Health advocacy emerges in the consumer-driven healthcare environment

February 1, 2006

Health advocacy has emerged as an important facilitator to help employers and consumers better navigate healthcare and insurance.

Health advocacy has emerged as an important facilitator to help employers and consumers better navigate healthcare and insurance. Through personalized medical and administrative support, health advocacy companies can help generate considerable medical-cost and productivity savings as employees receive quality care and are freed from the worries of dealing with the healthcare system.

Much of the interest in consumer driven healthcare plans are based on the premise that more responsibility for healthcare decision-making and expenditure control will encourage employees to become more savvy healthcare consumers. While initially slow to be adopted, both large and small employers now indicate in recent surveys that they will offer some type of consumer-driven, high deductible healthcare plan at least as an option along with the traditionally richer HMO and PPO plans in the coming year.

In theory this makes a lot of sense. In practice, however, many employees are not equipped or do not want to navigate the healthcare system on their own. Frequently, they embark on an odyssey at a time when they are least able to make sense of the clinical and administrative information they or their family members are receiving. The healthcare system is complex, and if consumers are going to play an active role, they will need a good deal of help and support.

With time-constrained schedules, people want to be able to make decisions without the delays and hassles often encountered in today's healthcare system. Also, lost productivity, as employees deal with their own and their family's health issues (e.g., eldercare issues, locating appropriate doctors, coordinating appointments and schedules), is costly to employers.

The Value of an Advocate

Health advocacy companies focus on solving problems that often interfere with an employee's ability to obtain healthcare services in a timely manner. Services are designed to save both time and money, allowing the employee to get the most value from healthcare benefits. Healthcare providers and insurers also benefit since the advocacy company helps to resolve thorny issues in a professional and objective manner.

Improving Productivity: A health advocacy program can reduce the time spent by managers and employees on health-related issues. A professional advocacy team understands the healthcare system and knows how to find answers quickly and efficiently. They solve problems that typically tie up valuable employer resources, enabling employees to go back to work free of these burdens.

Finding "Lost" Money: Health advocacy companies can find savings in several areas, including incorrect billing charges, improved provider negotiations and better purchasing practices.

Reducing Medical Claims Costs: Health advocacy minimizes medical "ping-ponging" when the employee or family member has a medical problem but cannot get the appropriate relief. As they search to find the "best" physician to treat or manage their condition, the result can be duplicated laboratory tests, unnecessary diagnostic procedures and wasted medications. Of course, claim costs in these cases grow exponentially. A health advocacy program can help members find the best provider and have their care properly managed. This "do it right the first time" approach saves both medical resources and significant costs.

Protecting Confidentiality and Limiting Employer Liability: The strict privacy requirements of federal law (HIPAA) is another reason employers turn to an advocacy service for help. An external advocacy service can be a "safe harbor" for employees, freeing the employer's benefits staff from having to deal with many sensitive issues and highly confidential information.

Increasing Employee Satisfaction: Plan sponsors and their employees who have used advocacy services have indicated that they value the services they receive from the company. Furthermore, an advocacy benefit can be used in employee retention and recruitment.

Supporting Plan Sponsors: Many employers choose to use the health advocacy company as an "extension" of their own administrative staff. Typically, this is done either because the in-house HR department does not have expertise to handle the problem or because the health advocacy company has the staff that can fulfill the assignment in a more efficient and cost-effective manner. Employers are the beneficiaries of reduced administrative and medical costs and increased employee productivity and satisfaction.