What’s new in disability claims management? Innovations and real conversations

Webinar will start at 2:00 p.m. ET.

Today’s presentation slides and recording will be posted to sunlife.com/disability

Marc Warrington SVP, Group Distribution

Our presenters

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Carrie BibensMBA, CRC, Associate Director, VocationalRehabilitationServices

Tracy Hamill MD, AVP, Medical Director

Patricia (Trish) Ward MBA, RN, Associate Director of Clinical and Health Services

Today’s agenda

• A clinical claims model that drives best outcomes

• The importance of agility: our COVID-19 response

• What’s new? Our Claims Innovation Lab

• Real conversations: “Live” claims collaboration

• Q&A

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Focused support for best outcomes

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Work Is Healthy

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Sun Life believes that work is an essential part of healthy living. Here are five ways our Work Is Healthy® program benefits you and your employees:

We help employees return to work through our Work Is Healthy philosophy, personalized claims process, and innovative short- and long-term disability policy provisions.

It creates positive experiences. We work with employees to assess what they can do—versus what they can’t. We talk about positive experiences at every opportunity.

It focuses on the right claims at the right time with the right resources, which leads to cost efficiencies and better outcomes.

It introduces the idea of returning to work early in the process. Where appropriate, we talk about returning to work during our first phone call with the employee.

It influences employer costs. Returning employees to work helps restore productivity and reduce the costs of absence that can extend beyond wage replacement.

It helps employers comply with the Americans with Disabilities Act. Employers are required to engage in a good faith interactive process with a disabled employee to determine whether a reasonable accommodation can be made. Returning employees to work helps employers comply with this and other legal requirements.

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Interdisciplinary team approach

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DURATION MANAGEMENT

✓ Early collaborative assessment

✓ Experts working together

✓ Proactive duration management

✓ Actionable return-to-work plans

✓ Reasonable accommodation support

Interdisciplinary Team WisH Approach

Our Expert Resources

• Registered Nurses • Independent

Physicians• Behavioral Health

Specialists • Vocational

Rehabilitation Consultants

• Full Time Medical Director

• National Networks IME/FCE/Peer Reviews

Early Intervention = Best outcomes

For employers • Expert risk management

• Minimized lost time and productivity

• Improved employee morale

• Collaboration on accommodations and return to work planning

For claimants• Speedy processing for routine claims

• Team of experts collaborate to promote optimal return to productivity

• Return to work support

• Social Security advocacy

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Leverage diagnostic codes and occupation/industry to identify claims with most potential for impact

Finding opportunities to enhance our overall return-to-work processes

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Proactive intervention

• Proactive Clinical and Vocational review of STD claims

• Setting RTW plans in motion as soon as claim is approved

Behavioral-health case management

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• Dedicated claims team

• Specialized clinical resources

• Vocational services

• Client focus

• Proactive provider outreach

Identify return-to-work trends for each Client

• Our vocational teams watch for trends with a Client’s claims

• We reach out to the Client to review, report and share ideas for improvements

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Created designated team

• Trained everyone who manage COVID 19 specific claims to understand the medical aspect, contract provisions, and legislative updates

• Designated 10 Team Leads and resources expanded through March, April, and May the STD to ultimately include over 70% of the STD organization

• Expanded Clinical Collaborations to include Medical Director to allow for greater oversight and intervention

Supported our Clients

• Developed customized COVID-19 specific communications for our Clients, including webinars and white papers

• Created reporting for internal and external partners

Streamlined processes

• Accelerated triage of COVID-19 claims with enhanced protocols for gathering information on incomplete claims

• Created a Physician Attestation that could be used instead of medical records or an APS (attending physician statement)

• Implemented DocuSign capability for all STD related documents

• Created centralized email box for Sales and Service to submit COVID-19 related questions

• Held daily leadership team meetings to address emerging issues

Our COVID-19 Response: We received our first positive COVID-19 claim in late March

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Clinical innovation

We are always looking ahead to better serve our Clients and members

Claims Innovation Lab created

Methodology: Centralized Interdisciplinary team reporting to Clinical Services with focus on a select/rotating claim segment (e.g. diagnostic category such as cancer, cardiac, musculoskeletal)

