Helping Ontarians Access the Chiropractic Care They Need

Working with Insurers, Patients and Employers to Support Ontario’s Recovery and Beyond

Covers of OCA-produced Understanding Extended Health Care guide for chiropractors, Patient's Guide to Extended Health Care Coverage and example infographic titled EHC Insurance 101.
To support a growing understanding of extended health care (EHC) among Ontario chiropractors, our EHC Advisory Council recently produced an Understanding EHC Guide for chiropractors, A Patient’s Guide to EHC Coverage and a series of infographics.

With COVID-19 pandemic restrictions easing, Ontario’s economic recovery is in motion but much of its success will hinge on maintaining a healthy and productive workforce.

As impaired spine, muscle and joint or musculoskeletal (MSK) health has been found responsible for the greatest loss of productive years in the workforce, now more than ever it’s important for employees to access the chiropractic care they need.[1] In turn, chiropractors also play a key role in helping employers provide ergonomically safe work environments, supports and processes to keep their employees healthy and productive, be they onsite or at home.

We can take pride in Ontario’s publicly funded health care system, but it doesn’t cover everything. We know 72 per cent of Ontarians pay for their chiropractic care and treatments privately through extended health care (EHC) insurance plans. [2] They are also called supplementary medical/health coverage plans or employee benefit plans and employers typically provide them as part of a total compensation package, but self-employed people may purchase them individually.

The more effective and comprehensive support EHC plans offer for chiropractic care, the greater opportunity there is for employees to get the expert care they need for their spine, muscle, joint and related nervous system or neuromusculoskeletal (nMSK) conditions. This broad availability also gives employees a choice about who they seek for that care from the growing number of chiropractors listed with EHC insurers.

That said, employees must navigate through the private pay, as well as the publicly funded system to receive the care they need to live their best lives. And this care can be limited by the amount of coverage for effective treatment plans.

Ensuring Employees Access the Care They Need

As the chiropractic profession evolves, research evidence continues to build on its positive benefits in treating nMSK conditions. This knowledge is translated into care plans for each patient’s condition, including treatments and timelines.

To ensure satisfactory patient outcomes, EHC plans should support employees to complete their specific course of treatment.

Most guidelines for nMSK conditions recommend care for four to six weeks. Unfortunately, many EHC plans have inadequate coverage for employees to complete their treatment plans, unless they opt to pay out of pocket.

When this happens, the employee may not complete their care and subsequently experience poor treatment outcomes. This scenario may also cost the employer more in the long term, as well as potentially hinder the employee’s job attendance and retention.

A recent survey of Partnership4BetterHealth, our patient and family advisory council, reinforces this position, as 64 per cent of respondents told us health care benefits factor in their employment-related choices and decisions.[3]

Flexible EHC Plans Foster a Productive and Attractive Workplace

Conversely, when EHC plans align with guidelines so employees can complete their treatment, they’re more able to keep working or return to work, if they’ve been off due to an nMSK issue. In fact, it’s been found that patients receiving chiropractic care have lower disability recurrences and for shorter durations, compared to those receiving care from other health care professionals.[4]

Data also tells us that employees who access chiropractic care tend to incur fewer costs because they’re less likely to be prescribed medications or end up with complex medical procedures.[5]  Similarly, as I outlined in my previous post, interprofessional collaboration between publicly funded medical doctors or nurse practitioners and privately funded chiropractors can help patients effectively manage their MSK pain, while reducing their reliance on opioids.

Given the pent-up demand for publicly funded care due to the pandemic, an efficient program of private care that helps employees get back to work and stay at work serves everyone’s best interests.

