Brad's Sharper Edge Past Issues
Here are a collection of past issues we have sent out that feature quick videos, links to educational content, relevant tips for the time of year, and more. Definitely check them out, and feel free to share the resources with your colleagues.
2023 high-cost claims report
Jan '21: Transplant benefit
Feb '21: Clinical 360
Mar '21: Stop-Loss resources
Apr '21: Benchmarking data
May '21: High-cost claims report
June '21: Stop-loss policy walkthrough
July '21: Renewals
Aug '21: Health Navigator, powered by PinnacleCare
Sept '21: Stop-loss economics
Oct '21: Lasers
Nov '21: Thank you, Partners!
Click on a year below to select A Past Issue
Welcome to the 1st edition of 2021 of Brad's Sharper Edge series.
Key takeaways for today:
•Central & North Florida 2020 Results are in: We wrote 29 new clients together in 2020
•Central & North Florida 2020 Results are in: We renewed at 80% over 100 clients on a Sun Life target of 75% and industry average in the 60s. Renewing my block at a blended leverage trend is critical to the good running block I have been able to maintain to provide stability for this year’s renewals and also for the opportunity to get aggressive and write New Business together in 2021.
•Sun Life Transplant Benefit – a benefit in your TPA administered Sun Life Stop Loss contracts - video above addresss this benefit w/ an example in the video & flyer: Sun Life SunExcel Flyer
January - Transplant benefit, SunExcel
It's time for the 2nd edition of Brad's 2021 Sharper Edge series.
February - Clinical 360
Key takeaways for today:
• The Sun Life Clinical 360 Nurse Team is a tremendous resource to research any large Medical or Rx ongoing claims you are seeing for a Sun Life client
• Click here for an overview of the Clinical 360 program with some Success Stories and Examples
• If you have a Non- Sun Life client who is experiencing a large ongoing claimant – reach out to me and I’ll work to engage a Nurse Case Mgmt on a one off basis to see if we can gain some insight to help you consult your client
It’s time for the 3rd edition of Brad’s 2021 Sharper Edge series.
March - Stop-Loss resources
Key takeaways for today:
• Use me, Brad, as your go to Self-Funded Medical Resource - I have 15 years of experience and a Stop Loss Economics Team behind the scenes that can help shed the light on new products in the market that we have reviewed and are currently reviewing
• If you’re interested in your Team setting up a Zoom call on any of the 3 topics I’m presenting on this year, please email me: Reference Based Pricing in Florida, Benchmarking & Price Stability, High Cost Claim & Clinical Review discussion
• Click here to see is my 2020 Broker Education Series - a savable 1 page PDF w/ links to 8 topical 20 min. presentations
• Click here to see my 2020 Sharper Edge recap 1 pager – in addition to 10 editions of Sharper Edge videos, there are downloadable links to many of our Thought Leadership pieces (benchmark sample/self funded playbook/why unbundle/high cost claimant report/etc)
Happy Friday – it’s the April edition of Brad’s Sharper Edge.
April - Data & Benchmarking for Self-funding
Key takeaways for today:
• Benchmark Example - Sun Life Sample Benchmark Report – this is a benchmark I can provide for inforce clients or prospects if you provide me a medical census
• Benchmarking at YOUR fingertips - Using Data to Create a Successful Stop-Loss plan
• The above link is simple to use and will help you select a deductible level (*check out the stop loss claim calculator)
Get excited, it’s time for the May edition of Brad’s Sharper Edge.
May - Thought Leadership - High Cost Claims Report
9th Annual High Cost Claimant Report – as the largest independent Stop Loss carrier, Sun Life has the data and resources to provide industry leading Thought Leadership.
Key takeaways for today:
• 9th Annual High Cost Claimant Report linked above – easy to read, educational document to review and share as a touchpoint w/ your clients
• Includes Legislative update summary w/ updates on surprise billing / pricing transparency / drug pricing / cobra subsidies
• Overview of COVID related claims and how it has impacted other claims for high cost claimants
It’s time for the June edition of Brad’s Sharper Edge.
