Sun Life partners with Somatus to provide comprehensive services for late-stage kidney disease and cardiovascular care

Rhea-AI Summary

Sun Life U.S. has named Somatus as a preferred partner to deliver a unique and coordinated care model for Sun Life's stop-loss members with late-stage kidney disease and heart disease. The partnership aims to improve patient care, reduce costs, and provide personalized care plans for Sun Life's clients. Somatus' innovative care model leverages AI-driven technology and has shown proven outcomes of 17% reduction in medical expenses and 31% reduction in clinically avoidable hospitalizations in the Medicare Advantage space.

Positive

• Sun Life U.S. has partnered with Somatus to provide coordinated care for stop-loss members with late-stage kidney disease and heart disease.
• The partnership aims to improve patient care, reduce costs, and provide personalized care plans for Sun Life's clients.
• Somatus' innovative care model leverages AI-driven technology and has shown proven outcomes of 17% reduction in medical expenses and 31% reduction in clinically avoidable hospitalizations in the Medicare Advantage space.

Negative

• None.

Insights

Healthcare Economist

From an economic standpoint, the partnership between Sun Life U.S. and Somatus addresses a critical aspect of healthcare economics—cost management in the face of rising healthcare expenditures. Chronic conditions, such as late-stage kidney disease and heart disease, contribute significantly to healthcare costs. Innovative care models that focus on coordination and personalized care, like the one proposed by Somatus, can potentially lead to more efficient use of healthcare resources.

By integrating AI-driven technology and a multidisciplinary care team, the care model aims to reduce medical expenses and hospitalizations, which are major cost drivers in healthcare. The reported outcomes from Somatus in the Medicare Advantage space suggest substantial cost savings, which, if replicated for Sun Life's commercial members, could impact the overall cost structure of healthcare provision and insurance premium calculations in the long term.

Additionally, the no additional cost access to Somatus' services for Sun Life's stop-loss clients could enhance the value proposition of Sun Life's insurance offerings, potentially increasing their competitiveness in the market. The emphasis on reducing clinically avoidable hospitalizations aligns with broader healthcare policy goals and may contribute to a more sustainable healthcare system.

Healthcare Policy Analyst

The partnership between Sun Life and Somatus may have implications for healthcare policy, particularly in the context of access to care. Sun Life's emphasis on improving access and quality of care through coordinated, personalized care models is in step with current healthcare policy initiatives that aim to shift from volume-based to value-based care. This approach is designed to reward healthcare providers for the quality of care provided rather than the quantity of services rendered.

The integration of data analytics and clinical expertise in the Clinical 360 program can lead to better patient outcomes, which is a key focus of healthcare reform efforts. Furthermore, the partnership's potential to reduce costs aligns with policy objectives to make healthcare more affordable for both employers and employees.

Given that a significant portion of U.S. employees are in self-funded plans, the success of this partnership could influence policy discussions on how to manage chronic diseases more effectively within these plans. If Sun Life and Somatus can demonstrate improved health outcomes and cost savings, it could serve as a model for other insurers and influence future healthcare policies.

Medical Research Analyst

Examining the clinical implications of the partnership, the integrated care model proposed by Sun Life and Somatus could potentially lead to significant improvements in patient outcomes for those with late-stage kidney disease and heart disease. The use of AI-driven technology and a full-service team approach to care coordination emphasizes a proactive stance in managing chronic conditions.

The reported outcomes by Somatus, including a 17% reduction in medical expenses and a 31% reduction in clinically avoidable hospitalizations, are notable. If these results are replicated in the commercial member population, it could signify an advancement in the management of chronic diseases, with a focus on preventative measures and early intervention.

The individualized care plans, which include home health, suggest a shift towards patient-centered care, which has been shown to improve patient engagement and adherence to treatment. The emphasis on empowering patients to take an active role in their health could lead to better self-management and potentially reduce the long-term impact of chronic diseases on the healthcare system.

WELLESLEY, Mass., Feb. 6, 2024 /PRNewswire/ -- Sun Life U.S. has named Somatus as a preferred partner to further support the company's strategy to increase access to care while managing rising costs. Through this partnership, Somatus will deliver a unique and coordinated care model for Sun Life's stop-loss members who have late-stage kidney disease and heart disease, two of the most frequently seen conditions in Sun Life's annual High Cost Claims report.

Sun Life's solution, Kidney Care 360 and Heart Care 360, are aimed at two different patient populations, using one unique care management approach that will be an extension of Sun Life's Clinical 360 program. Clinical 360 combines data analytics and clinical expertise to improve patient care and outcomes while reducing costs. Clinical 360 will work with Sun Life's clients to identify members who will benefit most from working with Somatus' multidisciplinary care team to help establish a care plan that is individualized to the member's needs and preferences, including home health.

