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Drive your Benefit Decisions with Claims Data

Posted by Medavie Blue Cross on July 5, 2023

Drive your Benefit Decisions with Claims Data

Posted by Medavie Blue Cross on July 5, 2023

More than ever before, claims data drives smart business decisions. As our own Pharmacy Benefit Manager (PBM), we have direct access to more data than insurers who use a third-party PBM ― and we are mining this data for deeper insights to enhance plan performance for our advisor and client partners. We recently turned our data analytics into valuable insights our partners can use to design and sustain their plans and shared them at our June 2023 Insights webinar.* We’ve captured some of the highlights here.

Demographics & Health Spends

  • Members age 40+ represent 47% of Medavie Blue Cross cardholders, but 70% of the spend.
  • Though females account for 50% of members covered by Medavie Blue Cross, they make up 56% of health costs.
  • At every age band, females are much more likely to claim for both antidepressants and mental health practitioners than males.
  • We see significant differences in claiming patterns between females and males regarding mental health and ADHD/ADD. Antidepressants and mental health practitioners are at #4 and #5 on the top 10 list of health categories for females, whereas neither of these benefits is in the top 10 for males.
  • ADHD/ADD is the #5 benefit claimed by males, yet for females, it’s in the #13 spot in terms of health spend.
  • A list of the top 10 health categories by sex shows biologics for autoimmune diseases are the top benefit for both females and males. Diabetes and massage are also highly claimed benefits for both females and males.

Drug Claims

As the very first Canadian insurer and continuing leader in negotiating drug prices, we achieved a block savings on drug prices in 2022 that now exceeds 6%.

  • In 2022, 67.4% of claim spend was on Drugs and 32.6% was on Extended Healthcare Benefits, or EHC.
  • Per capita trend was 5.6% for drugs in 2022, driven by Traditional drugs - a change from previous years where specialty drugs drove the trend. This trend was due to both utilization and inflation.
  • Drugs and indications reviewed by our Medication Advisory Panel in 2022 rose to 83% in 2022. We saw a decrease in new drug reviews for cancer drugs but an increase in new drug submissions for drugs to treat rare diseases.
  • The order of the ten therapeutic categories has not changed since 2021, with biologics for autoimmune diseases leading the pack for expenditure.
  • Diabetes is still #2 in terms of overall spend but represents a bigger portion of spend than ever before. It is also the #1 cost driver in 2022, taking the lead over from Biologic drugs in previous years.
  • We saw the order change in other categories. Cardiac fell from #3 to #5 place, while respiratory jumped from #6 to #3.
  • In terms of incidence, cardiac is the highest at 15.5% of members claiming. Respiratory is the fastest growing category, with a 55% increase in the number of members claiming compared to last year.

Extended Health Care Benefits

Though quite moderate, we continue to see increases in EHC Trend, with a per capita increase of 2.8% and primarily driven by inflation.

  • The order of the top ten EHC categories has mostly stayed the same over the last 3-5 years, except for the growth in the mental health practitioner benefit. It moved from the #5 benefit in 2021 to the #3 benefit in 2022.
  • Massage is the top EHC benefit, with 16.7% of our members claiming it.
  • Mental health was among the three paramedical practitioner categories that experienced the largest increase in per capita spending in 2022. 5% of our covered lives are now claiming for mental health practitioners.
  • The second fastest-growing EHC category is osteopath, increasing by 14% in 2022. Though the incidence is quite small compared to Massage or Physio, up to 2.9% of members now claim the benefit. The rise was primarily driven by an increase in utilization, corresponding with an increase in eligible providers.

Mental health

  • Mental health practitioners saw the largest increase of any benefit in the top ten for 2022, with a 17% increase in per capita spending. This grouping includes Psychologists, Social Workers, Psychotherapists and Counselling Therapists.
  • Mental Health Practitioners are now at 5% of our total covered lives. This has been steadily increasing over the last three years.
  • As more plans move to increased maximums for mental health practitioners, we have seen increased costs per claimant, over $100 since 2020, to $719.
  • The portion of our members claiming for mental health practitioners and antidepressants is nearly 10%, up 2% over two years ago. We see this as a great news story, with members accessing both sides of their benefit plan to receive the care they need.

Member Experience

We are advancing our own technology to support plan management and provide access to care and a seamless experience for members.

For example, as we shared at our May 2023 Insights webinar, we are leveraging Tiered Formularies, Step Therapy and Automated Prior Authorization technology to support physician prescribing guidelines and validate therapy indications for diabetes and weight management in real-time at the point of sale.

If you missed that webinar, or want a refresh, read our Insights blog, where you will see a link to watch the recording.

*Here’s the link to view our recorded June 2023 webinar on data claims and trends. The data provided was from our analysis of our private, group insurance business covering about 1.6 million members. This includes all types of plan designs, industries and funding arrangements and includes employees and their dependents who are covered by a Medavie Blue Cross plan.

As always, contact your Medavie Blue Cross representative to learn more about how our integrated health services company helps public and private sector clients across Canada address today’s key challenges by drawing on our technology, clinical expertise and strategic relationships to develop innovative health plan management solutions.

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