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Why the buzz about Stop-Loss?

Claims over $1 Million have increased 45%*

since 2019, according to a recent study.**

 

Smart Stop-Loss gives you comprehensive monitoring for today and smarter policy design for tomorrow.

Manage stop-loss deductibles and premiums to save millions.

 

*109 claims per million members in 2019 to 158 in 2022.
**SunLife study from May 2023.

Think about Premiums

Stop-Loss coverage de-risks self-funded employers from catastrophic or unpredictable losses associated with high-cost claimants.  Stop-Loss itself is not medical insurance – it’s a financial and risk management tool.

Annual premiums increase when too many claimants exceed their deductible. Be data-driven to reduce long-term costs.

Smart Stop-Loss uses data to:

  • Monitor an existing policy
  • Actively manage members approaching deductible thresholds
  • See rising risk and projected year-end spend
  • Determine premiums and deductibles that optimize costs

 

What is Smart Stop-Loss?

Smart Stop-Loss is an Analytic Package for HDMS clients.

See members and amounts, even before they hit a Stop-Loss deductible threshold. See details around:

Stop-Loss claimants

Flags members that meet policy trigger criteria (diagnoses, conditions, specialty Rx, etc.) on a running basis. See running totals.

Projected risk

Shows month-by-month actuals and projections. See who is likely to meet or exceed deductibles and when for accurate planning.

Potential risk

Uncovers rising risk. See who is approaching (configurable) thresholds, like 80% deductible AND projected year-end estimates.

Key features include:

SmartPolicy

Ingests your existing policy and adapts analytic processing to your contract details

Adaptive reporting

Reports reflect your policy, configured thresholds, and risk definitions

Predictive Models and AI projections

Predicts which members will meet deductibles

SmartDeductibles

Process sophistication accounts for Laser lists and varying deductibles.

What do you do with these insights?

Accurate planning

Increase the accuracy of forecasts, plans, budgets, spend and financial reporting

Optimize plan design

Design across health plan and stop loss policies to optimize costs

Hyper-personalize care

Help members with hyper-personalized care plans and healthcare resources

Set laser lists and deductibles

Stop-Loss policies are highly customized.  Many include laser lists – these contain specific individuals expected as high-cost claimants.  These individuals have a unique (higher) deductible.

Accurate laser lists ultimately keep Stop-Loss premium lower for the rest of the population.

Smart Stop-Loss packages up information for easy decision-making for next year’s laser lists based on existing health profiles and individual costs.

All analytic views produce results that account for each member’s unique deductible amount.

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HDMS provides predicitive models, pre-defined segments, model scores, historical predictions and more.

 

Bring member-level scores and cohorts into a cross-prediction analytic view.

There’s power and sophistication wrapped up in an intuitive user experience – so you can do more than look back on historical trends.

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Use data to look ahead. Then take action.

HDMS clients – have your team walk you through the latest models.

What do you do next? We’ll make sure your data supports your next steps and actions.

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How fast to SDoH insights?

So many options, tied directly to YOUR population

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What’s so special about the Enlight architecture?

 

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There’s so much data and so many metrics these days.  Maybe you don’t have time to check in and investigate results everyday.

Do more with data.

Create Alerts in Enlight. Let data tell you when you need to dig in. Use Enlight’s proactive insights to make more time in your day.

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Export data anytime you need it!

Export data with ease in Enlight.

Health data is complex, but once unlocked, gives us access to deep insights. Share what you see with others at your organization and break through barriers that slow down your transformation.

 

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Use Enlight’s analytic insights to help define a better path to health for your population.

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Health answers and insights in a flash!

 

KPI Dashboards and easy data access to connected health insights

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Health data is complex, but once unlocked, gives us access to deep insights.

See an example of KPI dashboards. Use or configure for customers or plan sponsors.

 

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Use Enlight’s analytic insights to help define a better path to health for your population.

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Take a close look at how social determinants influence costs and utilization for your population.

Point Solution Impact

See the value and impact of point solutions. How do they affect total costs and overall health?

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Point Solution Impact

See the value and impact of point solutions. How do they affect total costs and overall health?

DEI and Health Equity

How equitably do plans and networks meet diverse population needs?

Predictive Analytics

Predictive models help you anticipate costs and identify ideal targets for specific actions.

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