Health and Risk Solutions
Clinical 360
Our Clinical 360 program combines that data with clinical experts that act as a second set of eyes for our clients, reviewing claims to identify cost savings and care optimization opportunities. Clinical 360 is available at no additional cost to all Sun Life Stop-Loss clients.
As part of Sun Life’s Clinical 360 program, self-funded employers receive support from nurse consultants who monitor their claims to proactively identify care optimization and cost containment opportunities.
A targeted approach to care optimization and savings.
DATA-DRIVEN ANALYSIS
OPTIMIZING CARE AND COST
MONITORING AND TRACKING
Data-driven opportunity identification based on analysis of extensive claim and clinical data
PREFERRED PARTNERS
Access to a wide variety of programs including medical Rx management, negotiation specialists, and condition-specific management
CLINICAL EXPERTS
A dedicated and experienced team of nurses who work closely with both brokers and claim administrators to identify opportunities to
optimize care
and reduce cost.
Clinical 360 Success Story Library
Check out our library of Success Stories here!
In 2022, Sun Life's Clinical 360 program achieved over $30.5 million in savings.
*Source: Sun Life 2022 internal data
IV infusion alternative
Having a second set of eyes
Out-of-network bill negotiation
Verifying medication costs
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Repricing for multiple dosages
Lowers injectable drug prices
Correcting duplicate charges
Site of care change
Recognizing incorrect charges
Making site of care more convenient
Transitioning to infusions at home
From hospital to home infusions
Treatment delays lead to change in care
Moving to home infusions
Click here to filter
Administrator
Region
Type of outcome
Third Party Administrator
ASO Administrator
ALL SUCCESS STORIES
Out-of-network bill negotiation
Lowering injectable drug prices
Correcting duplicate charges
Site of care change
Recognizing incorrect charges
Making site of care more convenient
Transitioning to infusions at home
From hospital to home infusions
Treatment delays lead to change in care
Member's choice of at home provider
TPA SUCCESS STORIES
IV infusion alternative
Having a second set of eyes
Verifying medication costs
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Repricing for multiple dosages
ASO SUCCESS STORIES
Northeast
Central
West
CENTRAL SUCCESS STORIES
WEST SUCCESS STORIES
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Lowers injectable drug prices
Recognizing incorrect charges
Transitioning to infusions at home
Site of care change
Out-of-network bill negotiation
Correcting duplicate charges
Savings from transplant network agreement
Treatment delays lead to change in care
Member's choice of at home provider
IV infusion alternative
Having a second set of eyes
Verifying medication costs
Repricing for multiple dosages
Moving to home infusions
NORTHEAST SUCCESS STORIES
Meet the team
Regional nurse consultants
Lisa Hundertmark
Ellen Talbot
Peggy Voight
Mountain West Region
Southeast Region
Central Region
Northeast Region
Jodi Alden
Christy Mills
Deborah Williams
Marissa Heath
Marissa.Heath@sunlife.com
Deborah.Williams@sunlife.com
Christy.Mills@sunlife.com
Jodi.Alden@sunlife.com
Click here to learn more about clinical 360!
Not approved for use in New Mexico.
Group stop-loss insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 07-SL REV 7-12. In New York, group stop-loss insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12. Product offerings may not be available in all states and may vary depending on state laws and regulations.
© 2023 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life and the globe symbol are trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.
GSLCR-10937 #1160884668 08/23 (exp. 08/25)
Sun Life is your second set of eyes. Do you have someone who is looking at your expenses to confirm they are accurate?
To learn more, contact your broker or Sun Life Stop-Loss Specialist.
Site of Care
Savings Opportunity
Site of care change
Making site of care more convenient
Transitioning to infusions at home
From hospital to home infusions
Treatment delays lead to change in care
Member's choice of at home provider
SITE OF CARE SUCCESS STORIES
IV infusion alternative
Having a second set of eyes
Out-of-network bill negotiation
Verifying medication costs
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Repricing for multiple dosages
Lowers injectable drug prices
Correcting duplicate charges
Recognizing incorrect charges
SAVINGS OPPORTUNITIES SUCCESS STORIES
All Stories
Saving time moving to home infusions
Saving time moving to home infusions
Saving time moving to home infusions
Saving time moving to home infusions
West Region
Jennifer Powers
Jennifer.powers@sunlife.com
From hospital to home infusions
Making site of care more convenient
MOUNTAIN WEST SUCCESS STORIES
Southeast
Moutain West
Making specialty drugs more convenient
Transplant network contract placement
Negotiating a high-cost hospitalization
Evaluating high-cost specialty drug charges
Member's choice of at home provider
Savings from transplant network agreement
Evaluating high-cost specialty drug charges
Transplant network contract placement
Negotiating a high-cost hospitalization
SOUTHEAST SUCCESS STORIES
Making specialty drugs more convenient
Savings from transplant network agreement
Negotiating a high-cost hospitalization
Moving to home infusions
Evaluating high-cost specialty drug charges
Transplant network contract placement
Medical Rx Management, powered by OptiMed
Sun Life has selected OptiMed Health Partners as a preferred partner to help manage the rising costs of specialty Rx medications and deliver a better care experience for plan members.
