Plan sponsors may be underestimating the impact of chronic disease in the workplace, and how the workplace can negatively affect employees’ ability to manage their conditions, according to a survey by Sanofi Canada.
Fifty-nine per cent of employees have at least one chronic condition, such as high blood pressure, diabetes or depression. Broken down by age, 79 per cent of employees aged 55 to 64 have at least one condition, compared to 40 per cent among those 18 to 34.
But employers think just 32 per cent of employees have such a condition, found the survey of 1,500 primary holders of group health benefit plans and 500 health benefit plan sponsors.
Many chronic illnesses are not visible, such as high cholesterol, so the only way an employer would know how many workers are affected is by looking at claims plans, said Marilee Mark, vice-president of market development, group benefits, at Sun Life Financial in Toronto.
And with issues around data privacy, employers don’t have all the answers, said Thy Dinh, director of health economics at the Conference Board of Canada in Ottawa.
“They just know how much money’s being spent on drug plans and other benefits that are being used under their plans, so unless you know exactly who’s getting these drugs or certain services or programs, it’s really hard to tell the exact number or prevalence of any particular type of chronic diseases within their employment base.”
At the same time, there may be employees with chronic conditions who aren’t using the benefits for those issues, she said.
Sixty-two per cent of employees said their condition had no impact on their work, so that’s also invisible to employers, said Anne Nicoll, vice-president of business development at Medavie Blue Cross in Toronto.
“But if they start looking at their costs, they look at the utilization for health plans and drug plans, I think that starts to paint a very different picture, and hopefully with more time and analytics and awareness of how broadly chronic disease is impacting individuals in Canada, that gap will close.”
The gap likely means plan sponsors also underestimate the impact of chronic disease in the workplace. More than one-third of plan members (38 per cent) with chronic conditions said their illness has caused them to miss work (25 per cent) or made it harder to do their job (19 per cent). This jumps to 62 per cent for those with depression, found the Sanofi Canada Healthcare Survey.
If employers aren’t thinking about the impact, they’re not necessarily thinking about what they can do to support people, said Mark, “because if chronic conditions are not managed or caught early, it can lead to absences or higher utilization of claims, which then translates into costs, so that’s the danger.”
But 70 per cent of plan sponsors would like a better understanding of the burden of chronic disease in their employee population, found the survey.
In understanding the illnesses that are driving the costs, an employer can “make a business case to be able to identify more supports and inclusions and interventions to try and address that cost, but also to understand the burden in terms of how it breaks out to identify what to do, because there are different types of supports available depending on where the bulk of the need is,” said Nicoll. “So it’s partly a needs assessment and it’s partly a business case.”
An employer doesn’t need to know an employee’s condition, only if accommodation is required at work, so that’s part of the role an insurer needs to play, said Mark.
“And with privacy concerns, the insurer can be a conduit of information for resources, but it really has to be the employee who has to agree to that.”
However, 33 per cent of plan members said their work environment negatively affects their ability to manage their chronic condition, rising to 63 per cent among dissatisfied employees.
Some of it could be work demands, so workload can make it difficult to manage a condition, with increased stress, said Mark.
The connection between physical and psychological health is an important one, said Nicoll.
“It’s very hard to separate those things because if you’re finding that there’s too much work and the demands put on you are overwhelming, then it leaves less room for someone to make those choices and make those healthy choices.”
A great way to help employees is to take more positive action and to make healthy living easy, she said. That can mean providing flexible arrangements and access to healthy foods.
Sixty-four per cent of plan members with chronic diseases said they want more support, yet many employers don’t provide the kind of support that’s helpful. This can include providing more choice when it comes to services, such as certified diabetes educators or respiratory therapists who can talk about medications, self-care and self-management, said Nicoll.
“Historical benefit plans have not typically included that provider type and that’s where we’ve been working on incorporating additional provider types to allow that shift to occur where the individual can choose where to go for what they need when they need it,” she said.
“The key really is the flexibility, the access to services, and then allowing people to make choices so they can take action.”
However, EAP programs are often underutilized, said Dinh.
“Having a dietitian isn’t a bad idea or a nutritionist but if employees don’t know that’s part of their plan or they aren’t reminded ‘This is part of your plan, this is how it’s beneficial to you,’ then you run the risk of that not being used; at the same time, maybe it doesn’t mean much to the insurer because that means they’re not paying out for that particular service. But it’s nice to track that. I mean, we could look at (whether) that does integrate that into their plan and see what the uptake is like. Is it good or is it still status quo?”
The desire for choice is growing, and it makes sense with all the generations in the workplace, with different needs and expectations, said Mark.
“What employees need or expect now continues to change, so…We need to take a step back and look at ‘Are we offering the most relevant (benefits)?’”
One of the biggest challenges is adherence as many employees with “invisible” conditions such as cholesterol or high blood pressure may be reluctant or remiss in sticking to their treatment plan.
“It’s really important for someone to understand what the real risks to (them) are, what are the implications if you do or don’t do this,” said Mark.
There are programs where pharmacies send people notices when it’s time to renew, and additional information from a health coach, be it in-person, telephonic or digital, and that can help, she said.
“That may be a way from a prevention standpoint until they get into a good routine — it could send them a nudge.”
It’s very difficult for an employer to know if someone is compliant or not on their drugs, but pharmacists know, said Dinh.
“Compliance is huge because that really feeds into the effectivenesss of your drug, and if your drug is not effective for you, you’re paying for something that you’re not getting the benefit of… you’re not getting your full value from the employer and the health-care system.”
Boosting communication to workers would definitely help, she said.
“Even just to say, ‘Do you know that this many prescriptions go unfilled? Do you know that only 80 per cent of Canadians are fully compliant with their medication, and this results in…’ Those kinds of communications: ‘What does it mean for you if you aren’t staying on your drugs? Your health may not be managed.’ That could work and it’s relatively low-cost.”
Fifty-eight per cent of plan members would consent to receive health-related information — based on their own use of benefits — from insurance companies, found the Sanofi survey.
“It is about being specific and if someone does fill a prescription, for example, for a certain type of medication, say it’s their first asthma-related meds or Type 2 diabetes meds, to be open to receiving some targeted communication around that is great to see. And. again, how they manage that and access that information will be up to the individual, but the opportunity to make the connection at the time when it’s needed is the key, in our view — it’s got to be timely and it’s got to be meaningful,” said Nicoll.
“An employer needs to create the opportunity for an individual to have that dialogue, because health is personal, so the more personal and the more specific the guidance is, the better,” she said, such as having an advisor in the workplace or on-site events.
Really, if you’re trying to change personal behaviour, the message has to be directed to that person, said Dinh.
“That’s the only way it will resonate with an employee, (talking about) what it means for them, individually.”
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