Perspectives Fall Report: 2015 Plan Sponsor Survey

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1 Perspectives Fall 2016 Report: Plan Sponsor Survey

2 2 The Plan Sponsor Survey Report The plan sponsor survey is our eleventh annual survey of 100 plan sponsors with 500 or more members. Larger plan sponsors are important because, although they represent only 0.9% of all plan sponsors, they control the benefits of 47% of all plan members 1. As well, they tend to have a more thorough understanding of benefits, trends and options. This year s survey suggests that plan sponsors recognize more than ever the importance of wellness as a means to control health-related costs. Plan sponsors are, however, also expecting to make changes that directly impact the benefit spend. The survey followed the format of previous years. It contacted 100 senior benefits and HR managers who agreed to complete a detailed questionnaire, either online or by telephone. The survey was conducted by Research House on behalf of TELUS Health Analytics. The sample We attempted to recruit a sample that reflected as closely as possible the distribution by size, region and public/private characteristics in Canada. Figure 1 shows the distribution of the sample by size, province and sector. Compared to previous years, the sample more closely reflects the geographic and public/private distribution of plan sponsors. Figure 1: Description of plan sponsor sample Source for all figures in this article: TELUS Health Plan Sponsor Survey 1. Based on the TELUS Health block of business as of December

3 3 The Plan Sponsor Survey Report Plan design After reaching a peak last year in terms of share of plans using formularies, plans of all sizes seem to have backed off from this cost management strategy (Figure 2). Figure 2: Share of plans with formularies by plan sponsor size % 80% 70% 60% 50% 40% 30% 20% 10% 0% to 1,000 1,001 to 5,000 >5,000 Number of plan numbers Are sponsors cutting back on other benefits? If economic conditions influence drug plan design decisions, other benefits do not seem to be at risk. Figure 3 shows the share of plan sponsors offering four of the most common benefit programs. There has been a small change in each of these percentages 2, but the ranking and actual share of sponsors offering the benefit are virtually unchanged from last year. Figure 3: Share of plan sponsors offering key employee benefit programs Personal well-being days Benefit programs Wellness program or initiative Short term disability/weekly indemnity Employee assistance program 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 2. The actual plan sponsors sampled are different each year

4 4 The Plan Sponsor Survey Report How are plan sponsors tackling wellness? Last year, TELUS Health introduced a series of questions designed to obtain a deeper understanding of the programs, benefits and strategies sponsors use to get results from their wellness spending. Figure 4 shows the share of sponsors who indicated they had in place the different programs mentioned. The results this year are very similar to last year, with two notable differences: A doubling of the share of sponsors with programs for blood testing for diabetes, cholesterol and other conditions, and Close to 85% of sponsors now have disability management programs in place. As active management usually results in early return to work, this is part of the wellness spending that has a direct and measurable outcome for sponsors. Figure 4: Wellness programs by share of plan sponsors offering the program ( vs ) Other Blood work testing (e.g. for blood sugar levels, cholesterol, etc.) Use wearable devices (e.g. FibBit or Jawbone device) Disease management programs Wellness program examples Health screening with biometrics (e.g. for blood pressure, weight, etc.) On-site fitness centre Weight loss programs Fitness reimbursement Stress management programs Health coaching - with nutritionists, fitness trainers, etc. Organization wellness challenges Disability management programs 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

5 5 The Plan Sponsor Survey Report Are we moving away from cost and towards health management? In, we continue to see more sponsors focusing on health management in making their drug plan decisions. While Figure 5 shows that most sponsors are inclined to balance cost and health management, the share that has shifted away from a purely cost-based approach has declined significantly, with the Health Management focussed group increasing its share from about 22% in 2013 to about 38% of sponsors in. Figure 5: HR focus in providing benefits 60% 50% 40% 30% 20% 10% 0% Towards cost containment Cost and health management are considered equally Towards health management Influencers of benefit design Figures 6 shows respondents comments about factors that influence benefit design, particularly drug plans and also shows that for the entire sample, respondents agree that productivity, industry practices and corporate compensation strategy all influence plan design. Figure 6: Determinants of benefit design Our benefits are primarily determined from union negotiations Benefit design Our benefit programs are designed to optimize the productivity of our workforce Our benefit plan reflects practices in our industry Our benefits are an important component of our compensation strategy 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

