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May 18, 2023
NB adds to pharmacist services
New Brunswick Medicare is now covering more services provided by pharmacists, in a bid to improve access to primary care.
Effective immediately, patients can seek care at a participating pharmacy, instead of a doctor's office or after-hours clinic, for contact allergic dermatitis, cold sores, mild to moderate eczema, gastroesophageal reflux disease, impetigo, lyme disease prevention after a high-risk tick bite, and mild acne. Health Minister Bruce Fitch says there are about 80,000 visits to physicians each year for these minor ailments. "So we're freeing up 80,000 appointments, basically for another more complicated ailment that the doctors would be available for," he said.
About $300,000 has been allocated in this year's budget for pharmacists to assess and prescribe for these, Fitch said. Patients will still be responsible for the cost of any medications prescribed for these ailments, as well as any fees for injections provided by pharmacy professionals.
May 16, 2023
I&D support from employers growing
Gender-affirmation healthcare benefit offerings are on the rise in both Canada and the US.
Anne-Marie Nawar, an advisor in group insurance plans and health benefits leader at WTW, says its ‘Canadian Inclusive Benefits Survey’ found 97% of the employers who responded consider inclusion and diversity (I&D) an integral part of their organization's values and culture. The first year of the survey found 21% of employers were currently offering gender affirmation coverage and 44% were considering adding it.
While the insurance carrier market has been developing products, many were within the last year, she said. However, a lot of these procedures would be covered under government Medicare programs, although the coverage will vary by province. Insurance carrier products that could be included in a benefits plan are all supplemental to what would be covered by the government. This would cover things like Adam’s apple reduction and facial femininization or masculinization. “These are beyond what the government program covers,” she said.
The employer benefit program would be brought in to provide coverage for mental health services the employee needs. “That's not something new that would be added to the program, but it would be used in that context,” she said. Plus, in another benefit from COVID, many employers have enhanced mental health services and provide higher maximum coverage limits.
Still, it’s “very much an evolving area in the benefits space,” said Nawar.
In the US, an International Foundation of Employee Benefit Plans survey shows these offerings are up from 12% in 2016 to 30% now. "When searching for meaningful employment, individuals look for employers with cultures that resonate. Often this involves inclusiveness and employers that offer a range of benefits to serve a diverse population," says Julie Stich, vice-president of content at the foundation.
Its ‘Employee Benefits Survey: 2022 Results’ shows 27% offer gender-reassignment/affirmation surgery, 25% cover prescription drug therapy (hormone replacement therapy, etc.), and 6% include cosmetic surgery (facial feminization, Adam’s apple reduction, etc.).
"Offering gender-affirmation health care benefits is a way for employers to remain competitive in attracting and retaining talent,” Stich added. “This type of offering reinforces a culture of inclusion and belonging.”
May 15, 2023
Long surgery waits damage productivity
Long waits for surgery and medical treatment cost Canadians almost $3.6 billion in lost wages and productivity last year, says a study by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank. It estimates 1.2 million patients waited for medically necessary treatment last year and each lost, on average, an estimated $2,925 in lost wages and reduced productivity during working hours.
“Waiting for medically necessary treatment remains a hallmark of the Canadian healthcare system and, in addition to increased pain and suffering and potentially worse medical outcomes, these long waits also cost Canadians time at work and with family and friends,” says Bacchus Barua, director of health policy studies at the Fraser Institute and co-author of ‘The Private Cost of Public Queues for Medically Necessary Care, 2023.’ It shows the national median waiting time from specialist appointment to treatment was 14.8 weeks after a 12.6-week wait to see a specialist after a referral from a general practitioner. Taken together (12.6 and 14.8 weeks), the total median wait time in Canada for medical treatment was 27.4 weeks in 2022 ‒ the longest in the survey’s history.
