Agentes de seguros médicos
Advocacy solutions designed to anticipate potential health needs may help drive more informed health care decisions and better support members.
A recent survey revealed that all consumers had some level of difficulty understanding their health benefits or finding care — and those difficulties may lead employees to postpone care or choose care that may not be the best fit.1
That’s where advocacy may make a meaningful difference.
Consider Kassidy’s story.* At age 4, she was diagnosed with a rare condition causing muscle weakness and skeletal abnormalities that made performing day-today activities challenging. Recognizing that a power wheelchair would improve the quality of Kassidy’s life, her mother, Kaitlyn, set out to get her one — but it wasn’t a straightforward process.
Based on identification of Kassidy’s clinical profile, her family was matched with a dedicated Special Needs Initiative (SNI) Advisor to help the family navigate the health care system, reduce their out-of-pocket costs and improve their clinical outcomes.
Through the program and the work of her dedicated Advisor, Kassidy was able to get her power wheelchair — and it’s made a meaningful impact on her mobility and independence.
“I have gotten to know [our Advisor] so well ... I now can just send her an email and have her look into the things that I need help with,” Kaitlyn says.
There are many more stories like Kaitlyn and Kassidy’s, but the impact of this compassionate, hands-on support can extend on to the employer. Working with a carrier that advocates for its members and helps them navigate the health system may lead to more favorable health outcomes, reduced health care costs and a better benefits experience overall for employees and their families.
*Names have been changed to protect patient privacy.
Advocacy explained
UnitedHealthcare Advocacy solutions are designed to help deliver:
Proactive navigation using data and insights
up to 2-4%
in medical cost saved for employers enrolled in enhanced Advocacy models2
Data can provide powerful insights to help answer questions that are at the forefront of a member’s mind and may also be used to deliver recommendations members might not have considered.
Using data, including a member’s eligibility and interactions with the health system, UnitedHealthcare offers personalized support. One example is through active member intercept, which is built to help members avoid unnecessary costs with near real-time support that may lead to smarter choices. For instance, if a member schedules an appointment with an out-of-network provider or is approaching their benefit limits, they’ll receive an alert.
The predictive model also analyzes demographic information and claims history to estimate a member’s likelihood of utilizing potentially higher cost out-of-network services for future non-emergencies. With this information, employers may want to consider running a campaign to educate their workforces about using appropriate sites of care. Members may also appreciate getting a notification from an advocate about a lower-cost, network provider or site of care option.
UnitedHealthcare also works to proactively identify members who may need additional support. Advocates may connect members to resources and solutions that are designed to help meet their social, mental and financial needs, using a personalized dashboard that includes:
- Member profile – preferred name, reason for call, Net Promoter Score® (NPS®) emoticons, date and details of last call, flagged action items, communication preferences, birthday reminders and personal notes
- Care path opportunities – top 3 clinical opportunities within clinical programs, health education and decision support, pharmacy and cost savings opportunities
- Health assessments and incentives – 3 most recently completed activities, self-reported health assessment and related incentives and rewards
- Health spend and provider details – 5 most recent claims, alerts to encourage members to stay in network, provider information and cost tools, including the average cost for each service based on a member’s location
- Covered family members – information about a member’s covered family members and a summary of their benefits
Alternatively, members may use self-service tools to find online programs suited for them.
Efforts have also been made to incorporate machine learning initiatives, such as AI-powered coaching and real-time auto-call documentation, to improve Advocate performance and help simplify the member experience.
“Our Advocacy programs are focused on making sure that we’re meeting members where they are, proactively addressing their questions and helping them navigate the health system to make the most of their benefits regardless of how they choose to interact with us,” says Samantha Baker, chief consumer officer for UnitedHealthcare Employer & Individual.
Net Promoter, Net Promoter System, Net Promoter Score, NPS and the NPS-related emoticons are registered trademarks of Bain & Company, Inc., Fred Reichheld and Satmetrix Systems, Inc.
