How advocacy service models are reducing total cost of care

Even basic health care decisions make a significant difference in cost and care quality. Advocacy service models take the guesswork out of decisions and help reduce the total cost of care with streamlined information, patient education and holistic guidance.

“Advocacy service models continue to evolve in the right direction,” says Bart Halling, Vice President of Customer Solutions and Activation Strategies for UMR. “Ten to 15 years ago, advocacy focused on the speed to answer, accuracy and inbound-only calls. Even early concierge models were still pretty reactive and focused on making the most of inbound interactions.”

In the current environment of rising costs and increasing complexity, advocacy models are becoming strategic drivers of the benefits experience, more focused on two-sided and proactive outreach, consumer motivation and alignment with the health plan.

Data shapes experiences designed to manage costs

Data is driving the changes by enabling personalized recommendations and helping consumers find value. Today’s health care advocates have access to comprehensive data sets from a variety of sources to help them understand what’s happening with patients and their family members.

“The more data you have, the more you’re able to format the health care experience to be personalized for an individual,” Halling says. “Many advocacy programs are now bringing informed logic to the data to consider the points together and trigger an outreach. Not just outreach for outreach sake, but because you know what’s happening.”

Rich data and technology tools enable advocates to be more situationally aware and turn interactions into trusted relationships that significantly impact costs.

While managing care delivery, provider cost structures and program designs are important to reducing the total cost of care, advocacy models can have the most impact on consumer behavior, Halling adds.

“Advocacy unlocks efficient care delivery and forward-looking benefit design by engaging the consumer to shake them out of old patterns and become a catalyst for making better decisions,” Halling says.

In addition, advocacy service models that educate consumers about available options and help them take advantage of preventive care drive much of the cost savings.

Cost transparency changes expectations

Halling notes that recent legislative initiatives, including the Transparency in Coverage Executive Order and the Consolidated Appropriations Act, that seek to give greater transparency into health care costs are also playing a major role.

“The investment in technology that the industry has made to provide consumers with accurate cost estimates upfront will reshape how the industry and advocacy work,” Halling says.

Data and technology also enhance reporting and analytics capabilities related to advocacy service models. With the ability to access, integrate and analyze deeper data sets, advocacy models can better identify and address cost drivers and trends at both the employer and employee levels.

“If you can’t report on the impact to the total cost of care and the benefit of consumers changing to more positive behaviors or the risk of them failing to engage, you can’t drive engagement longer term,” Halling says. “Consumers are changing. Plans are changing. Advocacy, by definition, has to continue to reinvent itself.”

Learn more about how UMR, the nation’s largest TPA, delivers innovative advocacy service models to support employers and employees, improve quality of care and reduce total costs.

Ann Clifford is a freelance writer who translates her background in financial services marketing into specialized content focused on employee benefits and small business topics.