Evolving Data into DollarsEvolving Data into Dollars

Strategies and Accountability:

Four essential elements to meet the reality of higher-cost drugs

Oct 2012

Evolving Data into DollarsEvolving Data into Dollars

The Rationale for Benefits

Attract/ retain employees

Keep employees at work/return to work

Good corporate citizens

Balance of selfish and unselfish objectives

Evolving Data into DollarsEvolving Data into Dollars

Four Essential Elements

Innovation in plan design

Foster employee

consumerism

Challenge/lobby government

Measure and respond

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Innovation in design

• Why were drug benefit plans designed with a flat fee co-pay?

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Innovation in design

• Plan design needs to evolve to keep pace with evolving realities (escalating costs)

• Sharing of high priced drugs by insurers step in the right direction

• Need to examine ways to combine:– Flex benefits/defined contribution/healthcare spending accounts

• Pluck ideas from the US– High-deductible, account-based consumer-directed health plans

(CDHPs)

• Break the old Models– Carve out insurance for select disease categories and continue

ASO for balance

• Build exceptions into the process

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Employee Consumerism

Source: Harness the potential of Generation Y, http://www.sunlife.ca/static/canada/Sponsor/Bright%20papers/GenY%20BrightPaper%20E.pdf

Evolving Data into DollarsEvolving Data into Dollars

Employee Consumerism

Source: Harness the potential of Generation Y, http://www.sunlife.ca/static/canada/Sponsor/Bright%20papers/GenY%20BrightPaper%20E.pdf

Evolving Data into DollarsEvolving Data into Dollars

Employee Consumerism

• Employees need to make informed decisions about their benefits

• Need to examine ways to combine:– Flex benefits/defined contribution/healthcare spending

accounts– Elements of consumer-directed health plans (CDHPs)

• Allow accumulation and role over• Optional/non-optional insured components for high

cost disease areas• Seek tax advantaged treatment of premiums for high

cost areas (like LTD)

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Challenge/lobby government

• What percentage of drugs for renal cell cancer are funded by the private sector?

• Ten years ago?

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Challenge/lobby government

• Significant percentage of product pipeline in cancer are oral meds (1/3) and other biologics are often oral formats

• Private sector share of drug coverage increasing and will continue to do so

• Government NOT playing well with others• What can be done?

– Stop providing benefits– Dump on your employees– Live with it– Work to change the environment

Evolving Data into DollarsEvolving Data into Dollars

Challenge/lobby government

• Work to change the environment – Define government roles/accountability– Tax supportive policies– Push for trade offs– Quantify expenditures

Evolving Data into DollarsEvolving Data into Dollars

Measurement

• Considering all drugs paid for in the private sector in 2011, what are the top 3 diseases being addressed?

“While 82% of respondents agree that their company’s benefits plans provide good value … only 29% say they calculate the ROI of their

plans

Leigh Doyle | August 01, 2012

http://www.benefitscanada.com/benefits/health-benefits/justifying-the-investment-30572

• Considering all drugs paid for in the public sector in 2011, what are the top 3 diseases being addressed?

• What is the potential cost impact to the private sector of prostate cancer in 2020?

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Measurement

• Tools can be built to provide strategic insights in healthcare expenditures

• Challenge existing providers

• Create industry/private sector working groups to design/fund/build

• Work with the Pharmaceutical industry

• Utilize technology as an enabler

“While 82% of respondents agree that their company’s benefits plans provide good value … only 29% say they calculate the ROI of their

plans

Leigh Doyle | August 01, 2012

http://www.benefitscanada.com/benefits/health-benefits/justifying-the-investment-30572

Evolving Data into DollarsEvolving Data into Dollars

Who owns this?

Gov’tEmployeesEmployers

Health Care Community

Innovation in plan design

Foster employee

consumerism

Challenge/lobby government

Measure and respond

WHO NEEDS TO LEAD IT?