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Ask the Canadian Expert
Cherri Burdeyny, CEBSManager, Information Management & Plan Administration
Alberta School Employees Benefit PlanEdmonton, Alberta
12D-1
Agenda
• Benefits Past and Present
• Plan Challenges
• Reshaping the Future
• Interactive Discussion
12D-2
Benefits Past and Present
12D-3
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)
12D-4
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
12D-5
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
12D-6
Plan Challenges
12D-7
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
12D-8
Industry Environment
• Working in silos
• Stagnant engagement
• Technological and chemical advancements
• Reluctance to change
• Legal and regulatory requirements
• Government need to offset
12D-9
Demographic Environment
• Multigenerational– Differing health needs
– Meaningful communication
• Family structure• Higher education• Instant gratification
12D-10
Reshaping the Future
12D-11
Leaving the past behind in order to reshape the future…
12D-12
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
12D-13
Plan Management Readiness
DoNothing
Provide Nothing
Absorb Shift Contain Eliminate
How much? Where?Strategy? What?
12D-14
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)
12D-15
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!
12D-16
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
12D-17
Interactive Discussion
12D-18
OPPORTUNITYEN
GA
GE
COLLABORATEPLAN CHARTER
STRATEGY
PHILOSOPHY
WHOWHAT
KNOW YOUR PLAN
WHERE
HOW
12D-19
Thank you!
12D-20