Employer focus
Speaking out on patients’ behalf
Some employers think simply offering medical insurance to employees isn’t enough. They’d like additional help for staffers and families navigating the health care system. Enter the patient advocates.
Advocacy advice runs the gamut – from what questions to ask your doctor before surgery, estimates of the cost of care before treatment, the advantages of using a network provider and how to compare plans at open enrollment, to support with claims and appeals.
Typically, employees engage medical advocacy services through a free 800 telephone line. Thomas Lamb, administrator of Law Enforcement Health Benefits (LEHB) in Philadelphia, whose members include 8,000 city police officers, sheriffs, retirees and their families, had a different idea. The firm he hired, Guardian Nurses, also visits patients in their homes, doctors’ offices and hospitals. On average, the registered nurses make 50-75 “house calls” and counsel more than 400 LEHB members annually.
Getting personal
The benefits manager for a large state association had a different audience in mind when she engaged advocacy services in 2003. The association’s health insurance plan covers 2,000 retirees, many in their 90s and older. Before undertaking a major change in health plans, the benefits manager hired CareCounsel, a local California firm, to educate retirees about their options.
“Managing the intricacies of Medicare and Medicare supplements can be difficult,” explains the manager, adding, “and calls from retirees can be time consuming.” She felt her staff lacked the necessary expertise and would be more productive handling other inquiries. “We wanted to make sure our retirees had the tools to make the best decisions.”
Since then, the association has expanded the patient advocacy service to all its employees. Transferring medical records, coordinating benefits, identifying clinical trials and community-based support groups and establishing conference calls between patients, their doctors and health plans to resolve claims and billing problems are just a few of the ways advocates support employees, says Laura Valentine, MS, director of client services for CareCounsel. The association’s benefits manager expects the need for assistance will continue to grow as the impact of national health care reform becomes known.
Making enrollment house calls
Once a year, CareCounsel makes outreach calls on behalf of its clients to let employees know about the free service. LEHB also goes a step beyond traditional enrollment marketing. Four times a year two retired police officers call every member at home to remind them about the program and ask if they have medical concerns. A Guardian Nurses representative speaks at advanced training sessions police officers and sheriffs are required to attend. Each session draws 100-300 members. In addition, Lamb’s disease management staff identifies members who have had 12 or more visits to specialists or to the emergency room in the past year, then refers them to the patient advocates for follow-up (after obtaining the necessary HIPAA authorization, of course).
Support for HR, too
Patient advocates are a natural extension of the HR department. “They can help increase utilization of plan benefits overall and help employees make better use of specialized programs like wellness,” says Michelle Olef, director of advocacy services for benefits consulting firm Aon Hewitt, which has offered patient advocacy services to its clients and its own employees since 1999. What’s more, patient advocates can improve productivity by reducing the time away from work an employee might spend resolving a problem claim or finding an elder care facility for an aging parent.
Another benefit: an independent service creates a wall of privacy between HR and the company’s employees to help maintain patient confidentiality. Being a step removed from medical providers, advocates also have leverage to question a procedure or claim, or direct patients to a provider that’s best for a particular condition. “They bring more to the table than a single staff member could,” says Lamb, about the five registered nurses who respond to his members’ concerns.
The association benefits manager agrees. “Medicare is complicated; it’s hard to keep track of all the changes. Best to hire a specialist and pay them a service fee,” she says. In the association’s case, the charge is per capita. LEHB has a different arrangement. The plan purchases 500 hours of service at a time from Guardian Nurses based on an hourly rate contracted in advance. Before proceeding with a referral from the plan, the firm estimates how much time each case might take.
What about ROI? Lamb calculates his return to be seven dollars saved for each one spent. The big savings occur when a nurse advocate encourages a patient with a serious medical condition to seek a second opinion. Twice recently such referrals have uncovered a misdiagnosis that saved the LEHB plan thousands of dollars and spared the patient unnecessary anxiety.
Small wonder Lamb calls the nurse advocates his “guardian angels.”
Resources:
Center for Medicare Advocacy, www.medicareadvocacy.org
