PLAN SPONSOR

Mike Lee
Vice President Human Resources, Moosehead Breweries Limited (Saint John, New Brunswick)

Michael Lee joined Moosehead Breweries Limited, Canada’s oldest independent brewery, in 1999. In 2006, Mike represented one of seven employers participating in Inspire at Work, an asthma self-management program in the workplace. The program realized a return on investment of $4.24 for every dollar spent. Mike is a graduate of the University of New Brunswick with an honours BBA degree. He holds a Certificate in Employee Benefits from Humber College and is also a Canadian Human Resource Professional (CHRP).

* View Expert Q&A with Mike, see Question 1 below.

PLAN SPONSOR

Bruce Fraser
Manager Disability & Wellness, Sobeys Inc. (Stellarton, Nova Scotia)

In 2000, Bruce joined Sobeys Inc., one of Canada’s two national retail grocery and food distribution companies, which operates more than 1,300 corporate and franchised stores in all 10 provinces. After leading the group benefits department for over seven years, he is currently responsible for governance and integration of occupational and non-occupational disability claims management for Sobeys. He also manages the alignment of national wellness initiatives.

Bruce is a graduate of Acadia University with a Bachelor of Science and Certificate in Applied Science. In over 16 years in the industry he’s earned the RHU, GBA, CMS and CEBS designations.

PHARMACIST

Margaret Brna, B.Sc. Pharm.
Manager Pharmacy Professional Affairs, Shoppers Drug Mart

Margaret Brna has practiced pharmacy in various settings, including community pharmacy, pharmaceutical industry and retail pharmacy corporate office. Her experience includes consumer health marketing as well as development of health educational programs. In her current position with Shoppers Drug Mart corporate office, she is responsible for the development of fee-based cognitive services and manages customized health programs for the private sector under the HealthWATCH for Business brand.

* View Expert Q&A with Margaret, see Question 3 below.

PHYSICIAN

David A. Alter, MD, PhD, FRCPC
Chief Scientific Director, INTERxVENT Canada

In addition to his position at INTERxVENT Canada, David is associated with the Division of Cardiology and The Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto and The Toronto Rehabilitation Institute, Cardiac and Secondary Prevention Program. He is also an Associate Professor of Medicine at the University of Toronto. David’s research interests extend across many disciplines, including the examination of chronic vascular disease management and the evaluation of regionalization and/or decentralization of specialized cardiac services. Recently, he launched several pilot projects to measure the health and economic outcomes of disease management in the workplace.

*View Expert Q&A with David, see Question 1, Question 2, Question 3 and Question 4 below.

INSURER & PHARMACY BENEFITS MANAGER

Sal Cimino, B.Sc.Phm.
Manager, Pharmacy and Professional Services, Green Shield Canada

In 2001, after working as a hospital and community pharmacist and co-owner of three pharmacies, Sal Cimino became the resident pharmacy benefit consultant at Green Shield Canada. The department is charged with all facets of drug claims including, but not limited to, drug evaluations, formulary design/maintenance, drug pricing and drug policy. The department also serves as a liaison to the pharmacy community, the pharmaceutical industry and associations and regulatory bodies. Sal, who has his Bachelors degree in Science and Pharmacy, is currently a Director of the Board of the Essex County Pharmacists Association and a member of the Canadian Pharmacists Association and the Ontario Pharmacists’ Association.

*View Expert Q&A with Sal, see Question 1, Question 2 and Question 3 below.

BENEFITS CONSULTANT

Barbara A. Martinez Senior Associate, Mercer Health & Benefits Toronto, Ontario

Barbara Martinez helps organizations in both the private and public sectors manage their prescription drug benefit programs. Her background in pharmaceutical sales/marketing, government affairs and professional services has equipped her with extensive knowledge of the prescription drug, regulatory and drug approval process in Canada from both a government and private drug plan perspective. Barbara is a guest lecturer at the University of Toronto’s College of Pharmacy on the issue of direct-to-consumer advertising of prescription drugs and a frequent contributor to the work of the Canadian Pharmacists Association and the Ontario Pharmacists’ Association. She has spoken at conferences and as part of panel discussions to both the pharmacy and plan sponsor audiences.

