CARE ADVOCACY

It’s like having a friend
on the inside.

Make your health plan work harder for you and your employees.

Why Care
Advocacy?

The cost of healthcare is a top expense for every employer. While we’ve tried high deductible plans, cost-shifting, and consumer-facing cost estimating tools, it’s still an uphill battle.

But the real problem is that healthcare is so complicated that 75% of people don’t feel confident when they’re making decisions. Employers and employees need an advocate on their side.

Care advocate talking on phone to SentryHealth member

Clinical-first
direction that
makes a difference.

Unlike other care navigation providers, our Care Advocates are Registered Nurses with an average of 20 years of experience.

After working firsthand in clinical settings, they have the knowledge to help people make the best decisions about their care.

They know the questions to ask to really understand what someone needs. Then they apply their clinical judgment to create a personalized care plan, complete with recommendations for the highest quality, lowest cost care.

Finally, they’ll fight for what’s right every step of the way.

Care Advocacy Services

Care Concierge

Members receive unbiased, personalized assistance in making decisions about their healthcare.

From finding the best doctors, getting a second opinion, and evaluating alternative treatment options, Care Advocates investigate problems, deliver detailed education, and provide clear direction when it’s needed most.

Care Advocates proactively reach out to members, building relationships and getting in front of issues before they become problems.
Through extensive clinical experience and health plan know-how Care Advocates achieve more thoughtful and efficient assessment of needs.
We refer to the best providers based on our quality measures. In fact, only one in five physicians meet our strict standards.

Precertification/Prior Authorization

To ensure the most appropriate care, we determine medical necessity.

Leveraging national guidelines for medical review, we evaluate inpatient admissions, diagnostic testing, outpatient services and surgeries, chemotherapy, durable medical equipment, and more.

All precertifications are managed by our clinical team.
We check network participation and immediately notify members if their provider is out-of-network.
Our on-staff Medical Director oversees precertification, making medical decisions as appropriate.

Case Management

Going beyond typical care coordination, we assist members with complex medical conditions, recent hospitalizations, unhealthy lifestyles, and high psychosocial risk factors.

Our team of certified case managers assesses needs, reviews treatment plans, and coordinates care with providers.

All case managers are certified by the Commission for Case Manager Certification (CCM), the highest and most respected standard.
Our case managers have smaller caseloads to ensure personalized attention and more timely care.
We get involved before key decisions are made and costs are incurred.

Medication Management

Since 2014, prescription prices have increased by 1/3, exceeding increases for most other medical commodities and services.

Making the most of a member’s current prescription drug program, Care Advocates review medications for duplicate therapies, generic alternatives, and financial assistance resources.

Care Advocates carefully analyze current medications and medical history to determine the best medications, including alternatives.
We connect members to low-cost prescriptions, delivered right to their doors.
The average savings on PBM payments range from 35% to 40%.