"Healthcare costs and access are two of the biggest challenges Americans face when trying to address a health condition," said Jennifer Collier, president, Health and Risk Solutions, Sun Life U.S. "Sun Life is committed to finding ways to directly impact access and quality of care so that our members can experience better health outcomes. We are pleased to partner with Somatus so that our members with kidney or congestive heart disease will receive coordinated, personalized care that improves their health and reduces costs for our clients."

Somatus focuses on whole-person care when it comes to both chronic kidney disease and congestive heart failure. Somatus' innovative and comprehensive care model leverages AI-driven technology to address patient care needs related to medication management, care coordination, nutritional support, and transitions of care support that empower patients to take an active role in their health.

By providing full-service teams of experts to patients living with these conditions, Somatus works with patients' existing providers to act as an extension of their care plan and drive greater healthcare access, helping to ensure that all aspects of care are being coordinated and optimized for improved patient health.

"We are excited to expand our reach and bring our proven medical model to more people through this partnership with Sun Life," said Somatus' co-founder and Chief Executive Officer, Dr. Ikenna Okezie. "Our model has proven outcomes of 17% reduction in medical expenses and 31% reduction in clinically avoidable hospitalizations in the Medicare Advantage space, while proactively improving access to care where and when it is needed. We look forward to extending similar results to Sun Life's commercial members."

Access to Somatus' services will be available at no additional cost to Sun Life's stop-loss clients. As the largest independent stop-loss provider in the country, Sun Life protects self-funded employers when their employees have a high-dollar medical claim. According to the Kaiser Family Foundation, an independent source for health policy research, 65% of U.S. employees are currently in a self-funded plan.

About Somatus
Somatus partners with leading health plans and their in-network specialist, primary care, and health system providers to deliver integrated care for patients with, or at risk of developing, kidney disease and related chronic conditions. As the market leader in value-based kidney care, Somatus' vertically integrated clinical services and AI-driven technologies delay or prevent disease progression, improve quality and care coordination, and increase the use of home dialysis modalities and rates of kidney transplantation. The company is headquartered in McLean, Virginia and founded by a team of world-class healthcare operators, successful entrepreneurs, and leading clinicians. For more information, please visit www.somatus.com.

About Sun Life U.S.

Sun Life is a leading international financial services organization providing asset management, wealth, insurance and health solutions to individual and institutional Clients. Sun Life has operations in a number of markets worldwide, including Canada, the United States, the United Kingdom, Ireland, Hong Kong, the Philippines, Japan, Indonesia, India, China, Australia, Singapore, Vietnam, Malaysia and Bermuda. As of September 30, 2023, Sun Life had total assets under management of C$1.34 trillion. For more information, please visit www.sunlife.com.

Sun Life Financial Inc. trades on the Toronto (TSX), New York (NYSE) and Philippine (PSE) stock exchanges under the ticker symbol SLF.

Sun Life U.S. is one of the largest providers of employee and government benefits, helping more than 50 million Americans access the healthcare and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. Sun Life employs nearly 8,300 people in the U.S., including associates in our partner dental practices and affiliated companies in asset management. Group insurance policies are issued by Sun Life Assurance Company of Canada (Wellesley Hills, Mass.), except in New York, where policies are issued by Sun Life and Health Insurance Company (U.S.) (Lansing, Mich.). For more information visit our website and newsroom.

Media Contacts: 
Anjie Coplin
Sun Life U.S.
Anjie.Coplin@sunlife.com 

Lara Smith
Somatus, Inc.
smithl@somatus.com

Connect with Sun Life U.S.
https://www.facebook.com/SLFUnitedStates   
https://www.linkedin.com/company/sun-life-financial   

 

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SOURCE Sun Life U.S.

FAQ

What is the partnership between Sun Life U.S. and Somatus about?

The partnership aims to deliver a unique and coordinated care model for Sun Life's stop-loss members with late-stage kidney disease and heart disease.

What are the specific solutions offered by Sun Life through this partnership?

Sun Life's solution, Kidney Care 360 and Heart Care 360, are aimed at two different patient populations, using one unique care management approach that will be an extension of Sun Life's Clinical 360 program.

How does Somatus' care model leverage technology?

Somatus' innovative care model leverages AI-driven technology to address patient care needs related to medication management, care coordination, nutritional support, and transitions of care support.

What are the expected outcomes of Somatus' care model?

Somatus' model has shown proven outcomes of 17% reduction in medical expenses and 31% reduction in clinically avoidable hospitalizations in the Medicare Advantage space.

Will Sun Life's stop-loss clients have to pay extra for Somatus' services?

Access to Somatus' services will be available at no additional cost to Sun Life's stop-loss clients.