* View Expert Q&A with Barbara, see Question 1, Question 2 and Question 4 below.

UNION

Lyle Hargrove Director, Health and Safety Training Fund Canadian Auto Workers

Lyle Hargrove develops health and safety training programs for the workplace, including educational videos, for the auto sector of CAW. He is the coordinator for several workplace wellness programs, including “Brake for Health” with General Motors and other disease-management initiatives with Daimler Chrysler and Ford. Lyle joined the Occupational Health Clinics for Ontario Workers Board in 2001, becoming Chair 2002.

* View Expert Q&A with Lyle,see Question 1, Question 2 and Question 3 below.

Norm Ball Director of Sales & Marketing, Rx Canada, Mississauga, Ontario

Norm recently joined the senior management team of Rx Canada, bringing with him over 20 years of sales and marketing experience in the healthcare industry. In his current role, he works with patients, pharmacies and benefit providers to develop innovative programs resulting in improved treatment outcomes while controlling healthcare provider and employer benefit costs.

* View Expert Q&A with Norm,see Question 4 below.

Sal Cimino
It might be a bit premature to determine where you will get the most bang for your buck, without first focusing on data collection, analysis, and interpretation. Otherwise—like the expression "you don't know what you don't know"—you will not have the solid foundation you need to make insightful decisions that will result in the best cost-benefit scenario.

Your first step should be to take a step back, and take a closer look at your employee group. For example, at Green Shield Canada, we use what we refer to as Benefit Insight® reports to help our clients put their plan experience under the microscope. This gives them a solid understanding of employee health and acts as the foundation for making insightful decisions.

To help identify problem areas, you might want to look at benefit utilization reports that flag fluctuations in usage within benefit categories. Also, take a look at reports that highlight drug categories where total claims exceed predetermined values and year-over-year variances exceed set values. Another insightful report would be one focused on medical conditions and chronic diseases, because it can examine claims patterns to identify issues that could potentially develop into serious medical conditions.

You can also compliment this kind of data by getting an outside, bigger picture perspective: for example, take a look at reports that benchmark claims utilization data against a database of similar organizations within an industry or province, as well as reports that provide information about industry trends like how the introduction of a new drug may impact usage patterns and health outcomes. Once you have all of this data at your fingertips, you can give it to your EAP and disability carriers so that they can coordinate the data to do a number of things that will have a positive impact on your organization, such as:
• benchmarking leading indicators where disabilities may occur,
• examining the experience from a holistic perspective, and
• verifying employee compliance.

This wealth of data will help you realize the best value for your efforts, regardless of whether you end up focusing on disease management or health promotion and prevention strategies. Data collection and interpretation shifts your knowledge base from the position of “you don’t know what you don’t know” to “knowledge is power.” Now, armed with a clear picture of your employee group—everything from health status to drug usage to spending patterns—you can make informed decisions about where to focus limited resources.

Bruce Fraser
Congratulations for taking a most important step—you’ve identified the problem and articulated two viable approaches to addressing it.

I would suggest you begin by understanding your drug and disability cost drivers. If you don’t understand these drivers (your plan members’ most common and costly disease states) you can’t make the best use of those limited prevention resources. Looking at how your costs have trended over the past few years (and continuing to track them into the future) will help show which chronic diseases are a growing problem and could provide your best return for the efforts you make in prevention both now and in the future.

Your current carrier(s) will be a great data resource to start with. They should be able to provide you with metrics on which disease states are most prevalent in your employee population, and let you know which of those are most costly. Using your Drug Utilization Reviews (DURs), your extended health care (EHC) claims (these may not be high ticket items on your plan, but they do contain a wealth of information about your employees’ claiming and illness patterns) and your disability claims diagnosis metrics, your carrier should be able to see what drives these costs in your benefit plans. Privacy laws prevent an employer from doing this kind of analysis, but your carriers are uniquely positioned to conduct individual employee analysis to find patterns of use and cost connections among your plan members. This provides you with accurate meaningful data regarding what issues you should target for prevention. Most of this valuable data should be available to you at little or no cost.

Once you better understand what is causing your employees to be ill or off work, and what is costing your various plans the most money, you can better determine which initiatives align best with the issues your employees face (and the ones which your data shows will become more prevalent in your future workforce!). Decisions on how to target prevention will be based on the unique makeup of your workforce and industry, and influenced by other factors such as access to technology for your employees, whether you are in one physical location or scattered among many business sites, and what existing communication methods your company has available.

