Manulife’s insurance app rewards healthy lifestyles, but also raises ‘health surveillance’ concerns

Making 10 per cent of Canadians less sedentary by 2020 would increase the national GDP by $1.6 billion, according to a study

BY Nicholas Sokic | Financial Post 

Elevators at Manulife Canada’s Toronto headquarters are now adorned with signage that reads, “the stairs go the same way.” It’s part of Manulife’s efforts to change sedentary lifestyles, as it rolls out its life insurance app to its employees and the rest of the country in partnership with Discovery Health, the South Africa-based subsidiary of the financial services group Discovery Ltd.

The Vitality app tracks your health based on several personalized physical and mental personalized assessments. Users can reach bronze, silver, gold or platinum ranking based on their own fitness goals, and win discounts and gift certificates for hotels.com, Amazon, Cineplex and Tim Horton’s, among others.

Manulife launched Vitality in the U.S. four years ago under its John Hancock Financial division, and on an individual basis in Canada in 2017. The group benefits version was launched for Manulife employees in July, which reported 50 per cent participation in its first month.

The Toronto-based insurer has now opened the group benefits program to other companies during a staggered rollout, and already counts Walmart Canada and Scotiabank as customers.

The Vitality app is used in more than 20 countries with 10 million participants. Manulife signed a global pledge with other life insurance companies to make 100 million people more active by 2025.

“About a year ago we decided to launch it in the benefits business so that’s been about developing the platform for the employer market and testing it,” said Donna Carbell, the head of group benefits at Manulife Canada.

Participation in the program is entirely optional and there are no consequences for choosing not to participate, the company notes.

“Customers can select the method, type and amount of information they share,” according to Manulife. “The information is used to encourage customer engagement with the program and reward customers for participating in healthy activities.”

Despite privacy and other concerns, getting people to move around is an uncontroversial goal. During a presentation, Manulife’s chief executive officer Mike Doughty stated that four chronic conditions — respiratory, cardiovascular, cancer and diabetes — are responsible for 60 per cent of all deaths worldwide and 85 per cent of Manulife’s group benefits claims.

The highly personalized nature of the assessments in the app result in a radically different fitness experience for each user, even accounting for pregnancy, Carbell said.

“I may be a very sedentary person who has a chronic condition and it will create a different program for me so I will achieve a gold status with a very different exercise and fitness regime than a marathon runner will,” said Carbell.

Manulife cited a study from the Conference Board of Canada saying that making 10 per cent of Canadians less sedentary by 2020 would increase the national GDP by $1.6 billion and reduce national healthcare costs by $2.6 billion.

RAND Europe, an independent research institute, conducted a study last November surveying 400,000 people in South Africa, the U.S. and the U.K. and found that people using the Vitality app in conjunction with Apple Watch saw an equivalent of 4.8 extra days — an increase of 34 per cent — of physical activity on average each month.

Still, there are some obvious apprehensions in handing over the minutiae of your health information to a third-party.

“There’s always concerns about privacy,” said Carbell. “Any info an employee keys into the system, which might be my waist circumference or body mass index, all of that is housed with Vitality. We don’t even have access to that.”

Instead, the monthly report that employers receive would only contain demographic data such as how many employees are actively using the app.

“They could, theoretically, sell the information to third-parties without any consent on the part of the subject. But (totally voluntary) means nothing,” says Ann Cavoukian, the executive director of the Privacy by Design Centre of Excellence at Ryerson University. “Most people probably haven’t even looked at who the information is shared with, what that consent means.”

Toronto-based John Wunderlich of the self-named privacy and security firm also thinks the situation is not so cut and dry.

“I think it’s hard for me to see what the value offering is for both employer and insurance provider if it isn’t employee health surveillance.”

While employee consent is required, “the pendulum is swinging” on how rigorous that consent may be, Wunderlich says. For those that don’t want to participate, the impact could be anything from increased stress or pressure to perform in an unnatural fashion.

This hypothetical situation is not beyond the pale either. Last year, a statewide West Virginia teacher’s strike was partially brought on due to the Go365, a heartrate- and step-tracking app. A US$500 hike in a teacher’s annual insurance deductible was the punishment for failing to reach a certain amount of points. The program was later abandoned.

However, Manulife counters that it’s “committed to respecting and protecting” customers’ personal information.

“We have organizational, physical and technical safeguards in place to ensure the confidentiality, integrity and availability of the data entrusted to us,” the company said.

