Welcome to “Massaging the Data”…………………… GSC’s, and our industry’s, first ever, true Health Benefits Study. It absolutely has some of the old drug study favourites, constructed with the help of our friends at IMS Brogan. But what is totally new is our dive into the rest of GSC’s Health Benefits data. Why now? Well those of you that create, analyze and negotiate benefits renewals will have noticed the old split between drugs and parameds is shifting. The old 70/30 rule has edged towards 60/40. And the drivers? A combination of a pretty good drug pricing holiday the last few years combined with the steady growth of paramedical usage. If you do not like your insurers’ overall health trend, it is more likely because of the latter than the former. So what are we going to show you?
Well, one thing that is not different than past years is that you will be overwhelmed with a lot of fresh data. And the study period we are looking at is July 1, 2013 to June 30, 2014. (BUILD)
All in an effort to show you the really big picture in health benefits consumption………………
But we feel obliged to issue a clear warning. Because with all this data comes some surprising discoveries, and it provokes some pretty interesting questions…………. And we are not going to shy away from asking those of ourselves and our audiences. So…….even if it makes us a bit uncomfortable, we are committed to…………..well,
KEEPIN’ IT REAL! Seeking the truth in the numbers and the science.
So if you are going to participate with us in this unprecedented adventure, we have some tips for survival. There may be some uncomfortable and worrying moments when we consider the trends we are seeing………..
So survival tip one for today: Don’t get all defensive. We all in work in benefits plan management and we are all in this together. There are no easy answers.
Survival Tip Number 2: Approach the data and research you are about to see with childlike amazement and curiosity.
And number 3 – have some fun. Enjoy the conversation.
And by the end of the presentation, we hope we have given you some ideas to ponder…….in whatever role you play in benefits program management.
The fact is that everybody who sees this year’s study has a role to play in exactly that. Benefits plan design and management. And, let’s be honest, we have been doing a lot of the same things for decades now. At GSC, most benefits plans we administer look pretty similar. Sure, there are different cost sharing arrangements, some category maximums here and there, but the kinds of benefits we offer in group programs are quite consistent. Two questions then. Do they reflect the systemic health challenges Canada and its population faces? And if we were to start from scratch today, in 2015, what would benefits plans look like?
Now, there are no hard and fast rules about what should be in a Benefits program. And that is because there are a lot of different reasons we offer them. Last year’s Sanofi Healthcare Survey – our largest national survey of plan sponsors – proves this point. Why do plan sponsors even offer their programs? Here are their answers. Take a look………….. From the perennial number one answer – the “undue hardship to employees” reason. To the old “attract and retain our best talent” and “employee peace of mind”. And those are completely legitimate answers – using benefits as a form of compensation and comfort.
But there are three on the list that we at GSC are particularly interested in…………”Keeping employees healthy and productive”, “reducing absenteeism and disability claims”, and “coverage for treatments of chronic disease”. And this year’s study is dedicated to plan sponsors and advisors who are looking for more concrete results on the health outcomes side of things. Starting last summer, we set out to look at a lot of our data, more data than we ever have, and combine that with the best scientific research into the most impactful treatment strategies to bring long term health improvement. And now we are ready to show you what we found…………….
If you saw our 2013 Drug Study, you will know we used an age band study that showed our prescription drug usage from birth to school to work to, well, you know…… The End. Our audiences seemed to like it so we are going back to the well one more time. But with double the data…………….
So let’s start with the little ones – up to age 10. What benefits do they use?
First drug – and like last year, you will see a slide for both volume, i.e., the number of claims we saw in our book of business in this age band……..you see that on the right, lined up with drug class and disease state. And not surprisingly for the kids, it is fever and runny noses, coughs and nasty respiratory stuff that dominates. And, in third place, there is ADHD again this year……………….on a steady rise over the past decade. Next we will show you a second slide for drug costs……………….