From a purely financial standpoint, it makes sense to target your least healthy employees first. They are most likely to have more drug and disability claims in the present and near future. It also helps to be able to generate some shorter-term returns to demonstrate the benefit of prevention and intervention and to generate funds to apply to longer-term efforts.

If your budget is extremely tight, one approach that costs very little is to simply communicate to your employees exactly what your company’s biggest claim cost drivers are. State what your top four or five disease states (or illnesses) account for in percentage and real dollar terms out of your overall health plan and disability costs. Whenever possible, illustrate which of these disease states may be under an individual’s control to change—such as smoking, high blood pressure, obesity or lack of exercise. It may be easier to believe one can effect change when these drivers and costs are reduced to behavioral issues that one may see as something to personally take charge of in one’s own life. Awareness is a first step to action.

There are also many prevention resources available to you at low cost. Provincial and National Health Departments have many targeted programs and information resources available. If your company has an EAP, you could work with that provider to ensure your program provides supports targeting the most costly issues affecting your employees’ health. They can also assist you with communication and promotion of these support services. Many national societies that target disease states, such as the Lung Association, the Heart and Stroke Foundation, the Canadian Mental Health Association and the Canadian Diabetes Association, can be invaluable resources for an employer who wants to provide information and support resources to employees.

By taking advantage of these low cost starting points you can build some momentum and your business case for greater investment by your company to reap those ROI rewards in the future. Good luck!

David A. Alter
The effects of economic peril are far-reaching. The challenges regarding priorities, resources, and activities are always difficult, whether it be for individuals, government, or employers. Employers must approach this pragmatically, and decide how and where they are to most appropriately invest, within the framework of their own fiscal realities.

That said, employers (small, medium, or large size) must understand the health implications of economic downturn. Available evidence suggests a close inter-relationship between economy, stress, and health. Evidence has demonstrated that individual psychological distress, health-seeking tendencies, and adverse lifestyle behaviours all increase during times of economic downturn. Indeed, a recent Desjardins Financial Security National Health Survey examined the perspectives of 1,062 Canadian employees between March and April 2009, and determined that psychosocial stress has increased 33 percent over the past year, with nearly one-third of all employees experiencing significant anxiety, sleep impairment, headaches, and other generalized nonspecific health complaints. During this economic recession, employees have been working longer hours, are less satisfied, and are finding it difficult to balance work, life, and health.

Recent evidence also suggests that many employers are actually increasing their investments in health during this economic recession. Such investments are likely to pay dividends with improved rather than deleterious cost-effectiveness ratios. Why? The answer lies with the likelihood that employees’ baseline risks are higher during the current economic climate. Higher baseline risks yield higher absolute expected benefits and lower numbers needed to treat to avoid adverse health outcomes. The investment returns associated with health and wellness or disease management programs during economic downturn are also likely to be broadly manifested to include favorable effects on health claims, drug costs, absenteeism, presenteeism, short-term disability and employee engagement—metrics which have already been well demonstrated from such programs during times of relative economic prosperity.

If employers are to invest into employee health, wellness, and disease management programs, the key message is that such programs must be accompanied with appropriate benchmark metrics and evaluation. Program surveillance becomes essential, so that the mental, physical, and behavioural health attributes of employees are documented, refined and targeted for interventions appropriately.  Employers may want to consider programs that allow for broader flexibility in content—those that address health promotion, medication management issues, diseases, and productivity. Employers and health human resource teams may want program delivery to vary in intensity depending on health, productivity, or disability metrics; programs that track behavioural compliance in real time, allowing for the selective targeting of individuals whose behaviours are most modifiable, will maximize returns-on-investment resulting from such intervention.

One’s personal investment and commitment into health cannot be driven or dictated by economic cycles, but instead, must remain consistent and impervious to environmental challenges. An employer's investment into their company’s health should be viewed as no different. Ignoring health during economic peril may only magnify the adverse effects of the company’s health over time (financial, cultural, and medical).

