The Green Shield Canada (GSC) group of companies wants to stand out as the provider that offers the best digital access to mental and dental health care in Canada. To this end, GSC is building a platform that offers the full spectrum of digital health services.
Zahid Salman, President and CEO of Green Shield Canada, and Steve Laberge, Vice President Quebec and Strategic Solutions for HBM+ and Green Shield, spelled out their strategy to Insurance Portal in an exclusive interview. HBM+ is a division of Green Shield that provides drug claims management solutions, among other services.
In addition to having recently completed several transactions to expand its platform, Green Shield is striving to increase its presence in Quebec, where it is less established than in the rest of Canada. Steve Laberge will spearhead this development.
Philanthropic legacy
Salman began by emphasizing the not-for-profit nature of his company, which he sees this as a key component of the culture of the firm. Thus, Green Shield channels its earnings into supporting social causes dedicated to better health, with a particular focus on mental and oral health.
Green Shield’s CEO likes to tell the origin story of the firm, founded in 1957 by Bill Wilkinson, a pharmacist from Windsor, Ontario. One day a young mother came by to get two prescriptions, one for herself and one for her young daughter. She could only afford to pay for one. This young mother’s dilemma inspired Wilkinson to create Green Shield, which offered the first pre-paid drug plan, Salman explains.
Providing care
Zahid Salman points out that Green Shield is the fourth largest health and dental insurer in the country, “all-organic growth,” he notes. GSC is also one of the leading pharmacy benefits managers in Canada, and the biggest player in Quebec, the CEO continues. “In that business, we use our platform advantage and support other insurance companies with it,” he says. Quebec operations are led by Steve Laberge at HBM+.
What’s more, Salman considers dental care sorely neglected. This is why GSC, through its Green Door Project, donated $6.15 million toward a University of Toronto’s Faculty of Dentistry research program that provides free dental care to impoverished families.
“We’re trying to make more visibility around dental gaps in the healthcare systems. About one-third of Canadians don’t have any funding from their employer or the government to access dental care and it’s terrible. It has an impact on all our health if your dental health isn’t good,” Salman explains. He believes that research can give this problem more visibility to governments and other payors.
Open platform
Green Shield’s CEO is not satisfied with being one of the Top 4 insurers in the health and dental market. “We decided to reposition ourselves as an integrated health services company. In addition to providing benefits coverage, paying claims and administering plans, we’re going to be the only insurance company in the country who will also deliver care. We are now starting to acquire and fully own health services providers,” Salman explains.
Salman and Laberge confirmed that the CSG platform will be open to competitors and accessible to all levels of the distribution chain. They summed their strategy up with the words "acquisitions, partnerships and internal development,” adding that the resulting entities will coexist in its platform.
“We want to create an ecosystem of digital health partners, which we call The Digital Clinic, Powered by GSC. Some of the services on the platform will be services that we own; others will be services we have a partnership with. Maple is our partner for telemedicine. Partnering is better for us because there’s already a lot of good telemedicine companies out there,” Salman points out.
Green Shield Canada wants to allow insurers to use its platform, together with third-party administrators or payors, which it views as its clients. Salman notes that GSC already allows third-party access to its platform in the drug plan management business that Laberge leads.
Several recent transactions
On March 9, 2022, Green Shield Holdings acquired two pharmaceutical firms. Zahid Salman called this move a milestone in his repositioning as the only dual payer and supplier in Canada.
A Canada-wide network of four pharmacies and 19 clinics that focus on the treatment of complex diseases such as rheumatoid arthritis, migraine and multiple sclerosis, NKS Health says it serves 30,000 patients a year. The Health Depot, a digital pharmacy, specializes in the treatment of chronic diseases.
In October 2021, HBM+ entered into a partnership with New Zealand-based Sentro. The partners offer a policy and claims management platform, along with a fraud detection service.
In August 2021, Green Shield Canada added Tranquility Online, a Halifax-based company whose digital platform offers online cognitive behavioural therapy and mental health coaching.
In March 2021, GSC acquired Inkblot Technologies. In the announcement of this transaction, Zahid Salman said he intended to develop an ecosystem focused on digital healthcare. GSC now provides individuals, employers, health systems and governments with mental health care through Inkblot, a digital platform.
In December 2020, Green Shield Benefits Association acquired Benecaid from the April Group. Benecaid is an Ontario-based firm that acts as a third-party administrator of group health and dental plans for small and medium-sized businesses.
Green Shield has also invested significantly in select partners. When MindBeacon issued equity on the Toronto Stock Exchange in December 2020, GSC acquired nearly three million shares. A virtual mental health clinic, MindBeacon also counts Manulife and TELUS among its shareholders.
On its website, MindBeacon mentions that its programs are covered by insurers such as Green Shield, Medavie Blue Cross, Alberta Blue Cross, Pacific Blue Cross, Desjardins Insurance, La Capitale and SSQ Insurance (combined in Beneva), Manulife, and Sun Life.
Green Shield Canada’s ability to enhance the platform internally is another asset, Salman continues. In March 2019, GSC and HBM+ launched Claim Watch, a service that employs artificial intelligence to detect and prevent fraudulent claims. Steve Laberge mentions that non-client organizations are using this program.
Growing in Quebec
One of Green Shield’s key strategies is to broaden its presence in Quebec. “We are big in Québec today in one part of our business, pharmacy benefits management, but when you look at the rest of our business, insurance, digital health services, we’re not as big as we think we can be in Quebec. Under Steve’s leadership, we have an ambitious strategy to grow our complete business in Québec,” Zahid Salman says.
