Onwards and Upwards into 2025

For many around the world 2024 will not go in the record books as a good year. With war continuing in the Middle East and Ukraine, as well as famine in Sub-Saharan Africa, there is a lot to be concerned about. Closer to home there has been political posturing, resulting in lingering questions about the viability of comprehensive public programs like pharmacare, the Canadian Dental Care Plan and drugs for rare diseases.

In the meantime, our hospital system, at least is Ontario, is chronically underfunded, particularly since the COVID-19 pandemic and striking down of Bill 124. This has left Ontario hospitals struggling with burdensome lines of credit waiting for funding decisions by the province. Not a good time to be a hospital executive, and a tough time for Board Directors – and Chairs – like me.

After six years as a Board Director, the Chair position came earlier than I expected, and it’s been both enlightening and a challenge. While funding and compensation issues have been top of mind, hospitals were also faced with the possibility of increased scrutiny on spending by the Ontario government to look for efficiencies in the system. The Ontario Hospital Association responded with their second edition of Ontario Hospitals – Leaders in Efficiency report in August 2024.

The report clearly demonstrates Ontario hospitals are efficient. It’s worth a look, with results that are laid out very clearly. Some notable facts from the report about Ontario Hospitals:

• In 2023 Ontario had the lowest per capita hospital expenditure by provincial governments across the country, at just $1,885, plus
• The lowest cost of a hospital inpatient stay consistently from 2017 to 2022, and
• The low numbers of total hospital beds per 1,000 population
• Ontario and Quebec have the lowest average length of stay in hospital.

This and other results should help Ontarians understand why there are long wait times for surgery, emergency rooms working at over capacity, and why hospitals are keen to release patients to home care as soon as possible. These issues all have an impact on benefit plans.

It’s not surprising that there are challenges in the insurance industry too. The pressures in the public system increasingly impact the private sector. Several of the issues that have the biggest impact have been brewing for years and some came to a head in 2024. We have seen continued pressure on benefit plans for treatment of mental health issues, obesity and diabetes, along with the administrative challenges associated with some claims in these categories. Organizations are questioning whether investments in mental health are delivering results, and whether current benefit plan designs can continue to meet the needs of plan members and their families within a sustainable budget, particularly for small groups. Somewhat surprisingly the good news is the administrative burden for prior authorization (PA) of high volume and specialty drug claims is becoming unsustainable for payers, which means that they are much more willing to revisit the current manual PA process.

I believe there are opportunities in our industry to use financial resources more wisely and more efficiently, and to adopt reimbursement philosophies that are focussed on long term benefits for plan members and plan sponsors. That’s why I continue to find my work in the industry as an educator, consultant, and key opinion leader rewarding. Having worked in the benefits industry since the early 1980s I can say that while all good things take time, sometimes too much time is not a good thing. There is no question our industry can be guilty of this. The insurance industry must step up to address the acute pain points, and other outdated policies, practices and processes including paper based prior authorization that creates a heavy administrative burden for all stakeholders, and outdated vision care plans that do not support diagnostics and imaging for early diagnosis of serious eye diseases that can lead to vision loss and blindness. Changes in federal legislation this fall with the passage of Bill 284, the National Strategy for Eye Care Act, will help create change for the critical need for better vision care services in Canada for all Canadians. 

Looking inward, 2024 has been a big year for Connex Health. After entering into a purchase agreement for my educational events in late 2022, in summer 2024 the ownership of the Benefits Breakfast Club (BBC) and the online Benefits and Private Healthcare Associate (BPHA) Program reverted to Connex Health. Sometimes life throws you curve balls! With ownership of both the BBC and BPHA returning to Connex, I’ve been proud to honour sponsors financial commitments this season. The BBC is now the Connex Benefits Network (CBN) and we relaunched a new Connex website in November. Not to be one to sit back and let life pass me by, expect to see announcements in the New Year with new opportunities for our industry, including more on the Prior Authorization Framework and Accreditation (PAFA) Program.

Through a year filled with change I’m grateful for the support and encouragement of friends, family, colleagues and clients through the ups and downs 2024 has delivered. I’m also looking forward to new opportunities and to continuing to deliver the longest running, most respected and balanced educational programming in the group benefits industry.

Wishing you all the gift of time over the holiday season to rest, reflect and regroup.

In 2024 Connex Health has been pleased to support the Salvation Army, Guide Dogs of Canada. During the holiday season we also support Plan International where we have funded Health Services For All and Buzzing Bees to support humans and our planet.

Denise Balch and the team at Connex – Nathan Smofsky and Rad Karodia.