Barbara A. Martinez
Focusing on short-term strategies to lower drug plan costs is definitely one way to attain this objective. Proven ways are those used by provincial public drug plans, including placing limits on the list of eligible drugs, limiting the eligible cost to the price of generics, using pre-authorization for certain expensive drugs, and favoring therapeutic substitution. For important pressing cost reductions, an employer could be more adventurous and consider eliminating their company's subsidy toward dependents’ dental coverage for at least one year.

But why conclude that you need to choose between short and long term goals? Under this theme you could, for example, educate employees on stretching their healthcare dollars, inform employees on the relative cost of services available under provincial health plans and in private clinics, and promote the use of the health risk assessments (HRA) offered by your carrier at no cost. The employer could take further action on heath and wellness spending on a regular basis and build a momentum. For example if the HRA were promoted, the employer could report the results of the HRA and select interventions accordingly.

Norm Ball
Investing in your employees and helping them be productive is always a win-win situation. Many recent events have contributed to unhealthy stress and worries throughout most workforces. Economic and job insecurities are additional stressors which everyone is facing. Furthermore, employees who do not fully understand their own health issues and medical regime are often sidelined, resulting in lower productivity or prolonged absences covered through disability plans. If a company were considering an employee wellness program prior to this economic downturn, that consideration would be even more appropriate now.

Education adherence programs can offer an additional layer of support to employees to ensure pharmaceutical compliance and successful outcomes for them and the company. Such programs are key to ensuring employees understand their health issues, treatment plan and remain a contributing member of their organization.

When faced with the diagnosis of a chronic disease, many patients hear but do not fully understand the relationship between prescribed medications, lifestyle and commitment to a lifelong regime. It is well documented that the highest rate of medication drop off tends to be within the first 90 days of therapy.  Further research suggests that, for chronic disease, only 40 percent of patients still adhere to a medication regime one year after diagnosis.

Patient education adherence programs, however, can increase employees’ effective participation in disease management. The educated employee is better equipped to remain a productive asset and is less likely to require disability options. Customized patient education programs delivered directly to employees will assist those employees in both their personal and professional lives—a win-win situation.

Lyle Hargrove
Disease management in the workplace is so important that when resources are scarce we must be innovative in how we get disease management and education to our workers. In the short-term, we can get our HR people to contact health organizations in the community that are already funded by other sources, such as regional health units, the Heart and Stroke Foundation and the Canadian Diabetes Association. These organizations have educational materials and are more than happy to come into the workplace to help educate workers about different health conditions. In the longer term, when times and resources permit, you need a good comprehensive wellness program with a strong commitment from both management and workers that will make your wellness program successful and give you a good return on investment.

David A. Alter
Yes there are options. The key here is to take a long-term perspective on your organization’s health strategy. Once the blueprint has been established, its implementation can begin with smaller, simpler, less expensive steps. For example, simple health promotional activities themselves draw awareness to health, wellness, behaviours, and disease complications – awareness initiatives are essential to the successful execution of health-related interventions in the workplace.

Such health promotion initiatives may begin with the dissemination of publicly accessible educational materials related to health, risk, prevention, and screening activities. The vehicles for disseminating such materials may include lunch-and-learn seminars with a health professional. Others may embark on organizational healthy workplace initiatives (community-wide walkathons, team sports, etc.). The intent here is to begin undertaking a process of culture change within your workplace environment.

Such initiatives must occur with frequency, and must include the full commitment and active participation by all, from senior management downward. While such initiatives are not designed to alter the long-term behaviours, health or wellness of employees per se, organizational culture, excitement, and commitment is a prerequisite to the long-term success of any employee health and wellness comprehensive intervention (regardless of how costly the intervention is). Simple small-step initiatives may also have a positive impact on employee engagement, so returns with minimal investment may be eminently feasible.

The next step, while still largely affordable, may include the administration (through an independent third-party) of confidential health risk assessments to your employees. When doing so, you must ensure that the health risk assessment process allows for the quantification of biological and behavioral risk (indeed, most do). Health risk assessments do vary in complexity, accuracy, and comprehensiveness, so some due diligence may be required. Publicly-accessible health-risk assessments can serve as a start, but an organization will still require an independent third party to analyze the results and generate aggregate reports and interpretation. The quantification of risk through the use of health risk assessments not only serve to justify the need for the application of more comprehensive personalized health and wellness programs (assuming your employees risk-profiles warrant such intervention), but also help shape the program composition and intensity needed to maximize the health, wellness, productivity, and drug-utilization benefits.