This makes the $3.6 billion in lost wages likely a conservative estimate because it doesn’t account for all of the wait time. “As long as lengthy wait times define Canada’s healthcare system, patients will continue to pay a price in lost wages and reduced quality of life,” says Mackenzie Moir, a Fraser Institute policy analyst and study co-author.
May 19, 2023
Hybrid work comes with benefits
An increase in overall employee satisfaction, less supervision when employees don't have their manager or supervisor looking over their shoulder, and increasing safety by reducing infectious disease risks were some of the most obvious advantages of working remotely, says Michael Richards, a partner and co-chair of the Canadian Employment and Labour Group at DLA Piper.
He told its ‘Canada Employment and Labour Update’ that these were some of the obvious benefits during the COVID-19 pandemic.
However, now there are additional benefits. “Believe it or not, not everyone likes their co-worker. Remote and hybrid work environments also allow individuals to avoid negative work environments in the office,” he said. There’s also an improved work-life balance without losing productivity as employees save time by not having to commute to work.
Then there are the cost savings for the employer and employee. Companies may no longer need office space. Employees are saving money by not having to commute to work.
Despite the positives, there are negatives which may prompt employers to require their employees to return to the office, he said. For example, employers don't have the same ability to supervise their employees and there may be decreased productivity and accountability. “No one's looking over the employees’ shoulders, safety issues become easier to manage, and we have a loss of a less collaborative environment,” said Richards.
As people start to return to the office and as companies consider policies requiring people to be in the office on a regular basis, Cameron Fynney, an associate at the law firm, said “we have issues arising around constructive dismissal allegations with people saying that ‘no, it's now a term of my employment that I get to work remotely and you can't make me return’.” These requests for accommodation may be based on family status, disability, or personal circumstances that may not fall within human rights. For example, somebody has relocated to farther away and their commute is now much longer.
There's also issues with performance management. Can managers consistently manage performance when people are working remotely and how is that addressed, he asked.
This can prompt allegations of discrimination and harassment when “people are required to come back at the office because of performance issues, said Fynney. “Allegations are made that somebody's being targeted or harassed by their supervisor because they're required to come into the office, when truly the goal of this is to try and help them improve their performance and manage the performance issues.”
There's other issues, of course. Employees may move to other jurisdictions either within Canada or outside of Canada creating issues on how policies apply and then issues around ensuring that there's a safe work environment.
As well, the issue of costs come up from remote work, “particularly where remote work has been fully endorsed,” he said. “Employees are looking for compensation for things like internet and phone costs and for the equipment needed to set up the office at home particularly if the company is now saving money in those regards.”
One of the things they emphasize with remote hybrid working is making sure the company has clear policies. “Having those kinds of policies in place or having those terms in employment agreements is very important,” he said.
May 26, 2023
Modernized benefits meet plan member needs
One aspect of modernizing benefits is that one-size-fits-all no longer fits, says Michelle Khan, an associate vice-president, group benefits, at Gallagher.
Speaking at its’ Leadership Confidence Series’ session on ‘Modernizing your group benefits plans to support mental and physical wellbeing’ with Debra Hall, director of total rewards and HR operations at Ener care Inc., and Kimberly Sutherland, manager of client relations at Gallagher’s Calgary, AB, office, she said “we recognize that currently there are up to five generations now in the workforce and each one of these expects their group plans to be adaptable and flexible and to address their specific needs.
“Since multi generations respond to different ways of communication, employers really need to learn to collaborate with their employees to determine the preferences of these different people,” she said.
But this is just one aspect of modernizing benefits. In addition to looking at their demographics and their overall compensation, they need to keep their budget restrictions in mind while trying to address the needs of their employees.
One approach ‒ a holistically designed total rewards package can actually deliver a better employee experience while meeting their expectations across a wide range of interests. “This approach really allows employers to offer more options and yet still get a deeper understanding of their own employees,” she said.
This approach recognizes that the search for top talent is a struggle and requires more innovative approaches to pay and benefits. It changes how employees engage with their employers as employee-centered policies and practices are becoming essential to performance driven results. “You always have to keep that top of mind,” she said.