Employees are also likely to favour employers with EHC plans that give them the coverage they need to complete their treatment. And according to a 2019 AON survey, compared with past expectations, employees today expect increased flexibility and 56 per cent of respondents expect a high degree of benefit personalization.[6]

With current labour shortages across Canada, employers’ recruitment and retention efforts need to focus on compensation packages that highlight health care and meet needs and expectations across generations.[7]

Helping Patients and Others Through Our Extended Health Care Strategy

To help ensure more Ontarians have access to the effective chiropractic care they need and build internal expertise, we developed an EHC strategy, which complements the Canadian Chiropractic Association’s national EHC strategy.

Recognizing insurers must be accountable to the employers who purchase their plans, a key part of our strategy is to help our chiropractic members work effectively within this system. By helping our members engage effectively with EHC plans and guide their patients to do the same, we aim to support insurers to meet their mandates.

Building Internal Expertise and Providing Practical Resources

Our members know how important EHC coverage is to their patients. In fact, through our 2019 Environics study we learned that four in five chiropractic patients have private health care coverage, the vast majority being EHC.[8]

Members also tell us how they’re sometimes challenged by the complexity of the conditions or limitations that vary across EHC insurers.

Addressing this complexity and building EHC literacy was the genesis of our Extended Health Care Advisory Council. This council aims to develop EHC expertise within our association to best support our members, their patients and collaborate with insurers, while advancing our strategy.

This support includes helping our members to understand and follow leading practices in billing, receipts management and other priorities for EHC insurers, such as virtual care, orthotics and assistive devices.

We also recognize that it’s essential to help our members understand and follow each insurer’s processes as required. Otherwise, the insurer may request an audit and in extreme cases, cease to cover care the chiropractor delivers – leaving their patients to stop their treatment or pay out of pocket.

Based on our organization and others’ requests over the past couple of years, we are seeing more openness to transparency and improved clarity in processes within the insurance sector. We welcome this approach because a practitioner can only be as successful as their understanding of what’s expected of them.

According to the Canadian Life and Health Insurance Association (CLHIA)’s latest data, there are 72 insurers providing EHC coverage in Ontario alone.[9],[10] As patients may have coverage with any one of these, that’s a lot of insurers’ policies for busy chiropractors to keep track of.

To support a growing understanding among Ontario chiropractors, our EHC Advisory Council has recently produced:

  • An Understanding Extended Health Care Guide as a leading practices OCA member resource with practical tools to help patients get the most out of their chiropractic care and chiropractors to fully understand the EHC system.
  • A Patient’s Guide to Extended Health Care to help patients understand their EHC coverage for chiropractic care.

These comprehensive resources help our members, and their teams to effectively structure their clinic’s administrative processes. They also give them accurate tools to inform their patients about the insurance process and answer their questions.

To complement these resources, we produced this podcast on EHC trends and what they mean to Ontario chiropractors.

And we’re in the process of developing an EHC audit tool to help chiropractors provide the information insurers need to be accountable to employers and their EHC investments.

Opportunities to Enhance Patient Care and Outcomes

We also know that EHC insurers have incredible amounts of data that they use to analyze trends and look for opportunities but it’s not readily available.

If that data was shared with health care leaders, it could help private pay and the publicly funded system planners to collaborate on what’s in the best interest of patients and our overall health ecosystem. For example, this data could help inform areas of research that we should be pursuing within chiropractors’ nMSK expertise. We are working towards this ideal among other goals.

In the meantime, our aim is to continue to grow these relationships and become a trusted advisor among EHC insurers and major employers in Ontario.

Future of EHC and What’s Next

Since launching our strategy, we’ve been learning a lot from working with EHC insurers about what employers and patients are looking for.

We need to keep listening to patients about what they want from EHC plans because after all, we all contribute to this private pay system – from the employers who purchase them to the practitioners who deliver care. And as our Partnership4BetterHealth community grows, we want to continue to hear from our patients about their expectations, and what’s working or needs to improve.

Given our pandemic experience and the changes it’s prompting, I think we also have some important questions to address about future working conditions and employee needs that will impact EHC insurance. For example: Will employees continue to work from home? If so, how will the role of employers change vis-à-vis the occupational health and safety of their teams? What supports will employers need to safeguard their employees’ nMSK health and meet occupational health and safety mandates in this new world of work?