Sal Cimino
Faced with the challenge of limited resources, one of the best strategies to try to free up funds is to examine your organization’s drug cost budget allocation. Each year organizations typically allocate increased spending on drugs. This budget increase may in fact represent ‘hidden funds’ – funds that could be re-allocated to wellness initiatives.

The funds budgeted for drug cost increases may possibly be an avenue for accessing hidden funds, as over the last few years drug costs have remained stable due to the introduction of generics, patent expirations and other factors. This pricing trend is expected to continue until at least 2010. As a result, you could consider re-allocating these funds to wellness initiatives like health risk assessments (HRAs) and smoking cessation programs that provide a solid return on investment in terms of reducing drug utilization and improving employee health.

The HRA is an especially worthwhile investment because it provides baseline information about your employee population that can then become the foundation for your wellness strategy. This enables you to confidently plan your wellness strategy so that resources are not only dedicated to the right areas/initiatives, but also are not wasted on low cost/benefit scenarios.

In addition, the more advanced HRAs provide additional value by going beyond health status reporting by also incorporating ROI calculations. For example, in addition to evaluating health data provided by its users, Green Shield Canada’s HRA also tracks and assesses corporate spending on health-related benefits, such as paramedical costs, drug utilization, etc.

With limited resources, in addition to investing in an HRA, depending on your employee group’s issues, another cost effective investment is in smoking cessation programs. Research indicates that smoking cessation programs can play a significant role in decreasing health claims for high cost, high utilization drugs for illnesses such as lung cancer, coronary artery disease, stroke, emphysema and chronic bronchitis.

Research also indicates that the most successful smoking cessation programs include the use of smoking cessation products combined with counseling, so the ideal is to find a program that includes these elements. For example, Green Shield Canada recently administered an innovative smoking cessation program for one of its clients that extended the employees’ benefits package to include coverage for nicotine replacement therapy products combined with coverage for pharmacist counseling services. Rather than having to put your wellness plans “in the ‘pending file’ for another year or two,” consider developing a business case for re-allocating resources to focus on investing in just a couple of key tools like an HRA and possibly a smoking cessation program. You are likely to find that the business case will speak for itself in illustrating how even limited resources can go a long way in delivering a significant return on investment.

Margaret Brna
Take advantage of various not-for-profit health organizations such as Heart and Stroke Foundation and the Diabetes Association to gain access to educational programs, services and publications that are often offered free of charge. Services range from provision of speakers for educational sessions, print educational information, lists of local resources and healthcare professionals, and comprehensive websites with objective and easy to read information on managing health conditions. The mandate of many of these organizations is to create public awareness and to share their educational resources, so they may welcome a partnership with your company to deliver some programming.
 Create awareness of publicly-funded programs among your employees. Contact your local Public Health Unit as they have expertise and resources available through publicly funded programs. In Ontario, employees are also eligible to take advantage of the MedsCheck program through community pharmacies. It is a medication review program funded by the Ontario government for individuals taking three or more chronic medications. This is a solid first step towards engaging an employee in disease management. Participating in it can help employees gain a better understanding of their therapy, expected benefits, clarify how to properly take all medications and help to prevent drug interactions with over-the-counter medications or natural supplements. To take advantage of this program, an employee can contact his local pharmacy or an employer can set it up with a corporate pharmacy chain.

Various pharmaceutical manufacturers, independent pharmacies and pharmacy chains have recognized the business opportunity of helping organizations improve results through collaboration with pharmacists on delivery of disease management programs in the workplace. Rexall Network as well as Shoppers Drug Mart (under the HealthWATCH for Business brand) offer many types of programming to meet various employers’ needs and budgets. Contact them for more information.

While chronic diseases affect a relatively small proportion of employees, the cost to a corporation is high. These may be individuals with diabetes or cardiovascular disease who would truly benefit from disease management, but effective programming often requires resources, which are limited in many corporations. Newer options for more turn-key workplace health and disease support programs are emerging, and they will likely become widely available to corporations in the next few years.