Hall said how benefits are approached depends on the environment. “Enercare has both union and non-union employees so you do have constraints. We have to be cognizant of these when we're looking at design overall.”
What it has been doing is looking at its employee engagement results and it’s finding a lot of the engagement results are around total rewards. “So what we're trying to do right now is look at the plan holistically” and ask questions about how it does support physical and mental health through our offerings, and the affordability of it as well. “We want to make sure that we're providing what our staff needs, but we also need to keep in mind the affordability, not just do it for the sake of doing it. There needs to be meaning behind what we're doing,” said Hall.
In discussions with clients, Sutherland said, “we always like to talk about modernizing to create a targeted benefits program that really matches their populations’ wants and needs.”
But she is also seeing an increased focus on reviewing the contract provisions that are typically based on the insurer standards and considering whether they are designed in a way that is meeting the specific needs of today. An example of an outdated coverage provision is not enhancing dental program to include items such as porcelain crowns or implants. “No one needs metal in their mouth,” she said. Another outdated clause is some contracts will only cover oral contraceptives. “It should be opened up to all types such as implants or intra uterine methods like diaphragms,” Sutherland.
A major focus in the past few years is around DEI (diversity, equity, and inclusion). Organizations which practice this are more inclusive of different ideas, cultures, and lifestyles. This ultimately leads to improved satisfaction of employees. “A recent survey that I read showed 60% of job candidates actually said that they declined a job at a company that didn't value workplace diversity,” she said.
May 26, 2023
Results improve with holistic approach to chronic disease
A holistic approach to chronic disease management is more likely to produce long-term results because it goes beyond the underlying condition.
Catherine Biermann, manager, digital product solutions and partnerships, at Medavie Blue Cross, told its ‘A Topical Discussion on Diabetes and Weight Loss: What Employers Should Know’ session that this kind of approach targets the contributing factors that lead to underlying health issues which typically have the biggest and longest lasting impact on health.
Studies show that those who've received coaching and education services as part of a holistic approach to treatment are more successful in delaying, managing, and even reversing, in some cases, their condition than those who don't take that approach.
A holistic coaching approach is typically undertaken in the diagnosis or treatment phases of the health continuum, but by its very nature, this type of approach can continue to support a patient all along their health journey. “While some programs focus mostly on just the medical or just the dietary or just the activity levels when treating chronic diseases, a holistic approach looks at all of this together in combination and this really enhances the member’s wellbeing and increases the likelihood that they're going to achieve their health goals,” she said.
As well, holistic health coaching doesn't focus on a specific desired outcome based on the patient's health. “It's really based on the outcome the patients are looking for ‒ their desired end goals. By setting goals that are meaningful to each person, they are more engaged in that coaching process and this is going to also improve the learnings that they take in and retain,” said Biermann. This helps promote the adoption of new habits which means they'll also be more likely to have longer lasting adherence.
However, holistic approaches aren’t something found in the public healthcare system even though provincial governments have been impacted by people who are admitted to hospital or who just heavy users of the system due to their chronic medical conditions. The increasing incidence of diabetes and obesity is a case in point. This has been going on for decades and while some provinces have, for example, diabetes care centres, those tend to be focused on a single condition. Those with chronic conditions for many years who are trying to get back on track can't get into these programs because they're full of people who are newly diagnosed. “So access is a very difficult issue,” she said.
“While I think everybody would agree the public health system is probably the best place to have these programs, someone else needs to be found who may benefit from them.”
That someone is benefit plan sponsors. However, the reason employers should be focusing on it is not just the cost of a chronic condition. It's everything else that that goes with it ‒ absenteeism, presenteeism, potentially longer disability claims, future disability claims, or avoiding future life claims. If plan sponsors can reduce or eliminate those direct and indirect diabetes costs, “that's going to be a financial win for the employer year after year into the future.
“The question is can that be achieved and the answer is yes,” said Biermann.