June - A hover-over sample of the Stop-Loss policy
Key takeaways for today:
• Known as the hover-over policy, Sun Life has created a digital version of our sample policy (plain language easy to read definitions)
•Link to hover-over sample policy - http://view.ceros.com/sun-life/understanding-your-stop-loss-policy
•Cheer for the Tampa Bay Lightning Tonight in the Stanley Cup Finals
Understanding Your Stop Loss Policy – another great Sun Life tool - click below for quick 3 minute video to learn more
It’s Brad’s Sharper Edge -- monthly 3 minute video below (quick overview on why unbundling can make sense & reminder I’m taking over for Rich Schneeweis – Sun Life Stop Loss)
July - Sun Life Stop-Loss - why unbundle
Key takeaways for today:
• Why Unbundle Stop Loss
o sun life policies mirror the underlying medical plan doc
o upgraded contract features that BUCAs don’t typically include (namely the No New Laser Rate Cap Rider)
o second set of eyes on BUCA claims (they are often auto adjudicated)
o cost competitive compared to BUCA pricing
• Renewal process and philosophy (I’ll be back w/ you mid August to review this topic)
• Clinical 360 & Sun Life’s Pinnacle Care acquisition (health care navigation) – scheduled to check in late august to discuss what Sun Life is rolling out for 1/1/22.
It’s Brad’s Sharper Edge - Introducing a new product from Sun Life from the Stop Loss Team – Health Navigator – A quick 2 minute video to give you the scoop.
August - Health Navigator Introduction
Key takeaways for today:
• What is Health Navigator powered by Pinnacle Care?
o A health advocacy solution for employees to navigate the complex healthcare landscape
o Gives members access to a team of healthcare advisors
o Emphasis on high touch personalized guidance and solutions
o Support and guidance for members to confidently make decisions
• Click here for a brief overview/description of the Health Navigator product offering
• AVAILABLE : quoting begins mid September for January 1 effective new clients and renewals
While the 4th Quarter makes us run fast, I’m taking 2 minutes to explain how my Stop Loss Economics Team can help you and your clients
September - Stop Loss Economics Team
Key takeaways for today:
• Did you know I am not as smart as I look, I actually have a Stop Loss Economics Team supporting me?
o Evaluate narrow networks
o Review different Patient Assistance Plans
o Review different Drug Importation Programs
o Make 1 off pricing decisions when newer programs are being implemented but have not yet been fully evaluated/implemented into our manuals
• Reminder – running a benchmark at your client’s renewal is a great way to determine if your client is at the right deductible level or if they should increase at renewal.
It’s the October edition of Brad’s Sharper Edge (spoiler alert, I did not dress up this year, but we do have a Shakespeare Theme : “To Laser or Not to Laser, that is the Question”
October - to laser or not to laser, that is the question
Key takeaways for today:
• Lasers are much more of a discussion now than in the past
o Start w/ a No New Laser rate cap contract to have a worst case scenario
o Lean on your administrator to get additional information (case mgmt, treatment plans, cobra term dates, medicare prime dates)
o Engage Sun Life’s clinical 360 plan on large claims to see if change in Rx or change in site of care is viable
o Determine if there’s a PAP(patient assistance plan) for any monthly ongoing large Rx that may have a good opportunity to reduce plan costs
o Use this info to determine the best course of action for your client’s renewal
It’s the November edition of Brad’s Sharper Edge - Thanks for another amazing year.
November - Thank you Partners
Key takeaways for today:
• Thank you
o THANK YOU consultants and account executives that trusted Sun Life and me again this year
o We’ll write over 35 new clients and persist approx. 80% (industry average of 70%)
o THANK YOU to my account managers, underwriters, claims teams, and all internal partners that support our clients
o I wanted to take a second to reflect and make sure you all know (internally and externally) that I appreciate everyone’s time that they routinely take out of their day to pick up the phone, answer an email, help me facilitate what I feel is best for your clients
• Reminder – Next Month we’ll get back to some stop loss education!
It’s the Final 2021 Edition of Brad’s Sharper Edge
December - Stop Loss Education Refresher
Key takeaways for today:
• Mathews Holiday Card below (Yes, the Mathews were a Circus for Halloween….we’re probably a circus more than just Halloween so we’ve had practice)
• Make a coffee and watch one of my pre-recorded Education Series Videos
• Topics include (intro to self funding / benchmarking / reference based pricing / captives / clinical 360)
• Feel free to save this 1 pager w/ any colleagues that may want to save this as a resource document for both educational videos and quick link to Sun Life’s product features
Thought leadership and education resources available to you!