If developing a disease management program for a chronic condition is not within a company’s budget, start small by targeting common conditions that can be typically managed by the employee. Examples of these conditions are seasonal allergies (allergic rhinitis), menopause symptoms, migraines, arthritis and gastrointestinal disorders. The employees may often self-medicate for these conditions, trying to treat the symptoms, without investigating the causes. Provision of education to help employees treat the condition more effectively (through appropriate and efficient utilization of the correct medications) may drastically improve their symptoms and make them more productive employees who don’t need to take days off in order to deal with their bothersome symptoms. 

Set up a health resource library by sourcing educational pamphlets (from any of above mentioned organizations) and create a resource sheet of reliable and unbiased health websites. Utilize the company lunch room or other suitable area that all employees can access as the health library. An employee, who has access to even the most basic health information is already in a better position to manage his or her health.

In summary, if the organization is not quite ready to invest in a comprehensive disease management program, consider taking small steps towards employee health empowerment and education.

Lyle Hargrove
It is more important than ever for employers to have workplace support programs for workers with chronic diseases. Although they may represent a small portion of the workplace, workers with chronic diseases are most likely long-time employees of the company. These workers have played a major role in the success of the company over the years and may feel they have made the company a lot of money when they were healthy and have earned the respect of their employer. They feel that the corporation should look after them in their time of need.

In most cases of chronic disease the workplace has contributed to the worker’s illness. Many workers work with a lot of chemicals and materials that are carcinogenic or known to cause cancers. Workers suspect that these chemicals will cause them harm, but don't have scientific evidence to prove that they do. But I believe that employers have an obligation to support these workers.

David A. Alter
While it is true that chronic diseases affect a relatively small proportion of employees, they account for a disproportionate degree of health- and cost-related consequences to a corporation. In this regard, the health-related consequences of chronic disease in the workplace setting mirror that in the population as a whole, where 70% of healthcare-related expenses are consumed by only 30% of the population – most of whom have chronic diseases. Indeed, absenteeism in Canada costs employers nearly $16 billion annually. Studies have determined that improving the health and outcomes among employees with chronic diseases have significant economic advantages to corporations, through improvement in productivity, and through more appropriate and efficient utilization of medications. 

Indeed, the objective of workplace support programs is to prevent the disabling and costly complications of chronic disease. Workplace support programs include employee assistance programs and therapeutic lifestyle and disease-management programs (sometimes referred to as workplace “health and wellness programs”). The effectiveness of such programs are achieved by not only managing employees with chronic disease more effectively, but by preventing diseases and their associated complications from the outset.

Workplace support programs have evolved significantly in recent years. New and emerging programs now span the entire spectrum of disease, from “asymptomatic, pre-disease-states” to chronic diseases and their complications. Newer health and wellness programs incorporate employee health screening questionnaires (termed a “health risk assessment”). Health risk assessments are used to stratify employees into high, medium, and low-risk status. Those at highest risk would require management of specific disease-related complications, while those at lower degrees of risk may warrant specific lifestyle interventions in hopes of preventing disease. 

The rationale for screening all employees is two-fold. First, available evidence has demonstrated that a sizable proportion of the population has risk factors for disease, and don’t even know it. The consequences of unrecognized disease in the workplace can be devastating, and may include disability, depression, and death. Second, employee health screening initiatives allow for, and provide targeted programs to, those employees most in need of intervention. Indeed, recent Canadian guidelines advocate for the use of health risk assessments for every male over the age of 40 and every female over the age of 50 years of age (or who is postmenopausal). Therefore, the use of employee screening assessments in the workplace is consistent with consensus guideline-supported screening initiatives in the general population. Given significant variations in the health and behaviors of individuals, effective health and wellness programs must be tailored to the individual needs of employees. Such programs have demonstrated dramatic improvements in health, behaviors, drug utilization, work-related productivity, and costs.

