MEDICAL ADVOCATE PROGRAM

MEDICAL ADVOCATE PROGRAM

Empower better health and curb costs through personalized guidance and support.

Empower better health and curb costs through personalized guidance and support.

EMPOWER BETTER HEALTH

EMPOWER BETTER HEALTH

When employees are left to navigate our complex health care system on their own, they often end up confused and dissatisfied. They also don’t always get the best care at the best price.

And as spending continues to increase, effectively managing these costs has been a battle for many employers. While high-deductible plans, cost-shifting, and cost transparency tools are being used to fight this battle, none are really succeeding.

THE RIGHT CARE
AT THE RIGHT TIME

An integral part of WellOnMyWay, our medical advocates disrupt the status quo of our current health care system. They help employees make sense of their health care benefits and steer them to the right care at the right time.

We proactively show employees how to become better health care consumers by guiding them to the best possible care. As a result, employees take a more active role in their health, enabling them to live their happiest, healthiest lives.

MEDICAL ADVOCATE PROGRAM FEATURES

Care Advocacy

Employees receive unbiased, personalized assistance in navigating our health care system. From finding physicians with the best outcomes, obtaining second opinions, and offering alternative treatment options to assisting with billing issues. Our team deeply investigates problems, delivers detailed education, and provides clear direction when it’s needed most. As a result, employees are more compliant with care recommendations, costs are minimized, and overall health improves. Highlights include:

  • Medical Advocates proactively reach out to employees, building relationships and getting in front of issues before they become problems.
  • All care advocates are licensed clinicians for more thoughtful and efficient determination of medical needs.
  • We refer to the highest quality providers based on our quality measures. In fact, only 1 in 5 MDs meet our strict standards.

Precertification

To ensure employees receive the most appropriate care, we conduct precertification to determine medical necessity. Leveraging national guidelines for medical review, we evaluate procedures such as inpatient admissions, diagnostic testing, outpatient services and surgeries, chemotherapy, durable medical equipment, and more. Highlights include:

  • All precertifications are managed by licensed nurses.
  • Our full-time, on staff Medical Director oversees precertification, making medical decisions as appropriate.
  • We actively involve the employee, from case initiation through discharge.

Case Management

Going beyond typical care coordination, with case management, we assist employees with complex medical conditions, recent hospitalizations, unhealthy lifestyles, and high psychosocial risk factors. Our team of certified case managers assess needs, review treatment plans, and coordinate care with providers within a health plan network. As a result, employees can rest easy that they’re getting the highest quality care, at a reasonable cost. Highlights include:

  • All case managers are certified by the Commission for Case Manager Certification.
  • Our case managers have smaller caseloads than our competitors, ensuring that employees get personalized attention quickly.
  • Through referrals from our precertification and care advocacy programs, we get involved before key decisions are made and costs are incurred.
  • We take a psychosocial approach that integrates behavioral and emotional care.

Prescription Savings & Management

Since 2014, prescription drug prices have increased by 1/3, exceeding increases for most other medical commodities and services. Additionally, a record $67 billion was paid out-of-pocket by patients for prescriptions filled by retail pharmacies in 2019, up from $61 billion in 2015. As a result, both employers and their employees are looking for ways to find the lowest cost medications. Our medical advocates will review medications for duplicate therapies, generic alternatives, and will seek out financial assistance resources. Highlights include:

  • Our experts carefully analyze current medications and clinical history to determine the best medications.
  • We connect employees to low-cost prescriptions, delivered right to their doors.
  • The average savings on PBM payments range from 35% to 40%.
Medical Advocate Program, Care Advocacy, SentryHealth Integrated Health

Care Advocacy

Employees receive unbiased, personalized assistance in navigating our health care system. From finding physicians with the best outcomes, obtaining second opinions, and offering alternative treatment options to assisting with billing issues. Our team deeply investigates problems, delivers detailed education, and provides clear direction when it’s needed most. As a result, employees are more compliant with care recommendations, costs are minimized, and overall health improves. Highlights include:

  • Care Advocates proactively reach out to employees, building relationships and getting in front of issues before they become problems.
  • All care advocates are licensed clinicians for more thoughtful and efficient determination of medical needs.
  • We refer to a highest quality providers based on our quality measures. In fact, only 1 in 5 MDs meet our strict standards.
Medical Advocate Program, Precertification, SentryHealth Integrated Health

Precertification

To ensure that employees receive the most appropriate care, we conduct precertification to determine medical necessity. Leveraging national guidelines for medical review, we evaluate procedures such as inpatient admissions, diagnostic testing, outpatient services and surgeries, chemotherapy, durable medical equipment, and more. Highlights include:

  • All precertifications are managed by licensed nurses.
  • Our full-time, on staff Medical Director oversees precertification, making medical decisions as appropriate.
  • We actively involve the employee, from case initiation through discharge.

Case Management

Going beyond typical care coordination, with case management, we assist employees with complex medical conditions, recent hospitalizations, unhealthy lifestyles, and high psychosocial risk factors. Our team of certified case managers assess needs, review treatment plans, and coordinate care with providers within a health plan network. As result, employees can rest easy that they’re getting the highest quality care, at a reasonable cost. Highlights include:

  • All case managers are certified by the Commission for Case Manager Certification.
  • Our case managers have smaller caseloads than our competitors, ensuring that employees get personalized attention quickly.
  • Through referrals from our precertification and care advocacy programs, we get involved before key decisions are made and costs are incurred.
  • We take a psychosocial approach that integrates behavioral and emotional care.
Medical Advocate Program, Prescription Savings and Management, SentryHealth Integrated Health

Prescription Savings & Management

Since 2014, prescription drug prices have increased by 1/3, exceeding increases for most other medical commodities and services. Additionally, a record $67 billion was paid out-of-pocket by patients for prescriptions filled by retail pharmacies in 2019, up from $61 billion in 2015. As a result, both employers and their employees are looking for ways to find the lowest cost medications. Our medical advocates will review medications for duplicate therapies, generic alternatives, and will seek out financial assistance resources. Highlights include:

  • Our experts carefully analyze current medications and clinical history to determine the best medications.
  • We connect employees to low-cost prescriptions, delivered right to their doors.
  • The average savings on PBM payments range from 35% to 40%.

LET’S CONNECT

Want to learn more about SentryHealth? Simply fill out this form to request a consultation and learn more about our solutions.

LET’S CONNECT

Want to learn more about SentryHealth? Simply fill out this form to request a consultation and learn more about our solutions.