Compassionate, empathetic service in every interaction
12M
members served by UnitedHealthcare Core Advocacy solutions3
An Advocate’s main role is to look out for employees and their covered family members. At UnitedHealthcare, this looks like combining valuable support, empathy and a personal touch to each interaction they have with employees, knowing that health care may often be a sensitive and vulnerable topic.
“A person’s health is one of the most important things in their lives,” says Rebecca Madsen, chief executive officer of Advocacy for UnitedHealthcare Employer & Individual. “So, we need to be attuned to the unique situations members may be facing and give our Advocacy teams the tools to help members more easily find the care and support they need.”
6.4M+
inbound calls serviced by UnitedHealthcare Advocates3
And Advocacy support starts right away, at the onset of the member onboarding process. This includes evaluating whether a member’s usual providers are covered or considered out-of-network, in addition to reviewing their medications for comparable lower-cost alternatives available under their plans to help members more easily find the care and support they need.”
The goal is to have UnitedHealthcare Advocates available to members during all the large and small moments that matter in their life, with members choosing how they engage with Advocates based on their personal preferences — via phone, chat, email or text. Plus, knowing that health concerns don’t always occur during business hours, UnitedHealthcare offers virtual assistance for provider search, claims and prescription status, health plan ID card and benefit details, so members have 24/7/365 access to the information they’re searching for.
835K+
chats completed by UnitedHealthcare Advocates, with a 92% chat satisfaction rate3
When a covered employee is a parent or caregiver to a child with complex needs, even more support may be needed. Through the Special Needs Initiative and Complex Care Concierge (C3) program, UnitedHealthcare identifies adult members or families with children who have complex health care needs and assigns them a designated Care Advisor to provide 1-on-1 support.
Backed by a multi-disciplinary team, these Care Advisors work to help these families and members navigate challenging health situations, with the goal of better health outcomes, lower costs and more supportive health care experiences.
The impact of these programs is best expressed by members themselves:
“Her help was worth more than I can say in words.”
- Parent of child with cystic fibrosis who received support via the Special Needs Initiative
“She did all the research. I mean, she went totally out of her way to help me. And it’s something I never expected.”
- Member who received support for her high blood pressure and behavioral health concerns
More streamlined, simplified benefits experiences
63%
of enrollments into clinical programs are initiated by Advocates, with an 89% program acceptance rate3
Supported by teams skilled in health care delivery across a wide variety of specialties, UnitedHealthcare seeks to address all the factors that may impact a member’s overall health and well-being with a whole-person approach to its benefits strategy.
With one of the most robust datasets in the industry, UnitedHealthcare has the clearest view into a population’s needs and members’ interactions with the health system. Connecting all the pieces across the health system and helping members navigate each step of their care journey becomes easier when Advocates have access to members’ benefits information.
Integrating medical benefits with specialty (dental, vision and financial protection), pharmacy and behavioral, for instance, may create opportunities to diagnose and manage chronic conditions sooner, identify and deploy clinically effective treatments, streamline prior authorizations and more.
Advocates may then refer those members to care management and clinical programs, including solutions from third-party vendors that complement existing UnitedHealthcare solutions, such as those made available to eligible employees through the UHC HubTM.
Plus, members don’t need a referral to many of these clinical programs — they may self-enroll in eligible programs via their customized dashboards, for a more streamlined experience.
All in all, UnitedHealthcare Advocacy services may play a big role in a member’s experience navigating the health system. And the proof is in the numbers, with a 92% overall member satisfaction rate.3
Enhancing tools to help meet changing member needs
UnitedHealthcare is continually enhancing its Advocacy solutions to be more personalized, connected and simplified. These enhancements include:
- More real-time alerts via phone, email and SMS to help close gaps in care, ranging from preventive screenings to social drivers of health (SDOH)
- Opportunity to self-refer into programs (e.g., people with diabetes) and self-identify (e.g., parents of children with special needs)
- Increased access to behavioral health care
- Further reduction of prior authorizations