Here it is. Same idea in this slide – the percentage is on the right, again lined up with the drug class and disease state. The cost slide usually looks a fair bit different than the volume slide. Here is a perfect example - ADHD, despite being only third in volumes of claims, is number one in cost because those drugs are significantly more expensive than anti-biotics. Now, have we mentioned we have even more data this year? Buckle up. Here it comes.
Here is the Health Benefits data for the kidz. First the volume slide……………………take a look And, the first thing to note, whether it is drugs or health benefits, please remember that this age band is significantly lower in volume and costs than any other you will see today. Kids are generally much healthier and simply use less benefits. Now when we saw this data, we assumed the high volume of chiro was likely accident or mishap driven. We thought it was this guy……………… (BUILD)
Good use of safety equipment in this picture, but there can still be nasty falls. Well, it is partly this guy driving the number……………….but it is also THIS GUY! (BUILD)
Why is he laughing? Well, back to the data……………. (BUILD)
Yes, the age with the single highest usage and cost for chiro is 0! Under one year old.
Now over to the cost slide for the Kidz. Glasses are no surprise at number one. But something unique lurks in the data on this slide. This is the only age band when we will have the occasion to tell you that males cost more than females. To be specific, boys, primarily driven by speech therapy, are more expensive than girls. Studies show boys are three times more likely to have a speech impediment, and are three to four times more likely to be autistic. In total, in the numbers on this slide, boys cost 22% more than girls. But forget all about that going forward………….and this is not to provoke any old fashioned jokes about female spending habits, but from the next age band on, when it comes to health benefits, women cost WAY MORE than men. We will get to examples of that in a second.
OK, parents, here comes the surly attitudes………………..and plan sponsors, here comes increased dollars. In some of the most interesting places…………………….
On the drug side, it is the same as last year, folks – first and foremost our teens are busy getting busy – at least the 15 to 20 year olds are……….but clearly they are using lots of contraception. And like last year, we also see the full blown emergence of mental health claims early in the age band study. If you combine the different kinds of mental health drug claims you see in third and fourth place, they would rise to number one in this category.
Like with the younger kids, ADHD leads the way. But we also want to draw your eyes to number five at the bottom………..already biologics make their presence felt in the teen aged years. This is not for rheumatoid arthritis – this is the impact of Juvenile Arthritis and Colitis. As you can guess, the biologics will soon climb up these drug cost slides in the age bands to follow.
On the health side, in only our second age band, we see the emergence of what you may come to see as the “Holy Trinity” of health claim volumes in this age band study ……………the combination of Chiro, Physio, and the friend that we will talk a fair bit about today – we even named this study after it - Massage.
While glasses still dominate the overall spend, and speech therapy disappears completely, we add one as another influential benefit to our list That is orthotics. Please look closely and file away this grouping of Orthotics, Physio, Chiro and Massage………….we will get back to that interesting foursome later.
And before we leave the teenaged years, an interesting fact that lives inside the numbers we just showed you: Moving from the kidz age band into the teens, massage costs for girls increase 543%. How many claims exactly? Tens of thousands. And double the number for boys. When we saw these numbers, a question came to mind, especially among those of us with teenage daughters. That question: What on earth do teenage girls need massages for???
And, thus, we come to our first episode of Keepin’ It Real……..
Let’s face it folks, there are things that humans instinctively, but perhaps irrationally love. There are puppies and kittens and beautiful flowers and the wonderful Tom Hanks……and now, based on our data, we are required to add another to this list.
Massage, people. We love our massages. And, apparently, that love is now starting very early in life. Now, from this point in the presentation on, it may feel like we are picking on massage………. Just to set the record straight, the data analysts, researchers and writers of the GSC health study like massages too. In fact, they love it so much they did a deep dive on the science that documents the impact of massage on long-term health outcomes and we made a slide to show it.
