GreenShield pegs net savings at $114,000 for a 5,000-employee plan with chronic disease coverage
Members with chronic disease who had access to integrated coverage and care saw mental health paramedical claim costs grow 14 percent slower than insurance-only members with chronic disease
GreenShield’s October 2026 Health Outcomes Report found the integrated group saw mental health drug claim costs fall by an additional 2 percent, while chronic disease drug costs grew 4 percent faster among insurance-only members.
Applied to an illustrative group of 5,000 employees, 52 percent of whom qualify as having chronic disease, the differentials produce $100 per employee with chronic disease per year in mental health claims savings and $44 in chronic disease drug claims savings.
Against a total annual EAP investment of $261,000, based on $52.20 per employee per year for EAP and standard telemedicine, GreenShield puts gross annual savings at $375,000 and net annual savings at $114,000, or about $75 per employee per year.
A footnote in the report states that actual plan sponsor chronic disease burden may vary between 30 and 80 percent.
Across members with chronic disease who accessed GreenShield health services, the integrated payer-provider model returned $1.43 for every $1 invested through reduced mental health and chronic disease claims, before any value from reduced absenteeism or disability.
The March 2026 report in the quarterly series showed $1.50 returned for every $1 invested after adoption of the integrated model of mental health services, and the July 2026 report showed $2 for every $1 invested in women’s health.
Claimants in the top 1 percent by claim spend, averaging nearly $10,000 in treatment costs per year, were removed from the analysis.
Anti-obesity drug claims were excluded from the ROI calculation, which the report attributes to an inability to compare plan maximums between the integrated sample client and insurance-only clients while sponsors adjusted drug plans following Health Canada’s approval of generic semaglutide.
Nearly one in four members in early adulthood is living with at least one chronic disease. Among members under 25, GreenShield’s claims data showed 18 percent with one chronic condition and 4 percent with two or more.
Those shares reach 25 percent and 17 percent among members aged 25 to 54, and 22 percent and 52 percent among members 55 and older.
Members in middle adulthood were four times more likely to have multi-morbidity than younger adults, and members in older adulthood 13 times more likely than those in middle adulthood.
The condition mix shifts with it. Mental health accounted for 61 percent of drug claimants in early adulthood, ahead of chronic pain at 14 percent.
In older adulthood, heart conditions accounted for 59 percent, with diabetes and mental health each at 12 percent.
“Chronic disease is no longer a challenge that begins later in life, and our health system continues to be structured around responding once people become sick,” Yan Wang, senior vice-president of product, experience and health outcomes at GreenShield, said in the company’s news release accompanying the report.
Among members with chronic disease, 43 percent submitted claims for mental health medications or services.
One in three counselling providers available through GreenShield’s matching tool specializes in chronic diseases and pain, and two in five members with chronic disease showed reliable improvement of anxiety or depressive symptoms after three self-guided digital CBT sessions.
Members who received nurse coaching under the Preventive Health Program, launched in 2023, were three times more likely to self-report stable health than those who did not.
Twice as many achieved improvements in glycemic control through nurse-led care, a 33.4 percent reduction in HbA1C against 14.7 percent without.
