Member advocacy streamlining health plan navigation, promoting smarter decisions

Member advocacy has become an increasingly important means of supporting healthcare consumers in the selection of their health benefits and treatment options. Among the key themes that have emerged with this approach are a need to optimize the customer experience, navigate the healthcare system and coordinate benefits across the spectrum of care, as well as leverage technology to drive informed interaction.

Self-funded customers will find advocacy services particularly valuable because they have the freedom and flexibility to customize their health benefit plans, according to Stephanie Meyer, senior director of activation strategies at UMR. Indeed, members need an expert to help them understand the proliferation of available options – from clinical and nurseline to telemedicine and employee assistance programs. Layer on top of that traditional options such as PPOs and consumer-driven health plans, along with strategies involving tiered structures, narrow networks and reference-based pricing, and the complexity of a changing landscape has proven to be too much for most health plan members.

This area is critically important because it involves not only an individual’s health status, but also their personal finances, she points out in an interview. Advocacy takes the onus off consumers and places it on trusted advisers who can ensure that they’re well supported, educated and comfortable. Having grown out of a traditional customer service model that was transactional, advocacy now uses multiple communication channels to better support individual member circumstances. Meyer predicts that smart and purposeful artificial intelligence and machine learning will represent the next frontier in advocacy as it becomes more personalized and better anticipates member needs through real-time interaction and claims data.

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