Product overview
Gene Therapies whitepaper
Benchmark overview
Clinical 360 overview
Self-funded playbook
Aggregate reimbursement
Captives whitepaper
Cancer
rider
Dec '21: Broker education options
Kicking off a Monday w/ the first 2022 edition of Brad’s Sharper Edge – I am going to tackle the Drug Importation & Patient Assistance Plans stance and process for Sun Life to cover these programs.
January 2022 - Drug importation and patient assistance plans
Key takeaways for today:
Drug Importation Plan Guidelines
• Client’s self-funded plan must cover imported drug expenses
• Claims must be sent through an approved TPA
• If a TPA other than the client’s primary TPA submits expenses, expenses can be submitted once at the end of the policy year
Patience Assistance Plans (PAP programs)
• Client’s self-funded plan must provide coverage for PAP programs (we look to understand if there is an allowance for drugs not approved by the program to flow back to the underlying self-funded plan)
• Sun Life must approve these vendors (currently we have 6 approved and working on more)
• There is a memorandum of understanding with the vendor that lays out the reporting structure & how fees are covered(I.e. - % of savings)
Today is very exciting – 2 clicks today……the short video & then CLICK the hyperlink to see what I’m talking about https://view.ceros.com/sun-life/brad-sharper-edge
February - FINALLY A GO-TO STOP-LOSS RESOURCE PAGE
Key takeaways for today:
• Replacing sending you PDFs to save and resave, I have a website that can be updated so you’ll always have the most up to date content
• What does this Website house?
o Background and introduction of me
o Featured Content that will be updated throughout the year
o Historical Brad’s sharper edge (email overviews and videos)
o Updated Thought Leadership content (i.e. – updated catastrophic claims reports, white papers, covid-19 resources, etc)
Click on the link below where I share my insights on our new product Health Navigator --- Be Curious, Not Judgmental (find out in my video the 2 famous people that coined that phrase)
March - Health Navigator, Powered by PinnacleCare
Key takeaways for today:
• New Product : Health Navigator, powered by Pinnacle Care
o Sun Life is not just a stop loss company, explaining my division is Health & Risk Solutions
o Healthcare is expensive and complicated and we want to help the employee thru Care Navigation
o Package Opportunities w/ Sun Life (Spec – step down deductible / Agg – 3% agg factor reduction)
Thought Leadership Friday – not a Sun Life commercial but a real life topic worth discussing with your clients– INFLATION
April 2022 - Inflation
Check out my 3 minute Video – Background on 4 inflationary pressures that affect Medical along w/ Stop Loss and why inflation may affect the Medical world as much or maybe even more than the inflation we are reading about every day in the news.
Check out my 3 minute Video – I give some high level highlights of what’s covered in this year’s edition (spoiler alert – we’ve expanded from top 10 to top 20 conditions which now covers approx. 91% of all stop loss claims)
May 2022 - 10th Annual High Cost Claims Research Report
Key takeaways for today:
• Click here for a full copy of the research report to review and send to Clients (great leave behind after a mid year review/check in)
• Bonus – for a more interactive experience for the Research report - Ceros experience, link here: http://view.ceros.com/sun-life/2022-high-cost-claims-and-injectable-drugs-report/p/1
I wanted to honor the 4th of July this week and talk about freedom!
First of all, I know you have the freedom to work with many different carriers, so I want to take a second to say Thank You to all the consultants who trust me with their clients.
Check out my 3 minute Video on the freedom Self-Funded medical plans allow plan sponsors & the added freedom when you unbundle the stop loss piece (there are links below as follow up items from my video – a self-funded playbook that talks about the decisions to contemplate breaking down fully insured vs self funded and the second link discusses advantages of unbundling)
June 2022- Freedom
It’s time to get a gameplan for our 1/1 renewals together.