Despite being a major drug claims manager in Quebec, HBM+ is going nearly unnoticed, says Steve Laberge, Vice President Quebec and Strategic Solutions for HBM+ and Green Shield. “We have large clients like SSQ Assurance and the Commission de la construction du Québec (CCQ) to which we’re offering white label solutions. We settle claims but nobody knows it’s us behind the scene, because we enable our partners with their own brand,” he explains.
These two claims-paying titans are strong drivers of HBM+’s business. Of the 70 million claims its system processes annually across Canada, four out of ten come from Quebec, Laberge says. He now wants to increase the footprint of the GSC brand in Quebec, in terms of both social involvement and operational capabilities.
Unions and social action
Steve Laberge joined Green Shield Canada in 2014 after a sojourn of nearly 10 years with Desjardins Financial Security. He has been in his current position at GSC and HBM+ since January 2021. Laberge says he is renewing Green Shield’s commitment to Quebec. The GSC executive team has approved our strategy and we are poised to implement our plan to boost our presence in Quebec, he says. To this end, GSC launched the Green Shield Quebec LinkedIn channel on February 1.
One of the organization’s priorities in Quebec will be to showcase its technology tools. “We know Quebec has a lot of very complex plans, with bargaining agreements where the union requires the plan to be managed in an agreed upon way. Such plans need very flexible systems with very strong and capable technology,” Laberge explains.
To better serve these organizations with complex needs, Laberge will promote one-stop access to technology, cost containment solutions and a digital service offering that plan members can easily navigate through, from the device of their choice.
The Strategic Solutions VP will also focus on Green Shield’s social involvement in Quebec. “We want to make a difference in our society, in how we can help Quebecers to live their healthiest life.” For example, a partnership with the Foundation of Greater Montreal allows Green Shield to give a portion of its profits back to Quebecers.
A new insurance company
In late May 2021, Green Shield Holdings announced its intention to apply to the federal Minister of Finance for letters patent to incorporate a life insurance company. The insurer would officially be known as Green Shield Canada Insurance. Laberge says the name registered in Quebec with the Autorité des marchés financiers is Le Bouclier Vert du Canada. “In fact, we’re using the name Green Shield Canada or GSC in Quebec; the same name we use in Canada in English,” he points out.
The new company will be able to offer a diverse range of insurance products through partners, Laberge continues. These products will include life and disability insurance. At press time, the new company had not yet been launched.
Quebec presence in numbers
Green Shield ranked fourth in the Canadian group insurance market in 2020, with a 4.9 per cent share, according to Fraser Group’s Group Universe Report. Sun Life tops the list with a 24.6 per cent share, followed by Canada Life (20.5 per cent), Manulife (19.7 per cent), all the Blue Cross firms in Canada, Fraser Group aggregates (10.0 per cent) and Desjardins Insurance (6.3 per cent).
In Quebec, Green Shield Canada faces an uphill battle. The Group Universe Report puts Green Shield’s share in the province at 0.5 per cent in 2020 (ninth position if combining SSQ Insurance and La Capitale in Beneva, and 10th position otherwise).
The three group insurance leaders in Quebec controlled almost two-thirds of the market in 2020: Beneva held a 27.6 per cent share, when SSQ Insurance (18.6 per cent) is combined with La Capitale (9.0 per cent); Desjardins Insurance had an 18.6 per cent share and Manulife trailed with 13.3 per cent.
Next in descending order are Sun Life (12.4 per cent), iA Financial Group (9.2 per cent), Canada Life (8.2 per cent), the Blue Cross companies active in Quebec, namely Medavie Blue Cross and Quebec Blue Cross (6.4 per cent), and Empire Life with a 1.1 per cent share.
Medical generates half of revenue
In terms of group insurance revenue in 2020 in Canada, 48 per cent comes from medical benefits and 19 per cent from dental benefits, according to the Group Universe Report.
The report notes that long-term disability accounted for 20 per cent of total revenues, accidental death and dismemberment 8 per cent, short-term disability 5 per cent and critical illness 1 per cent. The total exceeds 100 per cent due to rounding to the nearest decimal place, the details of which are not provided in the report.
High demand for mental health
Green Shield has seen the use of its digital services skyrocket since the pandemic began. The firm’s CEO cites the Environics Research 2021 annual report sponsored by Dialogue, a telemedicine service provider that went public in the spring of 2021. The report Canadian Attitudes on Health and Virtual Care found that 82 per cent of working Canadians agree that employers should provide virtual care services for their employees.
“One thing we have seen during the pandemic across the country is that Canadians want to have more access to these digital solutions. These employers are now coming to the insurance companies and saying: can you help me do that?’” Salman observes. Hurdles in accessing care in person have also put enormous pressure on the Canadian health care system.
Demand for the digital mental health care services offered by GSC’s platform is steadily growing, the CEO adds. Inkblot Technologies statistics show that the number of unique mental health claimants grew by 25.9 per cent between 2020 and 2021.
Through Inkblot, Green Shield has also observed that the number of mental health care claimants and claims has grown much faster than the number of emergency health care claimants and claims. From 2018 to 2021, the number of mental health care claimants ballooned by 103 per cent, while the number of emergency care claimants increased by 14 per cent.
During this period, mental health claims increased by 140 per cent, while emergency care claims increased by 11 per cent.
Inkblot’s data also reflect the fact that many plan sponsors expanded coverage of psychological care in 2021, notably by adding new practitioners and services. As a result, psychologists accounted for only 36 percent of psychological care claims in 2021, down from 66 percent in 2018. In contrast, psychotherapists represented 26 per cent of psychological care claims in 2021, a sharp rise from 2 per cent in 2018. Social worker-related claims also increased from 32 per cent in 2018 to 38 per cent in 2021.
