Sun Life, Collective Health Partner on Integrated Stop-Loss

Offering Gives Employers More Financial Control of Their Healthcare Investment

A strategic partnership focused on transforming employer healthcare through more efficient, technology-driven products

WELLESLEY, Mass., and SAN FRANCISCO (June 25, 2018) — Sun Life and Collective Health today announced an integrated stop-loss offering that gives self-funded employers financial protection from high-dollar claims, while helping identify better treatment scenarios to get their people the right care at the right time.

With their health plan and stop-loss coverage together on the Collective Health Workforce Health Management System, companies’ HR and finance executives now have more ability to predict, manage, and control costs around one of their largest, most important enterprise investments: healthcare.

In a survey published last year by Sun Life, nearly half of employers maintained that while cost savings is their biggest motivation to self-fund, overall financial risk is the biggest challenge they face. This combined stop-loss product helps control that risk. The reimbursement process begins as soon as the claim hits the system, expediting reimbursement and offering greater opportunity to proactively identify options for cost savings.

In addition to seamless claims reimbursement, the new offering gives mutual clients convenient reporting, improved clinical and risk management, and the opportunity to benefit from pooled experience.

High Cost Claims Hit The Bottom Line

“For financial executives overseeing their companies’ self-funded health plans, high-cost claims can have a huge impact on their resources and bottom line. Now, companies can have better visibility into these claims, better controls to manage them, and can potentially be reimbursed before the claims hit their balance sheet, giving them more control of their healthcare expenses,” said Collective Health’s chief health officer and co-founder Dr. Rajaie Batniji. “We’re excited to deliver this fundamental solution early in our strategic partnership with Sun Life, and look forward to a long line of offerings that will allow companies to harness the power of the Employer-Driven Healthcare Economy.”

The combination of Sun Life’s extensive high-cost claims management expertise—it’s the largest independent stop-loss provider in the country, and has saved employers millions through cost containment strategies—and Collective Health’s flexible Workforce Health Management System will also help employers identify potential claims issues earlier in the process. Clinical claim reviewers can proactively take steps to address unnecessarily high costs, such as those stemming from duplicate billing, and may be able to identify more effective treatment alternatives, offering the patient added comfort and convenience in addition to savings for the employer.

For financial executives overseeing their companies’ self-funded health plans, high-cost claims can have a huge impact on their resources and bottom line

“We are very excited to be able to offer stop-loss to self-funded employers on Collective Health’s platform,” said Brad Nieland, vice president of Stop-Loss & Health at Sun Life. “The improved reporting, in conjunction with data and clinical expert-driven claims analysis, will offer employers the tools and knowledge they need to monitor and manage their self-funded plan while addressing healthcare costs and providing a great experience for plan members.”

About Sun Life and Collective Health’s Stop-Loss Offering

Sun Life’s stop-loss coverage on Collective Health’s flexible Workforce Management System offers employers and their financial managers the combined benefits of Sun Life’s extensive expertise in managing high-cost claims and Collective Health’s open infrastructure, access to data, and trusted member engagement platform.

Benefits of the product include:
– Analytics that enable smarter plan design: Easy-to-understand reports within the Collective Health Platform’s Employer Suite provide a holistic view of claims data, enabling employers to make smart changes to health plan designs when it matters—not six months later.
– The ability to better control high-cost claims earlier in their life cycle: Mutual clients will have access to the Sun Life Clinical 360 program, in which nurse consultants analyze clinical and claim data, and work closely with Collective Health’s team to communicate with brokers and administrators on opportunities for savings, such as correcting billing errors or proposing treatment alternatives that reduce costs and provide patients with better care.
– Work with like-minded employers: Eligible mutual clients can share favorable results via a pooled experience.
– Improved cash flow through automated reimbursement of high-cost claims: Eligible claims will be automatically reimbursed by Sun Life weekly, providing a seamless claims management and reimbursement process.

The offering is available for quoting immediately, going live for joint clients on January 1, 2019. More information can be found here.