10 steps toward chronic disease management

Chronic disease appears to be increasingly on plan sponsors’ minds, with good reason given its dominance in drug and disability claims. What can employers do to address its growing presence—and impact—in the workforce? Quite a bit, as it turns out.

Four out of five plan sponsors (82%) would like their health benefit plan to do more to support people with chronic conditions, according to the 2019 Sanofi Canada Healthcare Survey. This desire aligns well with the wishes of plan members who have chronic conditions: 87% of those plan members surveyed would like to know more about their condition and how to treat it.

What percentage of the workforce could benefit from these additional supports? At least half. Fifty-four per cent of surveyed plan members reported having at least one chronic condition, and 42% said they experience chronic pain. Combined, 67% of plan members have a chronic condition and/or chronic pain, according to the 2019 Sanofi Survey.

Given the alignment between plan sponsors and plan members and the large population that could potentially benefit, the evolution of health benefits and wellness programming to better support chronic disease management appears self-evident. Yet that doesn’t necessarily make it easy. Plan sponsors’ concerns about costs are the biggest barrier to taking action (60%), followed at some distance by a perceived lack of offerings from insurance providers (26%) and not having the right data/information to know where to focus (26%).

“Employers might feel the whole area of chronic disease management is too broad or too overwhelming, in terms of how to get at it,” confirmed Kim Siddall, vice-president, health solutions, Aon.

However, over the past few years there have been encouraging signs that employers can, indeed, make important contributions to employee health. Innovations in treatment and access to quality care, as well as the potential to better leverage technology and claims data to focus efforts and tailor offerings, open the door to cost-effective opportunities to support chronic disease management.

“We will see new types of programs come to market in the medium and long term that are intended to improve health outcomes, especially for conditions where outcomes can often be influenced by behaviour, such as type 2 diabetes, cardiovascular disease and obesity,” said Matt Gaudry, director, product support and management, Great-West Life.

“The opportunity is to spark employers to take action and empower them with new capabilities, including digital resources and communications that connect employees with what’s available to them,” said Jennifer Elia, assistant vice-president, integrated health solutions, Sun Life Financial.

Technology will be a main component of coming programs, both to engage plan members (e.g., with digital or virtual tools) and to manage costs (e.g., digital, targeted communications). “By leveraging technology we can increase scale and the employers’ capacity to help members while still delivering high-quality and really relevant support or education. That helps drive down the cost but does not diminish the value offering,” explained Gaudry.

As well, evidence is growing to show the benefits of improved chronic disease management in terms of productivity, absenteeism and disability leaves. “We are getting better at the ROI. The industry as a whole is learning to use their data more effectively to show that these programs are worth the investment,” said Gaudry.

How does all of this translate into actions for plan sponsors today? Our three experts offer the following 10 concrete steps to better support chronic disease management in their workforce.

1. Dive deep into data. Work with your insurer and advisor to analyse all claims data and zero in on one or two conditions to start. “You want to direct resources and design benefits and wellness programs to meet your employees’ greatest need. Mental health, musculoskeletal, diabetes and cardiovascular are often the conditions we see at the top of the list,” said Elia.

Insights from the data are also important to paint a picture of the costs of unmanaged or poorly managed chronic disease (demonstrated by an escalating use of medications, for example, or an increased frequency or duration of disability leaves).

2. Get senior leadership buy-in. Use the data analysis to make the case and secure resources. That may not necessarily entail funding, at least not at first; however, dedicated staff time is essential. “As we’ve learned with wellness in general, to have a really effective program you need someone on staff to own it. You’re more likely to get the outcomes you’re looking for if it’s not done off the side of someone’s desk,” emphasized Siddall.

Leadership buy-in is also essential for employee buy-in. “Your communications strategy needs to include visible leader support, to help foster a workplace culture that allows open conversation about health and chronic disease,” noted Elia.

3. Work with the right advisor and insurer. Is your advisor on board as a resource and guide? Are your insurer’s offerings evolving to address chronic disease management? What is the average caseload for your plan’s disability case managers: is it reasonable to allow for proactive communications and interventions with employees on leave?
4. Remove barriers in plan design. For example, if diabetes is one of the targeted chronic diseases, lack of coverage, coverage maximums or ongoing co-pays for non-drug medical supplies or devices may be barriers to successful diabetes management.

In the area of mental health, it’s interesting to note that utilization of psychotherapy services is often quite low, despite the fact that mental health issues are a leading driver of both drug and disability claims, observed Elia. This is partly due to coverage maximums that fall short, leading to the under-utilization of psychotherapy services in order to avoid out-of-pocket costs. “In our own organization we increased the psychological benefit significantly, and early results suggest that greater utilization of psychology benefits can lead to improvements in treatment in mental health disability claims trends, including earlier return to work,” said Elia.

Siddall also recommended expanding the psychotherapy benefit itself. “Psychologists are not always accessible in every community, so look at broadening the types of providers to include family therapists, for example. And check per visit maximums to determine if they need to be increased.”

5. Improve disability management. Siddall cited one of her clients as an example of how to improve chronic disease management support for plan members on disability leave. Concerned about the growing number of leaves due to mental illness and musculoskeletal chronic pain, the 4,000-employee manufacturing firm worked closely with its disability provider to be more proactive in case management and the development of individual return-to-work plans. “They also understood that it would take time to turn the ship. In year two claims started to slow down, and then years three and four saw decreases. We continue to see fewer claims going to long-term disability, and shorter claims duration for short-term disability,” said Siddall.
6. Implement HR policy for absence management. Certain chronic diseases may involve episodes or “flare-ups” of symptoms, which may cause late arrivals or early departures from work, or absences of a day or two. “Flexible work arrangements or remote work arrangements can help, when it’s possible,” suggested Siddall.
7. Evaluate all benefits and consider trade-offs to free up funds for chronic disease prevention and management. “Once you understand the impacts of chronic disease in your workforce, look at how you are investing in benefits and wellness programs. Are the resources targeting the areas of greatest need? The concept is to continually evaluate plan performance and plan design, to make sure you’re not allocating resources just because they’ve always been there,” said Elia.
8. Participate in pilot projects. When it comes to innovations in treatment (such as pharmacogenomic testing) or technology tools (such as targeted messaging based on personal claims data), pilot projects are essential to test for outcomes and feasibility. They can also be a way for plan sponsors to be progressive, at a lower cost. “Our role as a group insurance provider is to test and learn, and in an ideal scenario plan sponsors put their hands up to partner with us on pilots so that we can learn together, and design benefits for the future,” said Elia. “The commitment is not necessarily resource-heavy on the plan sponsor side, and they may think it’s more work than it really is. What we’re really looking for is an openness to try new capabilities and innovations.”
9. Communicate, communicate, communicate. Resources may already be available to support chronic disease management, particularly when it comes to lifestyle behaviour change, through an employee assistance program or paramedical benefits. Unfortunately, “lack of awareness is often the number-one challenge,” stressed Elia. “It’s critical to dedicate communications resources to ensure employees know what’s available.”
10. Stay on top of healthcare innovation. All three of our experts agreed that there is a lot of innovation going on in health care today; for example, medical-grade, wearable smart devices that generate clinical data that can be accessed by healthcare providers. Work with your benefits providers to stay informed and to evaluate their application to your workforce, and to generate excitement about the potential benefits for employee health and productivity.