Desperate for lifesaving insulin, Americans head to Canada

The excerpreted article was written by  | The Globe and Mail

There’s a new kind of drug runner in town – American mothers of children with Type 1 diabetes who cross into Canada in minivans to buy life-saving insulin at a fraction of the cost they would pay at home.

In The Washington Post, reporter Emily Rauhala tells the surreal tale of a caravan of Minnesota moms who travelled to Fort Frances, Ont., where they purchased $1,200 worth of insulin at a local pharmacy, a stash that would have cost them $12,000 in the United States. (Humalog, a popular product, sells for $34 in Ontario, without a prescription. In the U.S., the same vial costs as much as $300.)

The journey was loaded with symbolism, recalling the caravan of migrants headed to the U.S. from Latin America, which was turned back, in part, because President Donald Trump said it was harbouring drug smugglers.

But the insulin moms primarily want to draw attention to the perversity of U.S. drug prices, the absurdity of patent laws and the failings of the insurance system.

Insulin was discovered almost a century ago by researchers affiliated with the University of Toronto. It was one of the great medical discoveries of all time, a drug that has saved millions of lives. The pioneering scientists involved wanted patients with diabetes to receive insulin at little or no cost, so they sold their patent for $1 to the university.

In a rational world, insulin, a drug that is as essential to survival as water for some, would cost next to nothing.

Yet, in the wealthiest country in the world, patients with Type 1 diabetes ration insulin, and even die, because it is unaffordable.

Insulin was first derived from animal sources such as dogs and pigs. Then came synthetic “human insulin,” recombinant products and bioengineered insulin analogues. Once injected with needles and syringes, insulin is now delivered with pens and pumps, based on careful monitoring of blood sugars.

Each of these iterations has improved safety, efficacy, tolerability and convenience. They have also allowed manufacturers to secure new patents on the processes and products – and increase prices. And increase them they have.

According to a report from the Health Care Cost Institute, between 2012 and 2016, the average cost of treating diabetes for a U.S. patient nearly doubled, to $5,700 from $2,900.

READ MORE HERE: 

Your Pregnancy App May Be Selling Your Data – to Your Boss

Rachel Wells | Glamour

Tracking health data has gotten intimate. Thanks to the booming femtech industry, there are now dozens of fertility and pregnancy apps like Ovia, which give moms-to-be an easy way to input daily health updates during their pregnancy journeys. The apps, featuring colors like purple and blue, create a fun and welcoming environment to track women’s most personal data—sexual activity, menstrual cycles, fertility, pregnancy symptoms, dates for delivery, and even pregnancy loss—in a free, user-friendly mobile app. The idea that these apps might be selling your data isn’t new. But what if your data wasn’t going to some third-party advertiser but rather someone much closer to you—like your boss?

Earlier this week The Washington Post reported that Ovia Health, the parent company behind apps for fertility, pregnancy, and parenting, is selling users’ data to their employers. The Post spoke with Diana Diller, a 39-year-old event planner in Los Angeles who was using Ovia during her pregnancy to log daily activity such as bodily functions and sex drive. Her employer, Activision Blizzard, a video game company, was following along.

Activation Blizzard is part of a program offered by Ovia Health where employers can pay to offer employees a special version of the app as an employee benefit. The catch? The company gains access to the aggregated, anonymized data shared by its employees. Milt Ezzard, vice president of global benefits for Activision Blizzard, told the Post that offering “pregnancy programs such as Ovia help the company keep skilled women.” But experts worry employers could use the information to increase or decrease health coverage depending on what they see in the data. There’s also the fear that companies could use incredibly intimate details like whether or not a woman was having premature birth or suffering a miscarriage in order to make business decisions. “The health information is sensitive but could also play a critical role in boosting women’s well-being and companies’ bottom lines,” Paris Wallace, chief executive of Ovia Health told the Post, pointing to rising rates of premature birth and maternal death as the reasons they want to sell this information to employers.

“It feels like a very big breach of privacy,” says Brianna Bell, 29, a writer based in Guelph, Ontario. “It makes me feel uncomfortable, and it feels like this company has preyed on women who are in the most exciting and vulnerable time of their life.” Bell used Ovia’s pregnancy and parenting apps for 18 months without knowing the company could sell her information. (Ovia’s consumer apps—the free-to-download Ovia Fertility, Ovia Pregnancy, and Ovia Parenting—“do not share any data with employers,” a representative of the company said in a statement provided to Glamour. But the apps’ terms of service do state that by agreeing to use the product, users grant Ovia the right to “utilize and exploit” their anonymous personal data for research, marketing purposes, or sale to third parties.)

