Health System Needs To Meet Changed Needs

While there is some discussion about how to pay for extending medicare’s first-dollar coverage beyond in-hospital and physicians’ care to prescription drugs, contemporary needs demand the system’s expansion to encompass two additional imperatives, says a C.D. Howe ‘Intelligence Memo, It needs to meet the changed needs of people, many of them aging, who suffer from multiple, chronic conditions that are amenable to wellness-enhancing treatments provided in their own homes and communities by multi-professional teams of care givers; and, more fundamentally, motivate and educate people in ways to maintain life-long good health. Such expansion requires change in the very culture of healthcare, it says. One stimulus for this change is the fast-growing use of the technologies. As more and more people acquire wearable devices that monitor an ever-wider array of physiological parameters, they will look to physicians, nurses, and other providers for advice on what observed changes may mean and what to do about ominous ones. Technologies also already exist to consolidate every person’s health and care record in a single file under the control of the person to whom it applies, a record shareable with every institution, team, or other provider in the system from whom she or he may seek service. These will both enable and force effective communication and connectedness among the whole range of health service providers and drive workable protocols to make smooth and easy the transfer of patients among institutional and other providers that the current ‘systems’ don’t facilitate. Another stimulus of culture change yet on the horizon is the development of more effective measures of health and well-being. Those in use, infant mortality, life expectancy, quality of life years, and the like, are highly aggregated and reflective of change only over relatively long periods of time. Research is needed on both personally and professionally applied measures of health and wellness and their application to sub-populations ‒ those provided healthcare services by a given team, for example, or those living in a specific region. Those same measures should also be linked to accountability-based funding strategies to foster competition, especially among primary care teams, to provide ever better ways to optimize population health.

Non-beta Exposure Behind Underperformance

Recent underperformance is not the result of a deterioration in factor strategies performance, says a white paper from Scientific Beta. ‘What Really Explains the Poor Performance of Factor Strategies over the Last 3 Years?’ says since it has been possible to offset negative performance for some factors through the good performance of other factors, the issues relate more to the factor exposure implementation choices than to the factors themselves. For instance, in the last three years, the non-control of market beta exposure in a bull market context has prevented the vast majority of multi-factor indices on the market from benefitting fully from the important market risk premium. It is this poor market conditionality rather than the variations in factor returns that explains the disappointing performance of long-only factor offerings over this period.

Interest Rate Hedging Increases

Hedging of UK interest rates and against inflation increased during the third quarter the year to a record high, says a survey by BMO Global Asset Management. Inflation-hedging activity grew by 95 per cent to around £37.9 billion, while interest-rate liability hedging rose to approximately £40.9 billion, up 75 per cent from the previous quarter. Government bonds remained the most popular hedged asset throughout the period, as concerns over Brexit continued to dominate the market. However, despite the record-breaking hedging in the third quarter, some counterparties are still expecting the usual end of year LDI demand to be strong, once Brexit has been resolved.

Hub Expands Solutions

Hub International Limited continues to expand its Canadian employee benefits and retirement solution with six strategic services to provide end-to-end benefits that address the challenges Canadian employers are facing in their benefits offerings to achieve their recruiting, retention, and cost management goals. With the open-ended cost for pharmacy drugs unsustainable, it looks to assist clients with support and resources, including research and insights on drug efficacy; access to complex drugs; and a knowledge database. Taking a holistic approach to wellness, it has created a total member health strategy to support all aspects of health: physical, mental, organizational, and financial. Its support and resources include providing plan sponsors resources to identify problems and offer solutions. In terms of retirement, it is increasing retirement preparedness by building its Canadian retirement practice, including offering proprietary tools for plan sponsors to offer their members. It is also providing a Canadian communication and design service offering to deliver communication tools to clients in all market segments; creating a digital benefits platform that delivers proprietary administration solutions; and leveraging its geographic footprint to provide easy access to support and an efficient path to complete coverage solutions that many U.S. and Canadian businesses desire on either side of the border.

Canadian Equities Lead Way

With nearly 97 per cent of the investment managers tracked by the GMR Database having reported their third quarter performance data, its ‘Institutional Performance Report’ indicates that the Canadian equities universe leads all asset groups with a year-to-date (YTD) median return of 18.03 per cent. This is a huge upswing from the same 162 fund group that posted a -8.77 per cent return in 2018. Not surprisingly, the U.S. equities universe median is also very strong, posting a 16.7 per cent YTD return (243 funds reporting) through the first nine months of 2019. Not far behind is the global equities universe with a median return of 13.78 per cent YTD (266 funds reporting). For more information about the report, click here

Sabia Stepping Down

Michael Sabia, the chief executive of the Caisse de depot et placement du Quebec, is stepping down to become head of the Munk School of Global Affairs and Public Policy at the University of Toronto. He is leaving at the beginning of February. Sabia has served as president and chief executive at CDPQ since March 2009. Prior to that, he was chief executive of BCE Inc.

Session Looks At Biologics

Biologics will be the focus of a Benefits Breakfast Club session. ‘What They Mean To You and Your Clients: Preferred Listing Agreements, Biologic and Biosimilar Policies including the Biologics Savings Partnership’ will be examined. Allison Wills, a partner at 20Sense, will discuss the past, present, and future of biologics and biosimilars. Suzanne Nagy, a consultant, will speak on how product listing agreements (PLAs) are evolving, including point-of-sale savings and the link between PLAs, insurer drug formulary management, and patient access programs. Christopher Fearman, field director, private insurance government affairs and market access at Janssen Inc., will explain the objectives of the Biologics Savings Partnership, address the rationale for its development, and what it means to patients, advisors and insurers. It takes place November 28 in Oakville, ON. For information, visit Benefits Breakfast Club