Medical Confidence – Helping Clients Navigate the Healthcare System

by: Angela Johnson, President, Medical Confidence

Canadian employers’ and individual plan members’ concerns over the rising costs of health benefits and disability insurance are well justified. In 2016, Canadian companies spent $7.5 billion for long-term disability (LTD) coverage, the third largest cost to a benefits plan after health and dental.

Wellness and employee assistance programs have traditionally been the go-to answer to help manage these costs yet employers and individual plan members continue to experience rising LTD costs; in 2018, for instance, some carriers experienced premium increases of 4 per cent. This is because programs focused on addressing personal and emotional issues do not effectively address the needs of employees struggling with serious physical and mental ailments.

When Canadian plan members have a serious illness and require medical care, they are left to wait. In fact, Canadians experience the longest wait times for healthcare in the developed world. With more than 54 per cent of the Canadian workforce claiming at least one chronic disease or condition and wait times for specialist care being at an all-time high, the $2.1 billion lost each year in wages due to long waits for surgery and medical treatment should be no surprise.

Navigating the health care system and timely access to specialist care and treatment has become increasingly challenging for Canadian patients. According to the Fraser Institutes Waiting Your Turn: Wait Times for Health Care in Canada, 2018 Report, average wait times for consultation with specialists across the country rose from 10.9 weeks in 2017 to 11.0 weeks. The shortest wait times (8.3 weeks) were reported in Ontario while the longest waits were in Manitoba (17.9 weeks).

The Impact of Wait Times

Research has repeatedly indicated that wait times for medically-necessary treatments are not benign inconveniences. Wait times can, and do, have serious consequences such as increased pain, suffering, and mental anguish. In some instances, they can also result in poorer medical outcomes — transforming potentially reversible illnesses or injuries into chronic, irreversible conditions or even permanent disabilities.

As an example, mental health illnesses are associated with a high risk of disability and death. Earlier access to appropriate care, especially mental health treatment, can have a positive impact on medical outcomes.

The struggle to access care begins early in the process. For instance, family physicians report that their number one challenge is finding a specialist for their patients. There are other systemic challenges as well:

    · Lack of standardization in the referral process
    · Lack of technology to aid in the referral process
    · No standardized pathway for diagnostic testing and imaging
    · Low patient engagement in the referral process

Without clear processes and pathways, the result is often a significant shift in the administrative burden from physicians to patients to ensure they get the care they need when they are at their most vulnerable.

Addressing Obstacles to Care

In 2008, Angela Johnson was profoundly impacted by her sister’s struggles to receive quality care for a very rare neurological condition. This experience compelled her to establish Medical Confidence, a company focused on helping individuals overcome the obstacles impeding access to care in the Canadian healthcare system.

Since 2009, the Medical Confidence team has educated, informed and partnered with patients to help them assume a more active role in their care. Johnson believes if we think of a physician appointment being as important as a job interview, we will accomplish far more during each appointment. Timely access to the ideal specialist results in a more accurate diagnosis which, in turn, leads to more targeted treatment and improved outcomes.

The company’s approach includes both personal navigation support services and technology. When a plan member works with Medical Confidence, they receive education and coaching from a nurse to help them understand their medical condition. A healthcare navigator will leverage the company’s network of 16,000 Canadian physician specialists, a data base leveraging both artificial intelligence and predictive analytics, to map the most appropriate specialist candidates to the plan member’s medical need, geographic location, and the specialists’ practice and availability.

Once potential specialists are reviewed with the plan member, the nurse actively works with the plan member’s primary care practitioner to coordinate the referral to the selected specialist. Requisitions for any required testing and imaging are also coordinated by the Medical Confidence team so the specialist has the right supporting documentation at the time of their appointment with the plan member. Medical Confidence then secures the earliest possible appointments and helps the plan member prepare for their appointment(s). Following the appointment, the Medical Confidence nurse reviews the specialist’s clinical notes with the plan member, schedules treatment and answers any other questions they may have.

Delivering Results for Patients and Employers

The success of the Medical Confidence approach means plan members access specialist treatment 220 days on average sooner than if they had been left on their own. On average, those in need of a psychiatrist are seen 135 days sooner.

Medical Confidence delivers this value-added service through insurers at no cost to plan members in receipt of disability benefits. And it’s a service plan members appreciate: 95 per cent of plan members report they would recommend the service to someone in need, and more than 99 per cent indicate this service has positively impacted their perception of their insurance company.

One plan member had this to say about the service: “Medical Confidence helped me find not only a psychiatrist but also a psychologist, who were collaborative in designing my recovery plan. Both were supportive, collaborative and available, as needed. My family and I have noticed a huge difference and progress made in my recovery journey. I wish I had had the opportunity to begin working with this team closer to the beginning of my recovery journey, and could only imagine where I would be now.

My other wish is for other individuals struggling to have a similar experience to mine and find a very supportive, caring, and collaborative resource team, who were as dedicated and committed as mine were to my recovery.”

Over the last ten years, Medical Confidence has been able to not only help patients navigate the complexities of the Canadian healthcare system, but also deliver significant savings to employers. The reduction in wait times that the Medical Confidence team has been able to achieve results in an average reduction of time on disability by six months. Based on the company’s work with thousands of patients, it is obvious that timely access to information about the ideal specialist(s) is central to successfully reducing employees’ recovery time and potentially disability absence.

Recently, the company created a specialist search platform which provides plan members with easy direct access to its comprehensive, verified directory of specialists and technology. Once the plan member completes their search they can share their selected specialists’ information with their primary practitioner for referral. Employers offering this to their at-work employees can expect to achieve a 3-month reduction in employee illness-related absence.

Finally, Medical Confidence is piloting an innovative mental health navigation service that helps plan members access each of the care elements they need in their recovery. This service has been developed in direct response to insurance carriers and plan sponsor clients asking for a more comprehensive mental health solution.

Medical Confidence continues to look for innovative ways to help empower individuals to be informed and active participants in their health and healthcare decisions. The company believes engaged patients have more confidence in their treating team of medical practitioners and are more actively involved in their diagnosis, treatment plan and recovery. Working with Medical Confidence, individuals use the Canadian healthcare system to its full potential.

*Calculated in collaboration with insurance carrier clients. Involves review of current cases versus historical claims durations of similar claim type (location, disability classification, age, etc).