6 6 The Plan Sponsor Survey Report Retaining and attracting employees Respondents view the importance of benefits in retaining versus attracting employees differently. (Figures 7 and 8). In both cases, the majority of respondents agree that benefits are very or extremely important. However, respondents feel that they have more impact on initial attraction of the employees than they do on retention. The two findings are not necessarily in conflict it could be that respondents feel that if the sponsor has a good plan that was influential in attracting a new recruit, it will probably also keep the recruit satisfied once in the job. Figure 7: Importance of the benefit plan in attracting employees Figure 8: Importance of the benefit plan in retaining employees Others 22% 78% Extremely or very important Others 35% 65% Extremely or very important Cost increases still holding (for now) Figure 9 shows that most plans kept cost increases under 5%. Fifty-four percent of all respondents reported cost increases under this threshold in, compared to only 43% and 40% in and 2013 respectively. The only group that saw a smaller share of sponsors was the >5,000 employee category, and in that group the share dropped from 60% to 39%. Furthermore, the large plan sponsors also had the largest share of plans (17%) with cost increases of more than 10%. (About 5% of the entire sample had cost increases in excess of 10%). Figure 9: Share of plan sponsors with cost increases less than 5% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% to 1,000 1,001 to 5,000 >5,000 Number of employees

7 7 The Plan Sponsor Survey Report Figure 10: Responses to plan cost increases Pay the premium increase and add/ increase beneficiary co-payments Plan cost increase responses Other Pay the premium increase and add/ increase beneficiary deductible Change insurance carrier Change plan coverage type to decrease the premium Pay the premium increase and made no change to the drug plan 0% 10% 20% 30% 40% 50% 60% 70% What do sponsors do about cost increases? In almost two-thirds of cases, plan sponsors have absorbed the increase and not changed the plan or the carrier. (Figure 10) Those who did respond, took a variety of measures with no particular action more dominant than any other. What is driving cost increases? Respondents have not singled out any particular factor as a contributor to cost increases, but seem to acknowledge that it is a multi-factorial issue. (Figure 11) Pharmacist fees and direct-to-consumer advertising are somewhat less of an issue than in the past. Except possibly for stress, the only driver that plan sponsors have any ability to control is more high-cost drugs. This is one of the highest-rated drivers on all our surveys over the years, which likely means a continuing focus by payers on limiting access to high cost medicines as a way to manage rising drug costs. Figure 11: Perceived drivers of cost increases Consumer advertising (television or print) Pharmacists professional fees Cost increase drivers Increased utilization due to age Increased utilization due to stress Doctors prescribing more medications More high-cost drugs Government cost shifting/cutting 0% 10% 20% 30% 40% 50% 60% 70%

8 8 The Plan Sponsor Survey Report Plan changes under consideration In terms of administrative arrangements, the most likely change to plans over the next three years is for more plans to implement employee wellness programs. (Figure 12) Although mentioned only half as often, the next most likely changes are switching to a pay-direct card and adding flex benefits when it comes to the overall design of the benefit plan, respondents use a wide range of internal and external resources (Figure 13), including consultations or negotiations with employees. Figure 12: Changes to plan administrative changes under consideration Provide benefits to retired employees Administrative plan changes Remove/reduce benefits for retirees Health or medical savings account Multi-tier co-pay/plan design Switch to pay-direct card Add flex benefits to plans Implement employee wellness program 0% 10% 20% 30% 40% 50% 60% 70% Figure 13: People or groups who are mentioned as frequently consulted on plan design changes Frequently consulted people/groups Pharmaceutical representatives Your competitors drug benefit plans Corporate physician Employees Unions Your third party administrator or on-line adjudicator Broker Chief financial officer Insurers Benefit consultants 0% 10% 20% 30% 40% 50% 60% Conclusion Unlike recent surveys, the survey suggests that plans may be at a tipping point. On one hand, most are still benefiting from the low cost increases of the past. However, there is a small group for whom costs are rising beyond the 5% and even 10% level. These sponsors are more likely to act on cost management measures, according to our results. The plan sponsors who are experiencing the higher increases may be the ones who were early adopters of mandatory generics or other costcutting approaches. If so, they are left to find new ways to act in the face of rising costs. This, plus expected difficult economic conditions in 2016, could be a signal that plan sponsor focus on the bottom line may be the most important determinant of what happens to drug coverage and plan member cost sharing this year.

9 Information for life TELUS Health is a leader in telehomecare, electronic medical and health records, consumer health, benefits management and pharmacy management. TELUS Health gives health authorities, healthcare professionals, patients and consumers the power to turn information into better health outcomes. Visit telushealth.com. Perspectives Fall 2016 AST