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Bending the benefits cost curve
Benefits costs are rising – but Sun Life brings innovations and strategies that can help drive these costs down.
Technology continues to shape our lives, and innovations continue to be encouraged. At Sun Life, we’re using technology to create a strong impact – specifically, to empower plan members to make smart, cost-effective health-care decisions and help them live healthier lives. Plan members have a key role to play and we’re providing them with the incentive to follow through.
To find out more, download our Bright Paper: Bending the benefits cost curve – Disrupting rising benefits plan costs and listen to the podcast featuring Marie-Chantal Côté, Vice-President of Market Development for Group Benefits.
We empower plan members with information and tools to help identify products and services that are best for them.
We’re doing this in several ways:
We’re bringing cost transparency to plan members through our provider search tool for health, dental and medical equipment providers. Our first cost transparency initiative was for compression socks. In connection with a reduction in the maximum reimbursement limit for this product, we encouraged plan members to search for lower cost providers. We saw lower claim costs and a change in plan member behaviours. Where plan members have out-of-pocket costs, it’s in their best interest to seek lower prices and we’re helping them do that.
Ella, our digital coach, provides specific, relevant and personalized savings tips to plan members about how they can save on out-of pocket expenses.
Lumino Health Centre makes it easy for plan members to find resources and solutions to live healthier.
- Discover regularly updated wellness and mental health content. Read articles, watch videos, listen to podcasts and more.
- Need to find a health-care professional? Lumino Provider Search can help you find and book appointments.
- Find exclusive savings and special offers through Lumino Resources & Offers*. Browse categories such as Vision & Hearing, Medical Products & Resources, and Mental Wellness.
*This section will only be visible if Lumino Resources & Offers are part of your plan.
This Lumino Health Centre flyer will help you understand the features and benefits of Lumino Health Centre.
For more information about how we’re using digital innovations to bring costs down read our brochure Bending the benefits cost curve – Digital innovation or listen to our podcast.
We use our scale to negotiate discounts with health-care product and service providers and monitor the impact of the discount on plan and plan member costs.
These discounts can be especially valuable for group benefits plan areas that typically have maximum reimbursement limits, such as eyewear, orthotics and hearing aids.
We’re currently negotiating discounts for select paramedical services and medical equipment in areas where cost disparities show there is room for discounted pricing. More information will be shared when it is available.
One of our key strategies for bending the benefits cost curve on drugs is leveraging our scale to negotiate discounts with pharmaceutical manufacturers. These pharmaceutical discounts – known as product-listing agreements (“PLAs”) can:
- Help dampen future pool charge increases
- Strive to balance plan sponsors’ needs for drug plan sustainability with plan members’ access to effective therapy.
When we negotiate a discount, the savings generated lower the drug cost for the plan sponsor and, in some cases, even plan members directly at the point of sale. The plan members must use their pay-direct drug card at the pharmacy of purchase for the savings to apply.
The impact is substantial. Over the past five years, we’ve saved plan sponsors and their plan members more than $100 million through PLAs.
For more information about how we’re using digital innovations to bring costs down, please download our brochure Bending the benefits cost curve – Pharmaceutical discounts
Benefits fraud is big business – amounting to hundreds of millions of dollars of losses each year in Canada. We lead our industry in both the size and capabilities of our fraud and risk management team – and in our fast action to delist service providers who exhibit suspicious claiming patterns.
We lead all insurers in delisting suspicious providers, having delisted over 1,800 entities as of April 2019.
Service provider fraud and collusion schemes are estimated to represent 87% of all fraudulent group benefits activity1; the delisting of suspicious providers is important.
For more information, download our brochure Bending the benefits cost curve – Fraud – How we identify it and reduce it
1Canadian Health Care Anti-Fraud Association and The Fraud Box, Canadian Health Care Fraud Survey, 2004
Health-care innovations can do more than improve treatment for plan members – they can often lower costs too. Two innovations that show promise – and that are currently being tested and measured – are online cognitive behavioural therapy (CBT) and pharmacogenomics.
CBT can be done in person with a therapist, or virtually. Two of the potential barriers to in-person CBT are cost and access. Seeing a therapist in person is not always affordable. For example, the recommended hourly rate by the Ontario Psychological Association is $220. And access can be limited due to long wait times to see a qualified therapist, or due to barriers related to physical access and stigma.
With an online CBT program, plan members complete their therapy online through self-paced modules. A therapist is assigned to the plan member and checks in at regular intervals via email, tracking progress and assessing whether they are benefitting from the online format.
Research has shown that online CBT is just as effective as in-person therapy, with several added benefits. It can help overcome the challenge of accessing a qualified therapist for those living in rural communities, as well as those who may be hesitant to see a therapist in person due to feelings of shame and fear of stigma.
In terms of driving down the cost curve, online CBT can also be significantly less expensive than face-to-face consultations because of reduced therapist time. Exercises that a patient would previously do with a therapist are done online, with the therapist checking in at important junctures.
While the differences in how we respond to medications can be influenced by many factors, much of the variation can be linked to genetic differences in how each person metabolizes a specific drug.
Because we all respond to medications differently, prescribing a drug is often a trial-and-error process. This is especially true in relation to mental health treatments, where general physicians may have limited experience in treating these illnesses, and the range of potential medications is vast.
Pharmacogenomics testing – done through a simple cheek swab – can reduce or eliminate this trial and error process, helping to find the optimal drug for the individual quickly. The advantages in a group benefits context can be significant. These include better health outcomes for employees, cost savings for the benefits plan and, ultimately, reduced costs related to absence and disability for the employer.