Q4 is always a busy time and this year is no different – Every client is important and I commit to working hard to renewing as many clients together as possible
July - 1/1 Renewal Action Plan + Mathews Q4 action shot
Renewal Setup & Timing : I need the following data w/ approx. 2 -3 weeks lead time to get out the initial renewals
• Medical Census / Open year large claims 1/1/22 – current
• If Agg coverage : open year and prior year agg claims w/ enrollment (if first year renewal, please include 1/1/21 large claims to back out of agg calc)
• Please include any spec deductibles or changes you’d like to see(as in past, you’ll also get current and 2 alternate spec options)
Finalizing a Renewal :
• Once we have a timeline from the client on a renewal decision, we can understand if we can FIRM up w/ August(120 lock)(approx 25% of renewals) / September(90 lock)(most common) / October (60 lock)
• We issue a initial renenwal and then a FIRM renewal……we do not update a renewal each month along the way (exception could be if we find out something material about an ongoing risk that will materially affect the renewal, we can have that discussion)
We’re in Q4 and there’s always a curveball so here we go…….for this edition I’m changing it up – less from me and more from the experts :
~1 minute video below from me then a 2 minute video from Sun Life’s clinical 360 nurse team (see link “Clinical 360 2022 link just below my video)
August - Competitive Advantage - Clinical 360
Key takeaways for today:
• Clinical 360 digital experience
• The Sun Life Clinical 360 Team explains it better than - click here
• Here’s some success stories as I try to set the world record for links in an email (all available for easy reference if you bookmark the bonus link above)
o Clinical 360 Success Story 1: IV infusion alternative.pdf
o Clinical 360 Success Story 5: Validating high cost cancer drug charges.pdf
o Clinical 360 Success Story 6: Investigating anti-rheumatic drug charges.pdf
o Clinical 360 Success Story 11: Correcting duplicate charges.pdf
o Clinical 360 Success Story 18: Member's choice of at-home provider.pdf
2021
2022
Jan '22: Drug importation and PAP
Feb '22: Stop-Loss resource page
Mar '22: Health Navigator
Apr '22: Inflation
May '22: High cost claims report
Jun '22: Freedom
July '22: Renewals
Aug '22: Clinical 360
Sept '22: Timeline & Lasers
Mathews Q4 action shot
It’s Q4, we had a hurricane this week, and it’s a Friday --- 3 reason to keep it tight this month. (my thoughts and prayers out to my friends just south of Tampa in Fort Myers area, I hope all are safe)
Check out the short video below – Decision Timelines & Should your client take a laser??
September - Timing & Lasers
Oct '22: Blood Cancer
Nov '22: Breast Cancer
Dec '22: 2022 recap
Of course, Brad’s October Sharper Edge will have a Halloween Theme – BLOOD!!!!
Check out the 3 minutes video on two hot topics --- Blood Cancer & Hemophilia (sorry for the thumping in the background, Bones kept kicking the deck)
October - Blood Cancer
Please click on the link below for 2 minute video: Breast Cancer and the reminder to encourage Preventative Care.
November - Breast Cancer & Preventative care reminder
Happy Holidays – another Q4 in the books – while the work doesn’t stop, I hope you have a couple days planned to pat yourself on the back and spend time w/ your family.
December - Highlights of 2022
Read More – Click here for the Sun Life white paper on blood cancer and some more details.
Research More – I’m not an expert on Roctavin but it will be the 1st Gene Therapy Hemophilia treatment – estimated Mid 2023 approval and estimated at $2.7 to $3mil price tag.
Summary :
~ Breast Cancer will be Diagnosed over 300,000 time in the US in 2022
~ Breast Cancer has more treatment options than before but important to catch early (click here for our white paper)
~ Preventative Care – please encourage your employees to make sure they are up to date w/ preventative visits
~ 2022 High Cost Claims & Injectable Drugs Report and Website to save (breaks down claims by industry and size segment)
2023
Jan '23: Claims & Clinical 360 update
Feb '23: Self-funding refresh
Mar '23: Plan Doc Mirroring & Claims
Apr '23: Large Claimant Cost Containment
May '23: Brad's Sharper Edge final edition
Jun '22: Freedom
July '22: Renewals
Aug '22: Clinical 360
Sept '22: Timeline & Lasers
Oct '22: Blood Cancer
Nov '22: Breast Cancer
Dec '22: 2022 recap
January Sharper Edge highlights in the 3 minute video below:
• Sun Life’s Clinical 360 program w/ it’s expert nurses reduced medical claims by $24 mil in 2021 and likely when the dust settles over $30 mil in 2022
• We reach out reactively when a large claim is flagged, but please be proactive and feel free to reach out to me if you see an excessive claim you’d like us to research to see if it’s being treated optimally by provider (examples in my success stories of claims to be on the lookout for)…..these claims DO NOT have to be over the spec deductible for us to review
Click here for our Clinical 360 overview and success stories
January 2023 - Claims & Clinical 360 Update
Refresh of a great thought leadership document: the self funded playbook!
