Ask the Canadian Expert - ISCEBS€¦ · Tools and Support PAST: • Paper-based communication •...
Transcript of Ask the Canadian Expert - ISCEBS€¦ · Tools and Support PAST: • Paper-based communication •...
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The opinions expressed in this presentation are those of the speaker. The International Society and International Foundation disclaim responsibility for views expressed and statements made by the program speakers.
Ask the Canadian Expert
Cherri Burdeyny, CEBSManager, Information Management & Plan Administration
Alberta School Employees Benefit PlanEdmonton, Alberta
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Agenda
• Benefits Past and Present
• Plan Challenges
• Reshaping the Future
• Interactive Discussion
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Benefits Past and Present
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Tools and Support
PAST:• Paper-based communication• Limited interaction• Telephone, face-to-face
PRESENT:• Mobile apps, online claims access• Internet, live chat• Mobile devices
(gamification, contact lenses)
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Plan Member Relationship
PAST:• Parental: “we know best”• Benefit plans were costs• Challenged to cover everything
PRESENT:• Partner in health: benefit plan is an investment• Shared responsibility• Optimal health is key
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Health Provider Relationship
PAST:• Interaction left to TPA• Front-line communicator of our coverage details• Unsympathetic to providers’ realities• Transaction-based
PRESENT:• Spokesperson for our collective vision• Value-added services, integral to our success • Allies…if interested
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Plan Challenges
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Benefit Plan Pressures
Dental Costs
New Drug Costs
Formulary Creep
LowInterestRates
Employees Living Longer
Medical Inflation
Weak Audit Controls
Medication Non-Adherence
Generic Pricing
Reductions
Special Authorization
Process
Increased Employee
Engagement
Patent Cliff
ENVIRONMENTAL FACTORS
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Industry Environment
• Working in silos
• Stagnant engagement
• Technological and chemical advancements
• Reluctance to change
• Legal and regulatory requirements
• Government need to offset
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Demographic Environment
• Multigenerational– Differing health needs
– Meaningful communication
• Family structure• Higher education• Instant gratification
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Reshaping the Future
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Leaving the past behind in order to reshape the future…
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Benefit Plan Philosophy
PAST:• Thirty year journey• Prescriptive plan design approach• “Fire-proof” the plan
PRESENT:• More strategic• Various lenses: health impact, risk of not covering• Outcome-focused• Investment vs. cost
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Plan Management Readiness
DoNothing
Provide Nothing
Absorb Shift Contain Eliminate
How much? Where?Strategy? What?
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Data and Analytics
• Embrace “big data”– Cross sectional
– Adherence levels
– Disease states
• Know your VOI– High Cost/Questionable Therapeutic Value?
• Offer mobile health, drug and dental apps– Dual purpose (gather data; share knowledge)
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More Creative Plan Solutions
• Preventative dental• Therapeutic drug pricing
substitution• Enhanced special authorization• Step therapy solutions• Tiered Coinsurance• Maintenance medication
strategy• Product pricing agreements
Los Algodones: Dental Centre of Mexico!
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Strategies for Sustainability
• Managed health care plans
• Adherence focus
• Compensation for value-added services
• Abandon ”one size fits all”
• New responsibility matrix
• Redefined Strategic Partnerships
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Interactive Discussion
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OPPORTUNITYEN
GA
GE
COLLABORATEPLAN CHARTER
STRATEGY
PHILOSOPHY
WHOWHAT
KNOW YOUR PLAN
WHERE
HOW
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Thank you!
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