As Ontario’s recovery moves forward, we’ll need to be flexible, as we help to shape future strategies that respond to employees’ expectations and how employers, as well insurers, adapt to support Ontario’s workforce.

What are your thoughts about our current EHC system and how Ontarians access the chiropractic care they need? How can our members best support insurers and employers? I welcome your feedback.

In my next post, I’ll discuss our evolving evidence-based framework for chiropractic care and how patient preference plays a key role.


[1] Briggs, A., et al. (2018). Reducing the global burden of musculoskeletal conditions. Bulletin of the World Health Organization.

[2] Environics Research – Study commissioned by the Ontario Chiropractic Association. (2019). Attitudes of Ontarians Toward Chiropractors.

[3] Partnership4BetterHealth. OCA Patient and Family Advisory Community (council).

[4] Allen, H., Wright, M., Craigh, T., Mardekian, J., Cheung, R., Sanchez, R., Bunn, W. & Rogers, W. (2014). Tracking low back problems in a major self-insured workforce: toward improvement in the patient’s journey. Journal of Occupational and Environmental Medicine. 56(6), 604-620.

[5] Allen et al. (2014). Tracking low back problems in a major self-insured workforce.

[6] AON Hewitt Inc. (2019). Employee Benefits: Rethinking objectives in the age of flexibility and choice.

[7] Express Employment Professionals. (2021). Help Wanted – Labour Market in Crisis.

[8] Environics Research – Study commissioned by the Ontario Chiropractic Association. (2019). Attitudes of Ontarians Toward Chiropractors.

[9] Canadian Life and Health Insurance Association (CLHIA). (2021). Canadian Health and Life Insurance Facts: 2021 Edition.

[10]This number excludes property and casualty insurers that are currently actively providing health coverage.

3 Ways Boards and CEOs Can Shun Scandal and Sustain a Positive Culture

Businesswoman leading collaboration session with postit note board, possibly engaging the Board and CEO.Boards and CEOs bear enormous responsibility for the well-being of their organization’s people. In turn, organizations rely on fully engaged and motivated employees to deliver on their mission. Much is written about how ‘trust’ affects each employee’s engagement. Employees should be able to trust their organization to provide a safe environment that evokes pride and provides ample support for them to thrive in delivering quality work to the communities they serve. Employees are also expected to share values aligned with their organization and to come to work each day prepared to do the best they can. Informed leaders know that most employees share this goal. So when employee performance goes amiss, it’s frequently because the culture, including the systems, processes and tools, impedes their success.

Leadership creates culture. To build a culture of trust, ‘walking the talk’ as boards and CEOs is imperative.

The rising number of harassment incidents recently making headlines is a wake-up call for all boards and CEOs. Sadly, in numerous cases, the issues were known and ignored. Employers’ responses to these incidents are also alarming. For me, it raises the question: What is the priority for boards and CEOs?

To mitigate media exposure crises, contracts are usually abruptly terminated but what about long-standing workplace harassment issues employees face each day? What’s the impact to emerging leaders who may view the way senior members (leaders or staff) behave as the way to lead or get ahead?  What message does it send to employees? Does it suggest inappropriate behaviour is ok, as long as you can get away with it, but if you’re caught, you will be fired? These characteristics don’t belong in organizations that espouse to be just, caring, learning and innovative.

When harassment issues emerge, we should ask: What kind of governance and leadership processes might have mitigated damage to the organization, its employees and stakeholders?

In my previous post, I addressed the relationship between the board and the CEO, how to ensure each can simultaneously fulfill their role in harmony through meaningful conversations, particularly generative dialogue, learning and a united workplan.

Boards and CEOs need this harmony to meet their key mandate: To advance the organization’s mission. This mandate includes protecting and growing the organization’s assets. To achieve this mandate, the board must provide effective board governance oversight and the CEO must efficiently manage the organization.