While it is true that healthcare providers devote significant time to the management of patients with chronic diseases, the availability and supply of physicians are diminishing rapidly, as the prevalence and burden of chronic diseases rise. This combined with the escalating costs of pharmaceuticals and other medical technologies have led many policymakers to question the sustainability of Canadian healthcare system. Even where chronic disease management is provided in “usual-care-type” clinical settings, available evidence suggests that the quality of care is suboptimal in many cases. The delivery of preventive care services in usual-care clinical settings is even poorer than the delivery of chronic disease-management services, as evidenced by a recent Commonwealth survey which determined that the provision of lifestyle counseling in Canada was among the poorest worldwide. Currently, government funding for chronic disease-management and therapeutic lifestyle programs is minimal to nonexistent. Through the promotion of self-management, the provision of services in home-based settings, and mechanisms which close the loop between the employee and their physicians, therapeutic lifestyle and disease-management programs are being looked upon as potential solutions to the growing costs and sustainability challenges facing Canada’s healthcare system.

Should employees shoulder some of the responsibility of their own management? In the end, we are our own best health advocates. Effective workplace support or health and wellness programs empower employees to take control of their own health. The extent to which the employer invests in workplace health will depend upon the investment returns realized through improvement in health outcomes, health-seeking behaviors, productivity, and drug utilization.

Sal Cimino
Employers are making this kind of investment because it is good for their employees’ health and, in turn, good for the long-term health of their organization and their bottom line. Some of the issues driving this trend towards increased employee wellness programs, making them a necessity rather than just a “perk” are: 

• 8 out of 10 Canadians have at least one risk factor for cardiovascular disease.
• Approximately 48% of Canadians are defined as overweight or obese and obese adults have a greater risk of developing arthritis, diabetes, heart disease and stroke, high blood pressure, cancer, gallbladder disease, gout, and breathing problems.
• 1 in 5 Canadians will suffer from mental illness at some point in their lives.
• Over half of working Canadians report high stress levels and work-related stress/strain that have been linked to a variety of health issues, including mental illness and substance abuse, cancer, infections, increased risk of injuries and heart and back problems.
• Adults who suffered high stress had higher odds of developing a number of chronic conditions in later years, including arthritis and rheumatism, back problems, chronic bronchitis or emphysema, and stomach or intestinal ulcers. For men, they also included heart disease, and for women, asthma and migraine.
• One in 20 Canadians have diabetes and this is expected to double by 2016.
• Rates of asthma, hypertension, heart disease and stroke are higher in a diabetic population.
  
  

Barbara A. Martinez
Chronic disease is a major cause of death and disability in Canada. One needs only to look at disability and health plan trends to see the cost and human impact of serious, chronic illnesses. Further, the World Health Organization projects that death due to chronic diseases in Canada will increase by 15% from 2005 to 2015. Death due to diabetes alone is expected to increase by 44% in Canada. These pressures are even more significant given the aging workforce and the skill shortages that employers are experiencing.

The healthcare system and providers cannot do enough to help patients understand and manage their chronic conditions. It is time for employers in Canada to recognize that they have an important role to help employees take control of their care. These programs are about empowering and arming employees with the right tools and not about taking over the responsibility for their care. Education and supports to navigate within a strained health care system are needed now more than ever.

A disease management program is a fundamental component of any robust, targetted and successful workplace health and productivity strategy. The cost of supporting these programs do not need to be excessive with available technologies and a robust program. The return on investment for disease management programs is well documented in the US. The challenge is to identify the right program structure for a Canadian context.

It is time for employers to wake up to the reality that the perfectly healthy employee represents a shrinking portion of their workforce and people with chronic illnesses make substantial contributions to the workplace. With the right combination of incentives, program offers, and communications, employers can influence behaviours.

Barbara A. Martinez
Workplace wellness programs are an emerging trend in group benefit plans in Canada. Many employers are starting to introduce proactive wellness features such as education, information and incentive programs around health, diet, nutrition, exercise and how lifestyle choices may influence employee health. Unlike traditional plan benefits, which focus on treating illness, the premise behind wellness programs is that the prevention of illness will lead to an increased number of employees that are healthy, productive and at work. Wellness programs are gaining traction due to their potential to save costs and to attract and retain employees.

Wellness initiatives require more than a change in the benefit plan. For most organizations they mark a change in the corporate culture. Wellness is a long-term commitment that requires management cooperation and support, mentoring and encouragement, plus the funding and tools to enable employees to make healthier lifestyle choices. The benefit plan design will need to be aligned with the wellness objectives, structured to reward the desired employee behaviour, well communicated to all parties, and include measurements of the results.

