medical advocate program

Medical advocate programs have grown in popularity over the years. And for good reason. There are several ways that they help make health benefits easier to understand and access, which ultimately results in lower medical costs and better health outcomes.

Let’s look at the top ways a medical advocate program simplifies health benefits.

Improve Benefits Navigation

The health care system and health benefits can be confusing. In fact, 35% of employees say they don’t fully understand any of their employee benefits. This number is even higher for millennial workers. Many are unclear on the differences between an HSA and FSA, PPO and HMO, and in and out-of-network.

So what happens when people don’t understand their benefits? They get stressed out, don’t know how or what to use, and ultimately, they delay the care they need or give up all together.

A medical advocate program provides timely, easy-to-understand education surrounding an employee’s health benefits. For example, if Holly is a new employee and wants to learn more about what her PPO plan covers, she could connect with a medical advocate.

Perhaps Mike has a high deductible plan but doesn’t understand the difference between his deductible and co-insurance. His medical advocate can walk him through what each means and how to best optimize both.

When employees understand their health benefits, they’re more likely to use them in the most effective, cost-efficient way.

Locate the Best Providers

Think about the last time you needed a specialist. How did you find one?

Maybe you started by asking your doctor, friends, family members, or co-workers for recommendations. Then you looked at your provider directory (which may or may not be outdated) to see who was in your network. After that, you checked out the doctors online and read reviews.

But just because a doctor is in-network, has good reviews on Google, and your Aunt Rebecca loves him, that doesn’t mean that he’s the right choice FOR YOU. That’s where a medical advocate program can help.

Medical advocate programs go beyond obtaining basic information, taking into consideration several data elements to determine the right fit. This includes:

  • Network
  • Quality
  • Cost
  • Experience
  • Disciplinary Actions
  • Malpractice Issues

By understanding what’s underneath the surface, medical advocates can narrow down the list to a handful of high-quality practitioners. Employees can rest easy that each provider has been fully vetted and is a great fit for them.

Ensure the Right Diagnosis

One in 20 medical diagnoses is incorrect or missed. And 1 in 3 misdiagnoses results in serious injury or death. Those numbers are frightening.

Misdiagnosis can happen because of problems administering or reading diagnostic tests, miscommunication or lack of communication between the provider and the patient, or simply because the provider doesn’t have the complete picture. And let’s be honest, physicians are human too. They make mistakes.

That’s where a medical advocate program can help.

When people engage medical advocates as part of their care team, they have a clinical expert on their side who’s making sure they communicate the right information to the provider. They also can ask probing questions that may reveal information that wasn’t initially disclosed.

It’s like having a “built-in” second opinion. If you want work done on your house, you get more than one quote, don’t you? There’s no reason why you shouldn’t have a clinician review your health and your diagnosis as well.

Care Coordination and Case Management

Do you see several doctors? Does each know what the other is doing?

Take Jessica for example. Jessica has a primary care physician she sees for everyday medical problems. But because she has type 2 diabetes, she also has an endocrinologist, a podiatrist, an ophthalmologist, and a dietitian. Jessica works with her medical advocate to ensure that her care is coordinated, consistent, and appropriate.

Recent studies have shown that care management of complex medical cases improves care quality, reduces the risk of hospitalization, and lowers overall medical costs.

Medical advocate programs help employees avoid potential pitfalls by providing services like:

  • Needs assessment
  • Treatment plan review
  • Coordination with providers
  • Communication with the employee, providers, TPA, and more

Lower Prescription Drug Costs

The rising cost of prescription drugs is at a crisis level in the United States. Medication costs continue to outpace the rate of inflation. According to AARP, prices for 260 commonly used prescriptions increased nearly 3%, while the inflation rate was only 1.3%.

Nearly 13 million people are skipping or delaying filling their medications due to high prices. The bottom line is, many employees simply cannot afford the drugs they’re being prescribed.

When employees have access to a medical advocate program, they benefit from medical professionals who work hard to help them find the lowest priced medications available.

Jessica, from our example above, is on a few medications for her diabetes. When one of her doctors prescribes something new, she first reaches out to her medical advocate to discuss the prescription prior to filling. The medical advocate reviews the medication, reviews the other medications Jessica takes, and goes over her clinical history. They then evaluate options, including the availability of generics at a lower cost or the availability of patient assistance programs.

The medical advocate can even source a low-cost alternative and have it delivered straight to Jessica’s door. It’s important to note that this doesn’t replace an employer’s PBM. It just offers an alternative solution to a growing problem.

Empower Employees with a Medical Advocate Program

When looking at how a medical advocate program simplifies health benefits, it’s ultimately about empowering employees. When they have the information, knowledge, and support they need, they are then able to make better decisions that save money and improve health outcomes.

Medical advocate programs can transform an average provider network into an extraordinary one that is easy to access and use. Employees are not only more likely to use their health care benefits, but they’re more likely to be good stewards of their employers, making wiser choices about quality and cost.

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The SentryHealth Difference

SentryHealth is leading the charge in employee health and wellbeing. Integrating smart technology with personalized guidance from Registered Nurse Advocates, we empower employees to make more informed decisions while guiding them to quality, affordable care. The result is greater engagement, higher satisfaction, better outcomes, and lower costs.