The idea of your data—even if it has been stripped of your name—floating around out there for use is unsettling. But is there really anything to worry about? Users need to opt in to Ovia’s employer programs like the one offered by Activation Blizzard, according to the company, and of course, you can always choose not to input certain data. “An employer then only receives population-level data once a certain threshold of users has been reached,” Ovia told Glamour, adding that the app’s makers work only with large companies to reduce the risk of a specific pregnant woman being identified in the office. “We are not reporting personal, intimate information like cycle data or pregnancy symptoms to employers,” the company says.

But that’s not much of a comfort to many women. “It seems as though nowadays anyone can find any information they want on someone even if we think we’re in control of our data,” says Raz Pele, 30, who used Ovia’s fertility app for two years and the pregnancy app for six months, tracking information like her ovulation cycle and the dates of her period. Even with the limited information she put into the app, she isn’t comfortable with the idea of her employer, a large commercial real estate advisory firm, viewing it.

‘Exploratory’ research says devices could cut insurance costs

Read more

While some patients pay for biologic drugs, prison inmates get them for free

Glen McGregor, CTV National News

The Correctional Service of Canada spent more than $100 million over three-and-a-half years to provide inmates with prescription drugs, including revolutionary but expensive biologic medications that some Canadians living with serious illnesses struggle to afford.

Documents obtained by CTV News through the Access to Information Act show that the drug bill for incarcerated offenders is driven largely by spending on new medications that can effectively cure hepatitis C.

The service also spent $2.1 million between January 2015 and August 2018 on biologic drugs such as Remicade, Humira and Enbrel that have revolutionized treatment for people with serious autoimmune disorders, including arthritis and psoriasis and disabling inflammatory bowel diseases Crohn’s and ulcerative colitis.

Ongoing treatments with biologic drugs can cost as much as $20,000 annually. Patients who require them must navigate a patchwork of private insurance plans, provincial drug coverage and, in some cases, compassionate care programs provided by the drug-makers themselves.

Access to the provincial coverage for biologics varies by province, type of illness and with the severity of the disease.

Offenders in federal prisons — those serving sentences of two years or longer — are provided biologic drugs at no charge.

The Correctional Service of Canada says it is mandated under the Corrections and Conditional Release Act to provide every inmate with essential health care, including medications.

“Requests for all medications, including biologics, are made by a CSC physician after diagnosis and assessment of the offender,” the service said in a written statement.

“With respect to biologic medications, as these medications are listed as benefits with criteria, certain diagnosis criteria for coverage is required.”

While prisoners can get free drugs, some patients must fight with provincial health administrators for full coverage or partially fund their own medication.

The family of 21-year-old college student Tristin Ozard says they had to remortgage their home and use a line-of-credit to pay for Remicade treatments that the British Columbia’s provincial plan stopped fully covering when he turned 18.

The Victoria, B.C., college student’s disease responds best to a double dosage of Remicade, leaving his family paying $7,800 every second month while the provincial plan covers the other dose. BC PharmaCare would provide coverage for Tristin with a less-expensive ”biosimilar” of Remicade that Tristin’s family worries may not work for him.

The Ozards have had to raise money to pay for Tristan’s Remicade with a GoFundMe fundraising campaign, but those contributions have made only a small dent in the family’s drug bill.

“It’s hard because you can’t provide for your own family and that doesn’t feel good,” said Ozard’s mother, Melissa.

Though they could get the medication through a compassionate care program run by a drug-maker, Melissa Ozard says she wasn’t willing to provide access to her son’s full medical file that the application required.

She says she’d rather fight BC PharmaCare in court to make it easier for other patients to get the brand-name version of Remicade in future.

While most Canadians can usually get coverage for biologics, some still fall through the cracks, depending on where they live and the severity of their disease.

“Certain provinces do a better job than others,” said Arthritis Society CEO Janet Yale.

“Young or old, employed, unemployed, incarcerated or not, people should have access to their medicines no matter what.”

The discrepancy between the coverage provided federal inmates and patients like Ozard illustrates what critics have long-decried as a major gap in Canada’s health care system — that care from doctors and hospitals is paid for but essential drugs are not always.

“I think Canadians would think it’s unfair prisoners are getting expensive drugs paid for when many people are struggling and going bankrupt just trying to care for their loved ones,” said Conservative Party health critic Marilyn Gladu.