Learn more here!
Clinical 360 overview
Medical Rx 360
Navigation
Medical Rx 360, powered by Optimed
Using the Clinical 360 data-driven approach to identify individual opportunities, our clinical experts will work closely with OptiMed providers, broker partners, and administrators to deliver Medical Rx Management services at the case level. Engaging with the client and member, OptiMed will:
• Help the member access care outside of a hospital setting—reducing risk of infection and complications, delivering a better care experience with optimal outcomes, and a reduction of costs for all
• Ensure approved medications are clinically appropriate, with the lowest possible costs, helping to reduce the on-going treatment cost for high-cost injectable specialty drugs, while passing savings along to the client
Applying Medical Rx Management strategies to even just a small percentage of claims can reduce spend on certain high-cost drugs
Medical Rx Management comes as a value-added solution included with every Sun Life Stop-Loss policy. With our approach, we can help to reduce the financial pressure on self-funded employers and provide access to the best care to their members.
How it works
Clinical 360, our broker partners, and clients
Clinical 360 + Optimed + broker + health plan administrator
Clinical 360 + Optimed
Optimed + client + member
Identify cost management and care optimization opportunities
Assess individual opportunities for appropriateness, alternatives, and potential delivery avenues for treatment
Review opportunity with a cost savings analysis and solutions overview
After agreed upon proposal and signed service contract, OptiMed providers work directly with member to coordinate the best possible care and provide on-going care management
Hover over each step of the process to learn more
Patient case studies
Escalating intravenous Immune Globulin infusion costs
Factor VIII renewal obstacles
Remicade's annual impact
Click into each story to learn more
Remicade's annual impact
The Sun Life Clinical 360 team identified a pediatric claimant receiving Remicade infusions in a facilitaty two hours away, every four weeks, to manage their Crohn's disease. The employer group was being charged 4.6 times the average wholesale price for Remicade.
Optimed strategy
Optimed reviewed the case and proposed the best available pricing, and also recommended a change to at-home infusions from a dedicated pediatric care team.
The result
$396k
anticipated savings per year
Member impact
With Optimed's support, we were able ot provide a better experience for the claimant and their family, including:
• The security of knowing the infusions their child will
receive for years to come will be covered and provided
at no out-of-pocket cost to the member, or subject to a
health plan deductible
• The best possible care provided at home, allowing for
flexibility in treatment to fit in to their lives—no long
drives for treatments, a regular school and activity
schedule, reduced time off from work to provide care
Remicade is on the list of top 20 high-cost injectable drugs within Sun Life’s 2022 book of business
Escalating intravenous Immune Globulin infusion costs
A plan sponsor with 10,000 lives was concerned by the escalating costs surrounding their two patients receiving Immune Globulin (IG) infusions at their local hospital every four weeks.
Patient conditions:
• Primary Immune Deficiency
• Common Variable Immune Deficiency
Optimed strategy
The plan activated OptiMed’s solution in which the patients were redirected from the hospital setting to their homes – reducing risk of infection and complications – while providing a safer and more convenient administration with reduced costs for all.
The impact on cost
$100k
savings per year
Factor VIII renewal obstacles
In a 5,000-life group, one patient was diagnosed with Hemophilia and was receiving factor infusions for prophylactic and episodic treatments. The plan sponsor was concerned heading into a plan renewal with the mounting costs related to this treatment.
Optimed strategy
OptiMed engaged the patient into an individualized care plan that helped control costs and minimized the risk of adverse effects of the disease, such as unplanned emergency room visits, irreversible joint damage, and diminished quality of life.
The impact on cost
$115.2k
savings per year
Clinical 360 overview
Medical Rx Management
Navigation
Member-focused outcomes
Sun Life and OptiMed are focused on creating better experiences and improved outcomes for our members through our solutions. Medical Rx Management provides the most affordable price for specialty drugs, while also providing:
Click here to hear how this approach to care has impacted OptiMed patients.
• Access to the best treatments and infusion care at home
• Flexibility in treatment schedules to fit into a member’s daily life with limited disruption
• Reassurance knowing their medication will be covered and have the support of a dedicated care team
Click here to learn more about Medical Rx Management, powered by Optimed!