Objective: Develop new protocols, claims practices and insights; share learnings and raise level of expertise to optimize the impact of claims management for our Clients

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Legal/financial issues and resources

Emotional stress, depression

Marital/family issues

Behavioral health or substance abuse

Work-life needs and resources

Health care navigation

Coronary Heart Disease cost the US

about $219 billion each year from 2014-2015. This includes

the cost of health care services, medicines

and lost productivity due to death1

Heart disease facts

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1. Centers for Disease Control and Prevention, Heart Disease, Downloaded 1/6/2020 from https://www.cdc.gov/heartdisease/facts.htm

Coronary HeartDisease

Coronary Heart Disease

Heart attack

18.2 million adults age 20 and

older have Coronary Artery Disease (CAD)1

Coronary Heart Disease killed

365,914people in 20171

Every year, about

805,000Americans have a

heart attack1, other consequences can

include heart failure and arrhythmias

Legal/financial issues and resources

Emotional stress, depression

Marital/family issues

Behavioral health or substance abuse

Work-life needs and resources

Health care navigation

Circulatory (cardiovascular

disease) related illness

Coronary Heart Disease,

as a single sub diagnostic

Coronary Heart Disease

results in

$1.5 Billion in annual STD/LTD

total disability benefit payments1

results in

190 million annual STD/LTD disability benefit

payments1

results in

$5.9 billion of net lost

productivity2

The cost of employee absence

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On average, those with Coronary

Heart Disease have 5 other

co-morbid conditions

which increases risk for morbidity

and mortality2

1. Integrated Benefits Institute, 2019, Disability Diagnosis Analyzer (Beta), Oakland, CA, < https://www.ibiweb.org/disability-diagnosis-analyzer/>

2. 2. Integrated Benefits Institute, Snapshot of Chronic Health Conditions an analysis of data in IBI’s HPQ -Select Database. The HPQ-Select survey is an updated employer-focused version of the Health and Work Performance Questionnaire(HPS) that was developed by Dr. Ronald Kessler of Harvard Medical School and the World Health Organization. This is a reporting basis of 144,000,000 employe es in the US Workforce.

Our Claims Innovation LabA new, centralized, interdisciplinary team focused on select claims segments to identify emerging trends and opportunities to enhance our claims management

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PROGRESS:

Fully operational in fall 2019

Outcomes

Improve outcomes for RTW Protocols and Best Practices

Diagnostically relevant questions to promote optimal claims management

Predictive indicatorsfor RTW

Understanding the impact of emerging trends

Education for Claims Staff

Understanding the impact of co-morbid conditions

Other insights

Clinical Claims collaboration

• Kathleen (Katie) Saidla, Sr. Manager LTD

• Gretchen Hooper, Sr. Case Manager

• Brenda Gross, RN, CCM Clinical Consultant

• Susan Schmitt-Reyna, CRCC Vocational Consultant

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Q&A

Visit sunlife.com/disability for helpful resources

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© 2019 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.

GDIPPT-9477h 6/20

Appendix

Considerations for employers

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Sun Life’s Work is Healthy – We focus

on the whole person, and their ability to produce optimal

outcomes.

• The AHA estimates that by 2035,

45.1% of the US population

will have some form of Cardiovascular Disease (CVD).

• Total costs are expected to reach

$1.1 trillion in 2035; with direct

medical cost projected to reach

$748.7 billion, and indirect costs

estimated to reach $368 billion.Heat and Disease Stroke Statistics- 2018 Update: Chapter 12, Benjamin et al; AHA Statistical 2018 Update downloaded from http://ahajournals.org on January 2, 2020

Considerations for employers

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AFFORDABLE HEALTH BENEFITS PACKAGE

…includes Sun Life as your Disability and Absence Management partner because our Clinical Focus recognizes the complexity of Cardiovascular Disease, understands the impact to your workforce health and productivity, and the right time for RTW.

Create a culture focused on workforce health

Prevention is key to minimize risk

• Education

• Wellness programs

• Health Assessments

• Incentives for healthy life choices

– Nutrition counseling and healthy food options available

– Smoking cessation & support

– Physical activity