The business case for wellness rests on a cost-benefit analysis that is not always easy to articulate. It can be difficult to ensure you have the right information for the cost side of the equation, and the necessary broad-based research information on the benefit side. For employers the analysis starts with understanding their absentee rates and the reasons why employees are absent. Plan sponsors also need to look at what is driving health care costs, particularly prescription drugs. Wellness programs that target the source of health-related absenteeism and growing health care costs can then be implemented and measured for improvements in productivity, time at work, and plan cost reductions.

In a union environment it is important that plan changes are made in collaboration with the union as its ongoing support will be critical to the success of the program. As plan members tend to favour initiatives aimed at improving health, the introduction of a wellness program creates the opportunity for a win-win situation for all parties.

Mike Lee
You are in a great position for developing the groundwork for workplace wellness with 18 months until expiration of the CA. But you will need to start today!

There are two things you need to start at right away, and both will be beneficial in developing your case for the union as well as management. Both involve the gathering of information. First, get going on developing some relevant metrics. Data is king in any undertaking, and the more facts you have, the greater your arguments. Get a hold of your major medical carrier, and get some statistics on drug utilization. What are the top disease conditions? Are they preventable through early detection and interventions? What are the costs of these medications? Absenteeism reports are your next source of information. How many employees are on LTD? What are the causes of disability? Again, can these causes be attributed to manageable disease states? How much do you have tied up in disabled life reserves?

The second opportunity for success is to see what is happening in current employee-based committees such as EAP, safety, and any other employee committees. Are there any wellness-related issues on their agendas? If there aren’t, could you introduce some? Once you have the data and have made wellness an area of interest for other committees, it’s time to put forth an offer to the union to strike up a committee before negotiations to present your concerns about what you have discovered. Seed some ideas, and let them germinate.

Lyle Hargrove
I suggest you meet with the local union leadership and Health & Safety committees, as well as any other workplace committees (e.g., substance abuse, union counsellors and human rights) to educate them on the possibilities and benefits of wellness programs. A Wellness Fair in the workplace can really help build awareness. Invite all levels of management to participate so they can see the benefits of a wellness program using the community expertise. We’ve done Wellness Fairs with screening clinics for blood pressure and cholesterol readings and for diabetes.

Last but not least, set up regular meetings with the bargaining committee for the union over the 18 months leading up to contract deadline to make sure they understand that wellness is an important issue to their members and they are not to leave the table without money to implement a comprehensive wellness program.

Jennifer Kim
Chronic disease can represent a significant portion of the company's overall healthcare costs (e.g., STD, LTD, drugs). This is especially true when inappropriate medication use and lack of adherence to proper treatment programs result in costly medical complications, absenteeism, presenteeism and disability. I would suggest helping to control this factor by recommending awareness, education and one-on-one counselling sessions with a pharmacist. This a unique offering to employers, supported by much evidence in the literature (see references below) of cost savings related to health/disease management and skillful medication reviews conducted by pharmacists.

Recently, the Government of Ontario announced a medication management program called Meds Check. The purpose of this program is to promote improved health outcomes by maximizing patient adherence to drug therapy and helping patients better understand their medications to ensure medications are taken as prescribed. Within Ontario, this pharmacist service can be brought directly to the employer, thereby making this service accessible and convenient for the employees. Even outside Ontario, this investment for pharmacist services can result in long-term savings and improved health outcomes for employees with chronic medical conditions.

References

1. Evidence of the economic benefit of clinical pharmacy services: 1996-2000. Schumock GT, Butler MG, Meek PT, Vermeulen LC et al. Pharmacotherapy 2993; 23(1): 113-132.
2. Clinical medication review by a pharmacist of patient on repeat prescriptions in general practice: A randomised controlled trial. Zermansky AG, Petty DR, Raynor DK, Lowe CJ, Freemantle N, Vail A. Health Technology Assessment 2002; Vol. 6: No. 20
3. Medication reviews in the community: results of a randomized, controlled effectiveness trial. Sorensen L, Stokes JA, Purdie DM, Woodward M, Elliott R, Roberts MS. Br J Clin Pharmacol 2004 Dec; 58(6): 648-64.