The federal government last year appointed former Ontario health minister Eric Hoskins to lead an advisory committee studying the feasibility of launching a national pharmacare program. His report is due in March.

The bulk of the Correctional Service of Canada’s drug spending goes towards a new class of drugs that can effectively cure hepatitis C, which is transmitted by exposure to infected blood and so also carries a low risk of sexual transmission. It’s a potentially fatal liver disease that is common among offenders.

Since 2015, the service has spent $77 million on drugs such as Harvoni and Epclusa, which typically cost about $80,000 for a full course of treatment, though the government may be able to negotiate a lower price.

The Canadian Liver Foundation says this is money well-spent as the ongoing costs of older hepatitis C drugs like interferon will usually exceed the one-time costs of the new medication over a typical patient’s lifetime.

The assertive approach to combating hepatitis C has reduced the prevalence rate in Canadian prisons from 31.6 per cent in 2007 to 7.8 per cent by 2017, the service says.

Canadians in most provinces and territories can obtain provincial coverage for these hepatitis C drugs.

With files from Mackenzie Gray, CTV News national producer

Canada budget to include limited coverage for prescription drugs – sources

OTTAWA/TORONTO (Reuters) – Canada’s Liberal government will propose a limited expansion to the country’s universal healthcare system in the spring budget to cover part of the cost of prescription drugs, two sources with direct knowledge of the matter told Reuters.

The modest broadening of the healthcare program is set to become one of Prime Minister Justin Trudeau’s key campaign promises ahead of the October election, which is shaping up to be a close fight.

The government would not commit to meeting 100 percent of the cost of prescription drugs for those who have no insurance through their workplace, the sources said. That suggests the government is leaning toward a narrower, more insurance industry-friendly model of pharmacare, as it is called, than that recommended by a government health committee last year.

A spokesman for Finance Minister Bill Morneau declined to comment.

Officials have yet to decide how much detail to provide about the pharmacare system in the budget, which is expected in the week of March 18, the sources said. They may release a general commitment to boost coverage and leave the specifics for the campaign, they added.

But new information on pharmacare’s inclusion in the spring budget and its limited scope gives a first glimpse of the government’s blueprint for what has been called the “unfinished business” of Canada’s publicly funded healthcare system, called medicare.

The sources, who spoke in recent days, requested anonymity because they were not authorized to speak to the media.

Canada’s health system covers care provided in hospitals and doctors’ offices, but prescription medication remains largely the purview of private insurance, often offered through employers, and a patchwork of public plans geared primarily toward the old and the very poor.

Opinion polls consistently show strong popularity for Canada’s public healthcare system.

There have been calls for Canada to extend medicare to include prescription drugs since medicare came into existence in the late 1960s, and multiple studies have recommended its inclusion.

Surveys have found 20 percent of Canadians are either uninsured for prescription drugs or under-insured, and one in 10 Canadians goes without prescription medications because of an inability to afford them, according to the standing committee on health’s pharmacare report released in April 2018.

Manulife Financial Corp, Sun Life Financial Inc and Great West LifeCo are among the major insurers in Canada.

FILLING IN GAPS

The Liberal-dominated government health committee strongly recommended Canada adopt a universal, national pharmacare program that covers drug expenditures for all Canadians for a wide range of drugs.

That would not only improve equity and access, advocates said, but lower drug costs because there would only be one buyer negotiating with pharmaceutical companies.

The government’s budget watchdog estimated that would cost about C$20.4 billion ($15.5 billion) a year – a hefty price tag for the government, but offering an overall saving of C$4.2 billion compared with the total now spent on prescription drugs.

What the government is likely to include in its budget is a much more targeted plan aimed at filling the gaps in coverage not already filled by private insurance or existing public plans, the sources said.

That matches with the government’s finance committee recommendation late last year, which Morneau, himself a former benefits industry executive, has said he would prefer.

It is also in line with what the insurance industry has been asking for. Standing to lose business to a universal government plan, the insurers have argued that most Canadians have good private coverage and that pharmacare changes need only affect a small uninsured minority.

But the Liberals will likely face criticism from policy advocates and left-leaning political opponents for not pursuing a more comprehensive plan. Without a universal system overhaul, advocates argue, people will continue to slip through costly cracks in the coverage system.

An advisory council appointed to study the implementation of pharmacare is expected to come out with recommendations this spring.

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