It might come as no surprise that obesity rates in Canada are on the rise. What might be surprising is the rate of the increase. According to a study from Memorial University in St. John's, obesity rates have tripled, which represents a 200 per cent increase between 1985 and 2011. What's more, the Canadian Medical Association Journal (CMAJ) predicts that 21 per cent of Canadian adults will be obese by 2019.
In 2014, based on height and weight measurements, 20.2 per cent or 5.3 million Canadians aged 18 or older are classified as obese. According to Statistics Canada, almost two thirds of Canadian adults are considered overweight or obese and about 33% of children (ages 5 to 17) are considered overweight or obese.
What defines overweight and obese?
Body Mass Index (BMI) measurements are used to determine normal, overweight and obese classifications. Normal weight is represented by a BMI range of 18.5 to 24.9.
Overweight is a BMI range of 25 to 29.9 and obese is a BMI range of 30 or higher. (BMI is the measure of body fat based on height and weight.) In terms of the obesity spectrum, there are 3 classes: Class 1 is BMI 30 to 34.9, Class 2 is BMI 35 to 39.9 and Class 3 is BMI 40 or over.
In a report of the Standing Senate Committee on Social Affairs, Science and Technology published in March 2016, they summarized the results of nearly 24 meetings where the committee heard expert testimony about the dramatic rise in overweight and obese Canadians. We are ranked 5th among 40 countries for obesity prevalence (measured at 25.4% of adults).
What is the cost of obesity?
Obesity is linked to high blood pressure, diabetes, cancer and other conditions. As per the Associated Press, obesity costs Canada between $4.6 billion and $7.1 billion annually.
What is the employer's role?
While there are programs across the country analyzing and working toward solutions to stem the rapid rise in obesity, employers are faced with the challenge of controlling health care costs and modifying insurance-related programs. They continue to look for ways to motivate the growing number of overweight and obese employees in their attempts to help their workforce adopt healthier lifestyle practices. Sitting disease (inactivity) and poor diet, nutrition and lack of regular exercise continue to work against their efforts.
Observations and considerations.
Between age 18 and 65, Canadian adults spend much of their lives at work and so the value of an employer's role in health promotion can't be overlooked. Often, the size of employer dictates the comprehensive nature of their wellness program and weight management initiatives. Smaller employers, which represent the majority in Canada (under 500 employees) don't generally have the complexity, choice or robustness of the largest public and private employers where there is a more consistent emphasis on weight management and health promotion.
1) Environmental factors: Employers can work against themselves in their efforts to promote healthy lifestyles and weight management. Food choices in vending machines, dining and catering options and an absence of access to free filtered water may provide mixed or contradictory messages. Looking at what is offered in the workplace is helpful. Is there access to a company fitness centre or healthy dinners-to-go? Healthy on-site catering, open stairwells, treadmills, walking paths, break rooms for stretching and meditation offer consistent messages that reinforce healthier choices.
2) Culture of Health: Establishing a top-down leadership campaign with visible participation and clear communications about available health and wellness programs is important. Additionally, identifying formal and informal wellness champions to leverage the social environment in the workplace can have a strong influence on health promotion.
3) Family outreach: Employers can benefit from casting a wider net with their health promotion efforts to include family members and children. This is often achieved through targeted communications that can be read by the entire family and are written in plain language particularly when English isn't the primary language spoken in the home. When a family commits to supporting loved ones in their efforts to improve their health and weight management, success rates increase.
It's clear that we have an issue with obesity in our country. Employers carry an alarming portion of the financial burden related to it. By taking a more strategic approach to wellness programs and an analysis of claims experience, employee education that intrinsically motivates employees can provide positive results for weight management and obesity prevention. If you have questions about this topic or what can be done to better manage your benefits program, please contact us. We're here to help so that you can focus on what you do best.
Paramedical benefits have seen their fair share of usage in the last few decades. It is a bundle of benefits under regular scrutiny. Why? Because plan sponsors continue to experience increased costs associated with benefits like chiropractic, massage therapy, orthotics, orthopaedic shoes, nutritionists, dieticians, naturopaths, acupuncturists and more. According to Great-West Life, in 2013, paramedical services represented 19.3% per cent of healthcare claims.
Why the increase?
In the paramedical category, orthotics are prone to widespread fraud. There seems to be a constant, if not growing, interest in this benefit category. More plan members submit paramedical claims for orthotics than ever before. Is it a need, a sense of entitlement (use it or lose it) or something else? This is a question plan sponsors regularly explore.
Paramedical services, while designed to help treat issues, often times, also act in a preventative capacity. When plan members use these services, they may prevent a more serious illness or injury from occurring. So it helpful to keep usage in perspective, while still managing costs and protecting against fraud, waste and abuse.
Why the focus on orthotics?