15-55%
Source: OptiMed Health Plan internal data from 2018-2023.
Sun Life is your second set of eyes. To learn more, contact your broker or Sun Life Stop-Loss Specialist.
CLINICAL 360
Health and Risk Solutions
Clinical 360
Our Clinical 360 program combines that data with clinical experts that act as a second set of eyes for our clients, reviewing claims to identify cost savings and care optimization opportunities. Clinical 360 is available at no additional cost to all Sun Life Stop-Loss clients. Learn more about Clinical 360 and how we help our clients.
As part of Sun Life’s Clinical 360 program, self-funded employers receive support from nurse consultants who monitor their claims to proactively identify care optimization and cost containment opportunities.
A targeted approach to care optimization and savings.
DATA-DRIVEN ANALYSIS
SAVINGS
MONITORING AND TRACKING
Data-driven outlier identification based on analysis of extensive high-cost claim and clinical data
COST MANAGEMENT PROGRAMS
Access to variety of programs and vendors such as specialty Rx, specialized negotiators, and dialysis contracting to help with care and cost management
CLINICAL EXPERTS
A team of nurses with an average of 29 years of experience work closely with both brokers and claim administrators to identify opportunities and achieve cost savings
Clinical 360 Success Story Library
Check out our library of Success Stories here!
Since 2020, Sun Life's Clinical 360 program has achieved over $40 million in savings.
Nearly $25 million of that was saved in 2021 alone.*
*Data as of December 31, 2021
IV infusion alternative
Having a second set of eyes
Out-of-network bill negotiation
Verifying medication costs
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Repricing for multiple dosages
Lowers injectable drug prices
Correcting duplicate charges
Site of care change
Recognizing incorrect charges
Making site of care more convenient
Transitioning to infusions at home
From hospital to home infusions
Treatment delays lead to change in care
Member's choice of at home provider
Click here to filter
Administrator
Region
Type of outcome
Third Party Administrator
ASO Administrator
ALL SUCCESS STORIES
Out-of-network bill negotiation
Lowering injectable drug prices
Correcting duplicate charges
Site of care change
Recognizing incorrect charges
Making site of care more convenient
Transitioning to infusions at home
From hospital to home infusions
Treatment delays lead to change in care
Member's choice of at home provider
TPA SUCCESS STORIES
IV infusion alternative
Having a second set of eyes
Verifying medication costs
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Repricing for multiple dosages
ASO SUCCESS STORIES
Northeast
Central
West
CENTRAL SUCCESS STORIES
WEST SUCCESS STORIES
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Lowers injectable drug prices
Recognizing incorrect charges
Transitioning to infusions at home
From hospital to home infusions
Out-of-network bill negotiation
Correcting duplicate charges
Making site of care more convenient
Treatment delays lead to change in care
Member's choice of at home provider
IV infusion alternative
Having a second set of eyes
Verifying medication costs
Repricing for multiple dosages
Site of care change
NORTHEAST SUCCESS STORIES
Meet the team
Regional nurse consultants
Lisa Hundertmark
Ellen Talbot
Peggy Voight
West & CA Region
Southeast Region
Central Region
Northeast Region
Jodi Alden
Christy Mills
Deborah Williams
Marissa Heath
Marissa.Heath@sunlife.com
Deborah.Williams@sunlife.com
Christy.Mills@sunlife.com
Jodi.Alden@sunlife.com
Click here to learn more!
Not approved for use in New Mexico.
Group stop-loss insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 07-SL REV 7-12. In New York, group stop-loss insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12. Product offerings may not be available in all states and may vary depending on state laws and regulations.
© 2022 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life and the globe symbol are trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.
GSLCR-10937 SLPC 31423 02/22 (exp. 02/24)
Sun Life is your second set of eyes. Do you have someone who is looking at your expenses to confirm they are accurate? To learn more, contact your broker or Sun Life Stop-Loss Specialist.
Site of Care
Savings Opportunity
Site of care change
Making site of care more convenient
Transitioning to infusions at home
From hospital to home infusions
Treatment delays lead to change in care
Member's choice of at home provider
SITE OF CARE SUCCESS STORIES
IV infusion alternative
Having a second set of eyes
Out-of-network bill negotiation
Verifying medication costs
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Repricing for multiple dosages
Lowers injectable drug prices
Correcting duplicate charges
Recognizing incorrect charges
SAVINGS OPPORTUNITIES SUCCESS STORIES
All Stories
Saving time moving to home infusions
Saving time moving to home infusions
Saving time moving to home infusions
Saving time moving to home infusions