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

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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.

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[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.