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Drive your Plan with Data – Part 2

Posted by Medavie Blue Cross on May 10, 2022

Drive your Plan with Data – Part 2

Posted by Medavie Blue Cross on May 10, 2022

Our Claims Trends & Targeted Solutions

Want to know what's trending in health benefits? We took an in-depth look at our claims* to help plan sponsors and advisors navigate today’s ever-changing, fast-moving landscape with top-level data. Our insights were shared by our in-house specialists, Colleen Adams, Manager, Health and Digital Product Solutions Anne-Marie Smith, Pharmacy Consultant, during an Insights webinar hosted by James Deware Manager, Group Brokerage Sales. This is the second in a two-part series that captures key takeaways from their presentation.

Claims Trends

Mental Health

“Canadians of all ages are facing stress like never before. From pandemic-induced isolation, financial worry, health anxiety, workplace change plus all of the other ‘regular’ life stressors, many are having an increasingly hard time coping.” Colleen Adams
  • The incidence rate of members claiming for mental health medications or counselling is 18.9 claimants out of every 100 covered lives.
  • The number of claims for each claimant increased by 10% over 2019 to 4.3 per year in 2021. The annual average cost per claimant is $666.
  • Mental health utilization led to a 34% spike in cost in 2021.
  • 13.9% of the member population were claiming for drugs used to treat mental distress and disorders: benzodiazepines, antipsychotics and anti-depressants on average require 2.21 medications per claimant; 10.5% were also claiming for counselling and 34% were first-time claimants.
  • Atlantic members are taking these medications at nearly double the rate of members in the West. Ontario’s rates are closer to the West and Quebec falls in the middle at most ages across the spectrum.

Targeted Solutions

“We have responded to this heightened need by enabling access to greater supports and services for our members – with a particular focus on prevention. We are doing everything we can to increase access to care.” Colleen Adams

Mental Health Practitioners

We’ve expanded eligible practitioner types and increased maximums under our Mental Health Practitioners benefit. Our standard coverage for new plans is $1,000 minimum and the list of eligible practitioners now includes Psychologists, Social Workers, Registered Counseling Therapists and Psychoeducators.

Connected Care: Available to all members, our digital health platform connects them to innovative and effective health solutions, including solutions for mental health.

Digital Therapy

Through partnerships with leading providers, we offer premium access to options including internet-enabled Cognitive Behavioural Therapy (iCBT) programs and live therapy. This allows plan members to access care from the privacy of their homes in the modality of care they choose.

Mindfulness App

A recent addition to our ever-expanding suite of services is an app to help build resilience and support regular exercising of the mind, also known as mindfulness. Members can access training programs and guided meditations from a global network of experts. This timely solution enables self-care, builds resilience, and promotes ongoing mental health support.

Pharmacogenetic Testing

We also offer Pharmacogenetic testing through Connected Care to help advance mental health treatment. Also known as personalized medicine, this solution uses the member’s unique genetic profile to provide insights to help treating physicians choose the right medications and dosage for optimal health outcomes. This can be a game changer and means members can often find the right mental health drug at the right dose the first time.

Claims Trends


  • Spending for ADD/ADHD medication grew from 3.6% to 4.1% of eligible drug spend in just one year.
  • Inflation and increased utilization are contributing to this trend.

Extended Health Care

  • At 15.6%, Parapractitioners represent the biggest spending category and made up almost half of EHC’s 35% of overall health spend. (This category includes practitioners like chiropractors, physiotherapists, osteopaths massage therapists; does not include psychologists and other counsellors.)
  • The cost per capita for parapractitioner services was $650.
  • Parapractitioner spend even outpaced the top drug category of biologics which comes in at 12.9% of total spend. However, the average cost per claimant for biologics is $20,000. In other words, there are fewer claimants, but a much higher cost per claim for biologics.
  • The top 10 EHC benefits by claims are: massage, physio, glasses, chiro, mental health practitioners, diabetic supplies, CPAP, eye exam, osteopath, and acupuncturist. The order of this top 10 has not changed in several years.
  • While EHC benefit utilization varies by generation, massage is always among the top 5. Of every 100 covered members, 15 claimed for massage. Massage is especially popular with Gen Z (20.5%), Millennials (22.4%) and Gen X (20.8%).

*Note: The data is based on analysis of claims spending in 2021 covering about 1.4 million private group and individual plan members.

To get more insights into our claims data, read part one or our series or watch the webinar to hear the entire discussion. Connect with your Medavie Blue Cross representative to find out how our targeted solutions can work for you.

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