February - Learn more about self-funding!
Click below for the 3 minute overview and check out our attached self funded playbook. Spoiler alert – at the end of the video, I solicit topic recommendations for future Sharper Edge topics so please email me recommendations!
New!
Check out our new interactive digital experience on the self-funded playbook or read through the full PDF!
* Click on the images for more
• Cost Containment trends have gained traction as medical costs have increased (Unbundling Pharmacy / Patience Assistance Plans / Dialysis Carveouts)
• Sun Life has a specific VRC(vendor review committee) that has evaluated dozens of these cost containment 3rd parties (feel free to ask for our insights - happy to share!)
• Cost Containment for self-funded plans are traditionally discussed when exploring captives but now, have become mainstream w/ traditional self-funded plans
•Gene Therapies – amazing but costly drug developments that have started to emerge in this space w/ lots more in the pipeline – having a solution here is becoming more popular
Topic Summary & Highlights:
Let’s get rocking and rolling early – grab your coffee & enjoy the April Edition of Brad’s Sharper Edge – today we explore some Cost Containment avenues that are gaining traction.
April - Large Claimant Cost Containment
Click on my less than 3 minute video to the right!
Thought Leadership Library
• Plan Doc Mirroring – Make sure your stop loss policy mirrors the underlying medical plan doc
• Eligibility – Make sure the Employer’s Eligibility is reviewed and covers the employer’s intend (especially around leave of absence and extended leaves past FMLA)
• Covering Procedures Outside the Plan Doc – Understand the Liability (or maybe lack of liability) associated w/ the exception – check w/ your stop loss carrier before making plan exceptions
Topic Summary & Highlights:
This month's topic is on Plan Doc Mirroring and Claims Best Practices with a bonus minute (and a Ferris Beuller reference)!
Click on the 4 minute video to view and learn more!
Refresh on claims best practices and mirroring from our Self-funded playbook
March - Plan Doc Mirroring & Claims Best Practices
Back in 2013, Sun Life released the first high-cost claims report (then called the Catastrophic Claims report) and over the past eleven years, we have remained committed to sharing actionable insights with the self-funded community. While a lot has changed over the years, one thing has not: our commitment to providing vital information that can help Clients stay informed about conditions and medications most likely to result in a high-cost claim, and steps employers can take to manage that risk.
Webinar recording
Top 50 injectable drugs deep dive
Link to the full report
Top conditions by size and industry
Featured content: 11th annual high-cost claims and injectable drug trends report
Thanks so much for stopping by!
Broker resource library
Brad is no longer with Sun Life but we want to make sure that you still have access to everything you need to help advise your Clients. Please check out the wonderful reps that can assist you, scroll down and view Sun Life's thought leadership materials and best-in-class resources, or broswe through Brad's archive of video content. Everything you need to know about stop-loss all in one page.
Want more information? Contact any of the below reps. Click on their names to learn more or email them directly!
Hello and welcome to Brad's Shaper Edge. As you can see, the page looks a little different.
David Chiokadze
Doug Epps
Brendan Clark
Luke Donaphon
Brendan.Clark@sunlife.com
Doug.Epps@sunlife.com
Luke.Donaphon@sunlife.com
David.Chiokadze@Sunlife.com
Tampa and Orlando, FL
Jacksonville, FL
GA business
Tennessee
Topic Summary & Highlights:
May - The 38th and Final Sun Life edition of Brad’s Shaper Edge
• I’m deeply grateful from the strong partnership from many of you on this distribution list that has helped me grow my sunlife stop loss inforce block from $29 million in 2015 to $159 million inforce block today in 2023.
• After 17 years -- today is my last day at Sun Life, but not to worry, Brad’s Shaper Edge will be in your inbox in the near future from a different email address…..more to come!
• Yes, I realize (now) that I have the same shirt on as last month’s sharper edge (I guess I like this shirt). Quick reminder to check out last month’s hot takes on cost containment!
Florida – Aletha Billingsley
Tennessee – Jessica Kenel
aletha.billingsley@sunlife.com
Phone : 702-374-1470
Jessica.uliasz.kenel@sunlife.com
Phone : 954-621 – 8336
Your Sun Life Client Managers: