminating health benefits for retirees, and another 22%
may reduce company contributions. Flexible plans, together with Health Spending
Accounts, are also being used to manage and shift cost. Aon Consulting suggested
both current premium costs and growing balance sheet liabilities are to blame.
A far larger survey of 1,700 Canadian benefit plan members provides a different
perspective. The tenth annual sanofi-aventis Healthcare Survey (SAHS) indicates
benefit plans can help address skills shortages. Sixty-five percent of those age
55 or older said they would be likely to continue working or return to work post-retirement
if their employer provided a prescription drug plan. At 61%, dental plans were
almost as popular. In an interesting twist, 78% said the government should set
minimum standards for health benefit plans, suggesting significant employee concern
and the threat of regulation.
Finally, a large survey of US employers found that the first objective of benefit
plans was now to retain employees, not to control cost.
Now consider that Canadians aged 55 to 64 are the fastest growing age group,
and therefore a very attractive target for employers. Those nearing or entering
retirement numbered 3.7 million, up 28% between 2001 and 2006.
Employees now hold most of the cards. The right mix of pay, benefits, training,
and work hours could significantly reduce labour shortages. Rather than focus
solely on cost, employers will need to consider a broader approach or find themselves
outbid for scarce talent, and facing the risk of regulatory oversight.
Sources: (i) Majority of firms eye retiree benefit cuts, Globe & Mail, June
13, 2007. (ii) Press Release, 2007 sanofi-aventis Healthcare Survey, (iii) 2006
MetLife Study of Employee Benefits Trends, available at: www.whymetlife.com/brokerstudy.
(iv) The Daily, July 17, 2007, available at: www.statcan.ca.
Pushing the Envelope
Frequently, we find a greater appetite among American employers for strategies
that improve the health of employees and thereby reduce benefit costs. Though
the financial stakes are higher, sometimes the leading edge becomes the bleeding
edge.
Like all employers, Scotts Miracle-Gro Company faces the familiar dilemma of
how far to intervene in the lives of its 6,000 US employees, half of which were
overweight or obese. At the start of a new strategy in 2004, Scotts’ health care
costs were equal to 20% of its net profits. A recent story describes the two extremes
– one executive in apparently excellent health who responded to a company medical
examination that helped save his life, and a 30-year-old probationary employee
who was fired for allegedly smoking and violating the company’s nicotine ban.
That employee is now suing Scotts.
Employees at Scotts pay more (US$107 per month) if they refuse company-sponsored
and subsidized initiatives such as health risk appraisals and lifestyle modification
plans. Incentives such as cash, massages, travel rewards, and recognition also
play a role, and for most, they work.
There are important privacy, discrimination, equity, and responsibility issues
to resolve, and not just for large US employers. Population health data consistently
show that Canadians with lower income and less education have worse health status
than others, so cost-shifting tactics will be regressive and disproportionately
hurt those who need the most help.
Few employers will take the same aggressive, high-risk stance as Scotts, however,
complacency is not a viable strategy. The article closes with five guiding principles:
be inclusive, be honest about the issues, offer incentives to change, make health
a social event, and use family to reinforce good behaviour.
Source: Get Healthy or Else, BusinessWeek, February 26, 2007.
The Qualities of an Effective Asthma Program
Asthma is a chronic respiratory disease that narrows the airways and causes spasms
in the lungs. It can be controlled through long-acting ‘preventer’ and quick-acting
‘rescue’ medications. Often, these products are not taken properly, resulting
in unnecessary complications such as emergency department visits, hospitalization,
and almost 300 deaths a year in Canada.
Workplace asthma management programs have been introduced over the last several
years, often with poor support, inadequate follow-up, and inaccurate measurement
of effectiveness and economic returns.
A much more comprehensive and well-managed program, called Inspire at Work, was
offered by Medavie Blue Cross to seven Atlantic Canadian employers. Inspire was
a voluntary worksite asthma self-management program funded by GSK. (GSK is a sponsor
of businesshealth.) It was actively promoted, ran for nine months, and used a
certified asthma educator for both education and behaviour change. The program
included a comprehensive initial assessment, a follow-up visit, and two telephone
assessments.
Ninety-nine long-term and mostly female asthma patients completed the program;
only six dropped out. The asthma educator identified 46 drug-related problems
(DRPs) in 34 of those enrolled. Of these, eleven patients had more than one DRP.
Twenty were not receiving a required drug, 12 had poor compliance with therapy,
and 11 were being under-treated with the correct drug. There were also 53 “potential”
DRPs that required testing or referral to resolve. Though not part of this published,
peer-reviewed study, the lead researcher reported that participants had statistically
significant improvements in absence, productivity, quality of life, satisfaction,
and inhaler technique.
High quality worksite asthma management programs can be effective and provide
returns to both participating employees and their employers.
Source: MacKinnon NJ, LeCouteur Morais C, Rose, T, 2007. Drug-related problems
identified in a workplace asthma self-management program. Canadian Pharmacists
Journal 140(2), March/April: 110-115.
Cancer: The Good, the Bad, and the Ugly
As we age, the saying goes, every pain becomes a symptom…and cancer becomes a
fear in most of us. According to Manulife Financial, cancer was the third-leading
cause of long term disability in 2006, and though only ranked 12th (by incidence)
in short-term disability plans, they feature the longest duration of any STD claim.
Higher survival rates mean cancer can now be considered a chronic disease.
Most older cancer drugs are infused intravenously (IV) and therefore in-hospital.
However, private drug plans are already being hit as more oral drugs appear, and
most of the “pipeline” (new) oncology drugs will be taken orally. IMS Health notes
cancer drug sales have been growing at 18% annually, and forecasts that oncology
will become the largest therapeutic class globally by 2010.
Consistency is an issue. Provincial governments have many different cancer care
models, and of course, do not pay for all new cancer drugs. For example, Avastin™,
a drug for late-stage colorectal cancer, has good clinical results, but high costs
and therefore weaker economic evaluations. Only two provinces have approved it
(NL and BC). In response, private infusion clinics (e.g., Bayshore Home Health)
are appearing across Canada, and encouraging patients to seek reimbursement from
their private plan.
Even within one province, there is inconsistency. The Queen Elizabeth II Health
Sciences Centre in Halifax will not allow infusion of privately purchased medicines
not listed by Cancer Care Nova Scotia, but the Cape Breton Cancer Centre will,
in part because there are no local alternatives.
A diagnosis of cancer is extremely emotional and traumatic. Employers and their
advisors will need a comprehensive workplace policy that addresses reimbursement,
the kind and amount of company support, compassionate leave for patients and caregivers,
and the difficult ethical stance of where to draw the line.
Sources: (i) Manulife Financial, with permission. (ii) Hoffmann-La Roche, with
permission. (iii) IMS Health, with permission. (iv) Cancer Advocacy Coalition
of Canada, 2006 Report Card on Cancer in Canada.
IWH Update: Safety Training and Disability Management Practices
The Institute for Work & Health (IWH) is essentially the research arm of
the Ontario Workplace Safety and Insurance Board. In its most recent newsletter,
two articles present interesting and even alarming information.
The IWH analysed safety training data on almost 60,000 participants from three
editions of StatsCan’s biennial Workplace and Employee Survey. Only 21% of workers
received any safety training during their first year on the job. Two of the most
at-risk groups – younger workers and those in jobs with high physical demands
– were no more likely to receive safety training. Quebec had the lowest training
rates, Ontario registered 28%, and Manitoba had the highest rate at 34%. The chances
of receiving training were higher if the company also provided other benefit programs.
Of particular interest was that there were no statistical trends observed by industry,
occupation, age, or gender. All this flies in the face of mandatory health and
safety training, and the reasons for the low rate of early training will be investigated.
A second article highlighted the Workplace Disability Management Benchmarking
(WDMB) Collaborative, a new initiative by the IWH and so far, eleven large Canadian
organizations. The goal is to establish and promote “best practice” standards
in disability management. Reports will be collected from members, which include
three large but unnamed insurers. From those data, benchmarks will be created.
Participants will receive their own and aggregate reports, allowing them to see
how they compare to their peers in terms of processes, outcomes, and satisfaction
among different participants.
The Institute continues to provide valuable insight and innovative opportunities
of value to employers across Canada on most aspects of their health and safety
strategy.
Source: Institute for Work & Health. @work, Spring 2007. Available at: www.iwh.on.ca,
and www.wdmb.ca.
COMMENTS AND QUESTIONS TO THE EDITOR: cbonnett@businesshealth.ca
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