We are going to give you a few seconds to take in all the information……….. Got it? Ok, that is a joke. To be clear, we do not discount massage. Here is a more serious slide on the benefits of massage.
Take a read. Those words are in fact written by scientists. So massage can make people feel better. And that is a good thing.
But for those sponsors and advisors who are inspired by this earlier slide, there has to be pause for thought about the dollars spent on treatment that is more passive in nature and does not deliver more profound, long-term health outcomes. So, what is our take on massage?
Those scientists that wrote those balanced and thoughtful words about the impact of massage also wrote these: “There is no evidence-based reason to believe massage can influence the course of any disease”. The question that the startling massage usage numbers in this study prompt is whether massage has jumped the shark into in a whole different world.
Think back ten or fifteen years ago – the spa concept was for the richy rich. Maybe a special treat once a year. That has all changed.
Back to our life on benefits……………..
Yes, in the 20’s we continue to see very high volumes of sex. And something interesting is in the number three spot – methadone for substance abuse treatment. But it only shows up in the chart because it is dispensed daily as a safety precaution. So, fear not, you have not underestimated the number of addicts in your population. And you will see it does not appear at all in the cost chart………………….
Here on the drug cost side you see the steady rise of biologics……number three now..…. Why? Arthritis, on top of Crohns and Colitis, is starting to to drive some numbers…………
On the health side, the increasingly famous amalgamation of Chiro, Massage and Physio takes over in terms of claim volume.
Number one with a bullet. Already………………by our 20s…………massage takes over as the largest cost service.
Onward we go
Most of us understand this slide about our 30s. Sex takes a nosedive down the chart. ………….and depression is now number one. And look to the bottom for the emergence of ulcers and GERD. What is GERD? Let’s all say it together – gastroesophageal reflux disease. That will be in every drug volume chart you see from here on in.
For drug costs, it only takes until the 30s for the biologics to rise to the top of the charts. The Rheumatoid Arthritis claims increase in this age band and if you look in the middle of the chart, the 30s is also the most common decade for MS to be diagnosed. Something to remember when we see the biologics in the number one cost slot over the middle of the age band study………. With well over a million plan participants at GSC, less than a thousand are taking what meets our criteria of a high cost drug – namely $40 a day – or about $15K a year. So, we are looking at a very small number of people driving those biologics numbers.
On the health claims side, we fall into a now familiar pattern………..a combination of chiro, massage and physio lead the claim volumes………………..
But massage takes a really firm hold as the number one cost driver in this slide. It separates itself from the pack. In the 30s age band, it accounts for 25% of the female health benefits spend. It is just under 20% for males. That does not sound like a large gap, but as hinted at earlier, women, by far, are greater consumers of these health benefits than men. In the 20 age bands, women spend over 80% more than men on these paramedicals. Here in the 30s, women spend 73% more than men. Male apathy is undoubtedly part of that. Women seek more care – we see it with drug and dental benefits too. But you saw the ad earlier – is it also a triumph of marketing? More to think about.
Into middle age we go……………………
As we saw last year, in the 40s, the volume of drug claims starts to shift to the world of chronic disease – mental health still leads the way but at number 5 we see cholesterol rearing its head. What becomes clear in this data is that pain meds are closely tied to a whole host of chronic diseases and used in combination with a lot of chronic disease meds. See number three and four. We dug into the data here and confirmed the most common second drugs used by people on anti-depressants is pain medication.
A now familiar story emerges on the drug cost slide – biologics trailed by a whole host of categories, increasingly dominated by chronic disease.
For volumes of health benefits, the 40s look a lot like the 30s………..and the 20s…………..
Massage is still number one. But we see it dropping back closer to the rest. In this age band, we start seeing men getting off the couch and seeking more treatment……………from women outspending men by 73% in their 30s, it drops to outspending men by 47% in their 40s.
Time marches on…………..