At the heart of this accountability is managing our most important assets – the employees who deliver on our organization’s mission.

Sustaining Trust

Here are 3 ways boards and CEOs can work together to support our employees and sustain a culture of trust:

#1. Seek out the story behind the data –

Boards monitor performance indicators to gain insight. This must include setting performance goals and monitoring indicators that relate to culture and people practices, such as employee engagement, turnover, sick time and grievances. Data only gives us part of the picture. Its complement is insight into the story behind the numbers.

You uncover this story through generative dialogue with the CEO. To work effectively, we must give board members opportunities to use their intuition and judgement to ask the CEO probing questions.

Boards and CEOs must also be open to feedback from all stakeholders. A leading practice in performance assessment is the 360° feedback process. This can be cumbersome and the traditional process alone is outdated in today’s dynamic environment.

With social media and rapid learning cycles, we can connect this process to more dynamic feedback loops. CEOs can gain more dynamic feedback and insight through tactics like trusted blogs, town halls and webinars. Board members should seek opportunities to connect with the broader stakeholder community, gain feedback on their organization’s reputation and how it looks from the outside. Employees also talk about their work environment and their experience reflects how the organization interacts with its stakeholders.

If boards and CEOs listen, while connecting internally and externally, they can’t be blindsided by a longstanding, toxic work environment.

#2. Watch employee interactions throughout the organization

Boards and CEOs must have visibility into the work environment and how employees interact at different levels. How the CEO engages with senior staff, how executive team members support committees or communicate in board meetings often indicates how these leaders interact with the entire organization.

From the governance level, CEOs and boards can also look at internal relationships by participating in key events, such as recognition ceremonies, learning sessions or celebrations. When board members observe how employees and leaders interact, they discover context behind the data presented to them. CEOs must also make it their priority to spend time with all teams to get insight into rapport or tensions between management and employees.

#3. Prioritize and structure HRs’ role appropriately –

Human Resources (HR) must directly report to the CEO. This structure enables HR to advise the CEO and give the board the support it needs to deliver on people practices oversight and the organization’s culture.

We must also remember the HR function is not responsible for the culture. Culture is the role of the CEO. However, we expect HR  to ensure all leaders and employees have the tools they need to apply leading practices to their work and fulfill their roles. Equally important, it must be a strategic partner in ensuring the work environment enables its people to create the best outcomes for the organization. This role includes having: policies that protect employees who come forward with complaints; processes and standards for investigating these complaints; and learning best practices so that everyone knows their responsibilities. The board must provide oversight to ensure these appropriate policies are in place and reassessed, as required.

Caroline showing leadership with three other people participating in CN Tower Edge Walk
Toronto’s CN Tower has created a safe environment that fosters the trust visitors like myself need to attempt its Edge Walk. CEOs and boards must also create a safe workplace with a culture that gives employees the support they need to thrive.

There are no quick fixes to transform a contentious or negative culture. A long-term commitment to applying these 3 ways to foster the well-being of an organization’s people will start the journey.

Now is a good time to reflect on the past year, take stock of your organization’s culture and make plans to strengthen your long-term commitment to its people or most important asset.

What steps will you take in the new year to sustain a positive culture built on trust?  What needs to change, if anything?

I look forward to your thoughts on this subject.

Best wishes for the holiday season and for a positive 2018!

3 Keys to Make You a Successful Leader

Keys to effective leadership: listening, learning and leadingLeadership has been fundamental to our accomplishments for as long as we have shared stories of our successes and failures. Coordinating work or rather making the best use of an organization’s assets and the skills of its people, along with engaging everyone to advance a better future, drives us as human beings.

So why is effective leadership for positive change so challenging?

Frequently we hear people express their dissatisfaction with leadership. It’s hard to recall anyone writing about the thousands of exceptional leaders we have in the public or private sector. We tend to focus on the few outlier examples, positive or negative.