Orthotics are a device that can be inserted into the shoe to support, align, prevent or correct foot deformities and improve foot function. The orthotic should be made for the person and fabricated from a 3D model or cast of the foot, which captures the foot alignment and shape.
What's the deal with custom-made?
In recent years, insurers and service providers changed their claim processing for orthotics and orthopaedic shoes. In an effort to ensure that benefits are accurately and appropriately paid, many providers ask for confirmation that the orthotic has been custom made and that the orthopaedic shoes are specially constructed for the patient. They stopped paying for brand name orthopaedic shoes that haven't been custom-fitted and for over-the-counter orthotic shoe inserts.
Contractually, the issue comes down to ensuring that claims utilization adheres to contract provisions rather than expansion upon services that don't fall within the intent of coverage.
Plan sponsors hope to avoid the sense of entitlement that comes from offering benefits such as paramedical services. They hope plan members recognize that submitting a paramedical claim whenever they want a new pair of shoes isn't appropriate.
- Plan members should seek a gait analysis or a biomechanical assessment after a recommendation or referral from a medical doctor has been made.
- Once the orthotics or orthopaedic shoes are custom made, a detailed lab invoice should be included.
- Any claim should include a detailed paid-in-full receipt with a breakdown of charges.
- Additionally, it is a good practice to review adjudication procedures on a regular basis particularly related to assignment of benefits for compression stockings, orthotics and orthopaedic shoes.
Plan sponsors should establish maximums per visit and per practitioner and review their experience at least annually, if not more regularly. Plan sponsor communications to plan members should ensure that they know the prevalence of fraud and how they might unknowingly be at risk. This includes ways to protect their personal information including checking online claims to ensure they are aware of what has been submitted and paid. They should know who to contact and when to reach out if they are suspicious of any activity or any request that may constitute fraud.
Our goal is to maximize the value and efficiency of plan sponsor coverage for their members. In our efforts to help manage increasing costs, we monitor trends and keep our clients informed so their plans provide valuable coverage at the right time for those who need them. Have questions about this or other benefit-related topics? Contact us. We're here to help so that you can focus on what you do best.
This year marks the 20th anniversary of the Sanofi Canada Healthcare Survey (SCHS). It reflects how 1500 plan members and 461 plan sponsors feel about their health benefits and organizational health issues based on a cross country survey conducted in January 2017.
The SCHS provides valuable benchmark data on the views of survey respondents and can be used to assess plan sponsor and member needs, particularly for those revisiting their benefits plan design or strategic philosophy on benefits.
And the survey says...
The overall theme of this year's survey seems to reflect a slightly downward trend in 3 major categories.
1) Plan member satisfaction with their health benefits plan appears to have dropped. Only 53 per cent of plan members reported that their benefits plan met their needs extremely or very well. This is a big drop from 73 per cent who reported the same in 1999. However, when plan members are satisfied with their jobs, have access to health promotion programs and spending accounts, they are more satisfied then those without these elements.
Perhaps not surprising, non-unionized and private-sector plan members were less satisfied with their health benefits plans than those in unionized and public-sector plans.
Additionally, plan members who are in poor health were less likely to report that their benefits plan met their needs. There was also a growing perception that employers choose cost control over benefit quality. With this perception in mind, plan members feel less obligated to control costs based on the choices they make as healthcare consumers.
2) Fewer employers are making changes to benefits plan design.
Over the next few years, 11 per cent fewer employers are considering making changes to their health benefits plan design. (42 per cent in 2015 compared to 31 per cent in 2017).
Of the 31 per cent anticipating changes to their plan, what are they going to do? Respondents said they would restructure the plan design (39 per cent), introduce new or increased benefits (38 per cent) and finally, introduce or enhance wellness and illness prevention benefits (36 per cent).
3) Health promotion is levelling off.
While there remains significant unmet mental and physical health needs in our country along with an alarming increase in chronic disease conditions, plan sponsors report their appetite for investing in wellness and health prevention is waning. Even though there are significant workplace issues with stress, anxiety, depression and work-life balance concerns, only 31 per cent of employers plan on investing in wellness. This percentage is down from 68 per cent in 2011.
There could be a number of reasons for this levelling off all of which might be specific to the plan sponsors surveyed. Regardless, promotion of a culture of health in the workplace and looking for practical and affordable ways to prevent the prevalence of stress and chronic disease from growing is necessary. Part of our role is to help plan sponsors find ways to make strategic investments in their benefits plans that are sustainable, valuable and drive toward tangible outcomes. For more information on this topic or other ways to effectively manage benefits plan costs, please contact us. We're here to help so that you can focus on what you do best.
Dave Dickinson, B.Comm, CFP, CLU, CHFC
Experienced Benefits Specialist ready to optimize your group benefits and pension plans.