And here we are right in the middle of the age bands that have the highest volumes and cost for drug claims. You see the full impact of the group we have always called the Impactables. Middle-aged folks with chronic diseases – most pre-dominantly mental health, cholesterol, hypertension and as we drew attention to before, lots of pain meds mingled in………………..
Here is the cost slide. Please remember while we have shown you drugs costs starting with youngest of us, close to 70% of all the costs you see in our age band slides are generated by plan participants between the ages of 35 and 65. So, now we are into the very costly folks………..and as you can see above, we always urge audiences to add up all the percentages attached to those chronic disease states below the biologics.
We see the same old story on the health benefits side, but this is the first age group where we see a diminishing impact of massage………… Why? We firmly believe that these older generations do not have it as an integral part of a specific lifestyle as we see it in the younger age bands. To confirm, in this study, between the ages of 26 and 52, where most of the employees are, massage is the most costly benefit.
So, while still number one on this chart, this is actually the last hurrah for massage in the age band study. But before we leave the topic of paramedicals and their place in the study it is time for another episode of ……………………..
For the 12 month period of this study, there were about 145K GSC participants who had massage claims and 140K GSC participants who had chiro claims. Of these, about 75K were the same people using both benefits.
Of those 75K, approximately 25% received both the massage and the chiro treatments at the same location.
Plan participants that had either massage or chiro, or both, had higher drug costs than plan participants who used neither of the services. So, in our book of business, it does not appear that these parameds eliminate or reduce drug spend. (BUILD) Here are the numbers to prove it.
Have we got you thinking yet?
Two more age bands to go…………………
Chronic disease rules in the 60s…………………and as we asked last year, are advisors, sponsors and carriers looking at strategies to ensure that future generations do not have this problematic, costly and avoidable health profile?
To confirm, these age bands at the end of the study are our most costly employees when it comes to per capita drug spend.
And while the volumes of health benefits look similar to earlier slides………………………
New entrants emerge on the cost side, namely hearing aids, predominantly for males.
Here they are……………….
Take a look at those disease states – it is a roll call of chronic disease. And, finally, our last age band – our apologies, but we just lumped everybody else together into one…………… BUILD
Both in volume and costs, chronic disease rules………………….but, interestingly, we are also seeing the first generation of biologics users getting into their 70s and beyond.
And here you see a changing health benefits profile with support services and long term care emerging…… A small number of GSC’s largest clients have long term care benefits, and as you see in the cost slide……………..
Are they ever expensive……………….. If you avert your eyes below to more commonly offered benefits, you see hearing aids at the top and paramedicals shrinking. Last, we have pointed out the female – male splits in cost in distribution. We will end the Age Band study with a final, overall look at that phenomenon. (BUILD)
As we pointed out at the beginning, boys outspend girls, but then everything changes starting in the teens. To really significant differentials in the 20s and 30s……and then still significant but ever declining differences towards the 50s and 60s. The spike in the 70s is somewhat attributable to long term care costs for women who flat out live longer than men. So that brings our Age Band Study to a close – we know it was a lot of data in a short period………………
……………………but we are going to come back to look at what we think the bigger picture is before we finish.
Back by popular demand are a few slides on the prescription drug landscape over the past year.
First the Canadian Landscape – the big Canadian numbers. Up over a billion dollars from last year to $34.5 billion – almost $30 billion in prescription drugs.
Type notes here
And how do Canadians do at actually taking those billions of dollars in drugs? As you most of you will know, the topic of adherence has caught our fancy over the past three years – driven by high rates of non-adherence that waste valuable benefits dollars and contribute to poorer health. We will give you an update on four dominant disease states.
We will start with hypertension. This slide tells you people taking hypertension meds in the GSC book of business have three times more claims and cost three times more than people that do not take hypertension meds.
Like last year, the highest adherence rate we see is among hypertension patients. But still over a third are non-adherent.
Here is cholesterol. Very similar volume and cost numbers to hypertension.
But lower adherence.
