Delivering quality health care benefits to an employee population has only become more complicated due to legislative policy and escalating claims costs - making consumer education and empowerment all the more important in containing cost increases.
"The role of consumer-employee engagement in being a champion for their own journey in health and health care is critical," says Andrew Webber, president and CEO of the National Business Coalition on Health.
In recent years, employers have embraced health care advocacy programs as a way to guide patients toward the most effective and cost-efficient health path. Currently, 46% of companies have health care advocates available for employees, according to a 2011 survey by Fidelity and the National Business Group on Health. Further, 11% of companies are planning to introduce advocates into their benefits package.
The advocate can be the glue for a disconnected health system. Many baby boomers are turning to advocates to help them with caring for aging parents, as advocates can stand in when an employee can't leave work to accompany a loved one on a doctor's appointment. Such programs "can work out very well, but first you must build that foundation of trust, commitment and a real culture [of health] so employees feel comfortable in that organizational environment," says Webber. Ultimately, they need to feel that the employer is "on my side," he says.
As such services become more common, employers considering adding an advocacy benefit have a variety of models to choose from in getting "members to understand their part in this puzzle," says Michou Reichelsdorfer, senior vice president of operations at Prairie States Enterprises, a third-party administrator that includes health advocacy among its services. "Getting employees to connect - not just with their benefits services, but with a primary care physician - is really the future."
Health care advocacy models can become "an arm of the employer," says Webber, as they typically utilize phone-based counseling to assist employees and their families in getting professional medical advice on treatment protocols and advice on the best and most cost-efficient facilities to obtain care. Basically, he says, advocates offer "the full gamut of consumer coaching and counseling services."
While Webber says this is a good model, he warns "it's a voluntary benefit, so it only works if the employee picks up the phone."
In addition to employee inertia, another obstacle to effectively weaving phone-based advocacy services into an overall health and wellness strategy is that many times, insurance companies provide the advocates. Whether true or not, the stigma that insurance companies only care about their bottom line - not the people they cover - prevents many employees from using their advocacy services.
"One of the critical issues here is trust," insists Betty Long, RN, MHA, president and founder of Guardian Nurses, a health care advocacy organization. Guardian Nurses uses a slightly different model with its clients - usually employers, unions or employee assistance programs. Instead of employees calling Guardian, workers may approach their HR/benefits manager to discuss benefits related to a health issue. From there, the benefits manager will have the registered nurses at Guardian call the employee directly.
"We'll guide them through [the health delivery process] and in the instances when we can accompany a patient, we'll go with [the patient and spouse] to the [physician] appointment," Long says. "The nurse is the most objective person in the room, so that we can digest everything for them. You don't always need a nurse to deal with an insurance issue, but when you're talking about a treatment plan for cancer, you want to have a clinical person there."
PSE's FiveStar Health program sparks engagement among employees by using registered nurses as a single point of contact for the employee. This clinically trained "concierge" coordinates scheduling, answers questions and accesses services on a per-employee-per-month compensation structure.
"Not only can a nurse handle simple benefits or eligibility questions, they can also do things like precertification or help a member schedule a preventive visit or get them to their onsite clinic, if available at their employer. So, there is a broader scope of things that [a nurse] can help them with," says Reichelsdorfer.
Personalized patient care
"[Health care advocates are] mature professionals who know the ropes of the health care system. They can get a patient in to see a specialist when the front desk says there's [a long wait]. They have a way to talk to people," says Kathleen Henry, human resource specialist for Creative Benefits Inc., whose company offers Guardian Nurses' services to its 46 employees and employer-clients.
Henry has seen the positive work Guardian Nurses have done for her colleagues and her own family.
When Henry's uncle was diagnosed with bladder cancer, her family employed Guardian to find him the right care. Long and her team got him to the right hospital to participate in a medical trial beyond his normal chemo regime. Three years later, Henry's uncle is healthy and still has his bladder.
"When you have a loved one facing a health crisis, you are so closely tied to that person that you think you hear everything, but you don't." Even though both she and her sister have nursing backgrounds, they needed help from an objective partner. Long would type up notes from each physician appointment for their reference, and to keep her uncle's multiple physicians informed of each others' actions.
The FiveStar Health program not only includes concierge services with a nurse, they provide wellness coaching, health questionnaire utilization and disease management programs.
Guardian Nurses offer in-person attention to patients and families by following up with the patient long after they're done with a procedure. "[The advocate] doesn't make them feel like a name in a waiting room, but [rather] she makes the patient feel like a person," Henry says.
"It is a great service, but a lot of people are paycheck to paycheck," says Henry acknowledging the major challenge with advocacy programs. Creative Benefits has paid for Guardian Nurses' services for its employees. In a larger company, Henry suggests cost sharing between the employer and employee to implement a highly valued advocacy service.
Guardian does not operate on a per-member-per-month pay structure; rather the firm charges in block hours, such as 100 hours per year.
"If [the company helps] a valued employee or family member ... people don't put dollar amounts on that," says Henry. "[My uncle] still has a bladder today because he took the time and initiative to call [Guardian Nurses] and find the best facility and best doctors available. You can't really put a price tag on that."
Webber concurs: "Improving the health of our workforce has a direct impact on productivity and the bottom line [as does] improving the health care delivery system to make sure it's more efficient and effective and using better outcomes for people [who] get sick."
Accolade offers unique payment model for health advocates
Accolade, another advocacy model, works primarily with self-insured employers, whose health costs are even more critical to the company's bottom line. For this reason, Accolade has introduced a unique payment structure where it only gets paid a percentage of what the employer saves in health care costs through the advocacy program. So, if the employer saves nothing and the program fails, Accolade receives nothing.
The advocacy group works in a team structure, so that when employees call the 800 number on the back of their benefits card, they are directed to someone they've most likely spoken to before or someone that works on that team and has knowledge of their benefits plan offerings and limitations.
The organization claims a 93% satisfaction rate among users and has shown net medical benefits cost savings of 5% to 10%.
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