Different stakeholders express their expectations of leadership from their varied vantage points.

  • Clients/Patients/Customers no longer tolerate organizations that do not engage effectively with them, understand their needs and make a difference to their lives. We need to identify which principles guide our interaction with these priority stakeholders, particularly as this is our reason for being in health care or a service industry.
  • Employees are seeking a different work experience. The workplace is filled with different generations but it’s time to stop labelling them. Yes, we need to understand trends but each employee brings a unique contribution and their own expectations within a multigenerational team. In her “Body of Work,” Pamela Slim describes a workforce who sees their work and personal lives aligned with their drive, passion and values. How will we learn to lead in this environment? My experience in public service and complex environments, such as health care, suggests that it’s crucial for leadership to enable this alignment. This alignment creates a culture that retains talent, which is essential to success in any service or care industry.
  • Boards of Directors are challenged to understand a dynamic environment where they are expected to have their “nose in” but “fingers out” of the business. Can boards deliver on their accountabilities without duplicating the management function? Stakeholders are quick to lay blame if the organization fails to deliver on its mandate, as we have seen time and again. Balancing the governance accountability with the management/CEO role requires leadership in itself.
  • Funders expect their constituents to be satisfied. However, we have just begun to scratch the surface of understanding, through dialogue and big data, what constituents expect. How will we rapidly gain a better understanding so that we can be strategic and thoughtful about the changes we implement?

In previous posts, I have shared my teams’ successes, from working in a complex health care environment. These learnings also apply to other settings.

In upcoming posts, I am going to focus on what I believe are the important considerations for leaders to succeed in their roles. As Ontario’s employee demographic shifts during the next 10 to 15 years, leaders will need to get much better at rapidly learning how to effectively lead others and employees will need to ramp up their ability to collaborate.

I believe the following three attributes are keys to success, which I will focus on in upcoming posts

  1. Listening to gain insight – In my last post, I shared my perspective on how important listening is to our work with patients and families. A key part of listening is having meaningful conversations so that we can uncover what’s really important to our patients, so that we are in a better position to meet their needs. These listening strategies and approaches can effectively guide engagement with other stakeholders. I will explore how these strategies and approaches can improve interactions with boards, funders, residents and employees.
  2. Learning to adapt what we know to the context – Learning is a skill that must be mastered by individuals and organizations. In his book “Getting Everything You Can Out of all You’ve Got,” Jay Abraham addresses the issue of how to avoid the costly learning curve. He recommends we master the ability to borrow success practices from other industries and then apply them to ours. We need to understand that there are well established, proven ways to work with people to deliver what they as individuals need. The methods can be transferred. It’s coordinating the intervention or support and its outcomes that are unique to each individual. “Agile” is a term used frequently these days to describe how organizations learn and improve. It also describes the culture and leadership practices of successful organizations.
  3. Leading with authentic intention – In any business/sector/enterprise, leadership is essential to deliver on the mission or mandate its stakeholders set. In a guest Leadership Lab column I wrote for the Globe and Mail earlier this year, I described ways a leader can engage with their stakeholders to steer their organization through complex change.

Leaders will be successful if they listen and learn and apply that learning with their skills to lead an organization.

Recently Andre Picard wrote in the Globe and Mail about Dr. Philpott’s move from the health file to Minister of Indigenous Services. He listed the strengths she brings to her new, even more complex role. Among those strengths are many that all leaders need today. Most significantly for me he noted that: “her unofficial title will certainly be Minister of Social Determinants of Health.” Given our success locally incorporating this perspective into our strategies, I am excited to observe how this will impact outcomes for our Indigenous People and other areas of our health services. She will continue to “Listen, Learn and Lead.”

Please watch for upcoming posts where I will explore these three critical attributes.

What do you think about these three attributes? I’m particularly interested in hearing how, as leaders, we can more effectively lead multigenerational teams. What challenges do you face?