Depression – again three times the claims and costs as claimants not taking depression meds.
And as we see every year, the lowest adherence to medication therapy.
Last, the epi-centre of chronic disease in Canada – Diabetes. These are the plan participants with the highest volume of claims, and the second highest costs only behind biologics users. Four times the claims and costs of non-diabetics.
And, worryingly, only 55% are adherent to their medication regime.
So more about the origins of Change4Life…………………….and as you have seen today, it all lives in the data. Last year we used Keith Richards as the symbol that humans are living far longer than they reasonably should. And in Canada that means almost 80 years for men. And mid-80s for women. And those ratios on the slide tell us that in the 1960s we had eight workers contributing towards the healthcare costs of every one senior. Because of lower fertility rates and longer life spans, in the next thirty years, that will drop to only two workers for every senior. That suggests a looming healthcare cash crunch, if it doesn’t exist already.
And want some more depressing news? Canadians think they are world class healthy. Remember we told you last year that nine out of 10 Canadians rank their health as good, very good or excellent. That is the highest self-perceived health status in the world. Apparently we deserve a gold medal. But if you just spent the last half hour looking at the same data we did, we welcome you to join us in worrying that we are pretty delusional. After all, we are the only nation in the world that ever looked down and its plate of French fries and thought………………………….. (BUILD)
No. That is way too healthy.
Take a look…………………survey the slide. This stuff is for real. And if you go to fairs and exhibitions across our country, you will find the stands that sell this stuff. Yes, we can laugh at it, but there’s a problem.
It is what we eat. And what do – most notably sit. All day. Never have humans been so sedentary.
But GSC is not going to give into cynicism about our ability to drive change. The headlines are too consistent in the world now……… The strain on our healthcare dollars is growing too great and Keith Richards just told us it is only going to get worse in the years to come.
Please remember – we think we are healthy, and we are not.
And in this study period GSC plan sponsors spent a whole lot on benefits that have zero impact on those very problems. That is $144 million dollars on glasses, massage, chiro and shoes. How much on dieticians and nutritionists? Squint and you can still barely find it. $100K. Versus $144million.
Which leads us to a question that is starting to stare in the face. What is insurance really for? Something that looks like this, I think. (BUILD) Or something that does this.
Do we need it for this? (BUILD) To be clear, we are not saying there should not be any coverage for these paramedicals, but is it growing at the expense of other, more impactful and necessary things?
Food for thought. We hope healthy food for thought.
We have swamped you with tons of numbers and we hope some unique observations. But before we go, we thought we would offer a couple of tips. It is only fair to give a couple of answers after tossing out difficult questions………………
First, we have provided options to improve our personal health – you know them by now……………… Eat Healthy
Kick the demon weed. Any particular one you choose……………
And stop at two drinks…………………..ok, maybe three……………. First, you need to stop smoking. You know that. But of the other three, diet, exercise, less alcohol, if you could only do one………what does the research tell us is ultimately the most impactful? What do you think?
We should not have made fun of Richard Simmons all those years. He was right! It’s exercise.
And on the plan design side? It is hard to find a path to change because we know people love getting glasses paid for…………….and getting their parameds………………… But if we were to think of new things we could offer, what would they be? Back to the Sanofi survey last year, and, look, plan sponsors are starting to think about Change4Lifeish type stuff…….fitness classes, health coaching, exercise equipment - they are all in there – and that is good news. And look, there is pet insurance there too.
How about plan members? What are they thinking of? The study tells us that too. Some of the same fitness and exercise stuff is there again……………..very cool. But, look at the bottom, they are even more in on Pet Insurance. So, our last, very important word of advice today. Whatever you do, do not offer pet insurance. Because if you have learned only one thing today, it is that the moment your pet finds out they have an insurance plan………………… (BUILD)
You know they are just going to run out and get a bloody massage.
Massaging The Data: Collette Morgan, Senior Account Executive, Green Shield Canada