1. Uncovering the voice of plan members living and working with chronic illness December 14, 2010 – Montreal December 15, 2010 - Toronto

2. Agenda 1.Survey Overview 2.Chronic Disease 3.Key Survey Results 4.Lessons for Employers 5.Workplace Wellness Programs 6.Summary

3. Survey Overview

4. Goal Better understand the needs and challenges of plan members living and working with serious chronic conditions.

5. Survey Overview Survey of Canadians who have been diagnosed with a serious illness who had a benefit plan Online Survey (January 2010) 214 Respondents Reviewed by Expert Panel

6. Expert Panel 1.Andrea Strath, Ontario Canadian Diabetes Association 2.Meera Jain Ph.D, Chronic Disease Unit, Health Systems Policy & Relations Branch Health System Strategy Division, Ministry of Health and Long-Term Care 3.Donna Carbell, Manulife Financial 4.Paula Allen, Shepell.fgi 5.Vic Medland, Ontario Teachers Insurance Plan 6.Dr. Alain Sotto, Ontario Power Generation and Occupational Medical Consultant, Toronto Transit Commission 7.Joan Canavan, Chronic Disease Management Unit, Provincial Programs Branch, Ministry of Health and Long-Term Care 8.Wes Jones, The Great-West Life Assurance Company 9.Teresa Negrich, The Great-West Life Assurance Company 10.Suzanne Lepage, Private Health Plan Strategist

7. Chronic Disease

8. Diseases of long duration and generally slow progression 1 Illness that is prolonged, does not resolve spontaneously and is rarely cured completely 2 1 - WHO - http://www.who.int/topics/chronic_diseases/en/http://www.who.int/topics/chronic_diseases/en/ 2 - Centres for Disease Control and Prevention/Washington. 2002. "Chronic Disease."

9. Chronic Disease 33% Canadians (8.9m) have at least one chronic condition Canadians aged 40 to 59 37% have at least one condition 30% have two or more conditions Chronic Disease accounts for 89% of all deaths in Canada 2 Will increase by 15% by 2015 2 1 - 2005 Canadian Community Health Survey, Statistics Canada 2 - Region and country specific information sheets http://www.who.int/chp/chronic_disease_report/media/canada.pdfhttp://www.who.int/chp/chronic_disease_report/media/canada.pdf

10. Chronic Disease Canadians with multiple chronic conditions… twice as many consultations with a family doctor 1.5 times as many consultations with specialists and other doctors four times more likely to stay overnight in hospitals three times more nights spent in hospitals four times as many consultations with nurses eleven more times more likely to receive home care services WHO - http://www.who.int/topics/chronic_diseases/en /

11. Chronic Disease Economic burden > $150 billion in direct and indirect costs annually 1 Lost productivity = 30% of total costs 1 Lost productivity from presenteeism was 7.5 times greater than productivity loss from absenteeism 2 1 - Centre for Chronic Disease Prevention and Control. Public Health Agency of Canada. WHO – World Health Organization: Preventing chronic diseases: a vital investment 2 - Employers Health Coalition, Inc. The Changing Face of U.S. Health Care.Tampa, Fla: Employers Health Coalition Inc; 1999.

12. Chronic Disease

13. People with chronic diseases are significantly more likely to suffer from depression 1 – Depression appears to precipitate chronic disease 2 – Chronic disease can exacerbate symptoms of depression 2 1 - Depression, chronic diseases, and decrements in health: results from the World Health Surveys Saba Moussavi, Somnath Chatterji, Emese Verdes, Ajay Tandon, Vikram Patel, Bedirhan Ustun Lancet 2007; 370: 851–58 2 - Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. Prev Chronic Dis 2005;2(1):A14. http://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm http://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm

14. Key Survey Results

15. Type of Condition

16. Multiple Conditions

17. Impact on Productivity 80% would come into work even when they are not feeling well 51% find it difficult to focus on their work.

18. Managing to work

19. Out of pocket costs 55% had to pay some portion out of pocket (excluding co-payments) for the treatments or prescriptions related to their health condition 28% say that costs relating to their illness are a serious concern Seriousness of the cost varies based on type of illness and income level.

20. Out of pocket costs

22. Medication Adherence 76% adjust how much or how often they take their medication in some way 22% have taken a prescription less frequently than prescribed 12% have taken a prescription at lower dose than prescribed 23% considered not taking a treatment because it was not fully covered by the benefit plan 19% have not taken a prescription medicine because of cost

23. Lessons for employers

24. Lessons for Employers

26. Employees with chronic diseases value their benefits 83% say medicine helps them remain healthy 73% feel that company drug benefits give them peace of mind 94% valued their prescription drug coverage 85% are “loyal to their employer”.

27. Workplace Wellness Programs

28. Workplace Wellness programs 1.Management of specific diseases Adherence programs Health Coaching 2.Management of behavioural risks (or risk factor reduction) HRA Fitness Program Smoking cessation Nutrition and Healthy Eating Workplace screening

29. Workplace Wellness programs Workplace is an ideal location Employees spend a growing amount of time at work Offers an effective method to reach a large portion of the adult population. Employers can: influence behaviour by providing supportive environment leverage existing infrastructure to offer low-cost but effective interventions

30. Summary

31. 1.Impact of Chronic disease Productivity Chronic disease and depression Multiple conditions

32. Summary 2.Lessons for employers Access to medications Flexible schedule Cost concerns Adherence Workplace Wellness

33. Questions and Discussion