Advocating for members throughout their health care journey

“The end-to-end care was so important. He didn’t know where to start. He was really grateful,” says Anderson, who now works as a consumer affairs specialist at UnitedHealthcare.

UnitedHealthcare uses a multi-pronged Advocacy approach to help employees navigate the health system. Advocates can go beyond basic benefit and claims questions and offer employers the data and insights needed to evolve their benefit plans especially when an employer integrates medical coverage with pharmacy, behavioral and specialty benefits.

This approach has become even more important as employers seek to retain and attract talent in a competitive job market by offering more robust and personalized benefits.

As part of the member experience, Advocacy solutions are designed to deliver:

• Proactive guidance through data and insights

• Compassionate, empathetic service in every interaction

• Simplified experiences by streamlining the benefits experience

Support offered through the Advocacy solutions UnitedHealthcare offers starts early in a member’s health journey, with proactive onboarding beginning during plan enrollment. It helps set members up for success by evaluating whether their usual providers are network or out-of-network (OON). Medications are also reviewed for any comparable lowercost alternatives based on their plan.

For additional support, advocates use predictive personalization to help connect employees to the most appropriate resources when they call. Advocates are available through the phone, live chat, email or text.

Advocates go beyond customer service, providing whole-person guidance across a broad number of health care needs, such as mental health, clinical and complex care support, financial and benefits/claims. They use a dashboard that offers a comprehensive view of the member, including their current health condition, history of calls, utilization of myuhc.com® and the UnitedHealthcare® app, utilization of the health system, clinical recommendations and health account information.

“Being able to quickly view the information for an HRA or FSA account, give more referral options more quickly and easily, and update communication methods very easily has been greatly appreciated by the UnitedHealthcare representatives on the floor,” says Sammi Flentje, a supervisor in the UnitedHealthcare Enhanced Advocacy program.

Proactive outreach by advocates can include instances where members receive prior authorization requests for certain identified clinical codes for treatments or surgeries. Knowing those certain treatments and surgeries are often accompanied by ensuing claims for durable medical equipment (DME), medication and follow-up care, the advocate can begin to help provide information to the member proactively to help steer them to quality, lower-cost options for those items and services they may need in the future.

“When a lot of people think of advocacy, they’re thinking customer service and call center support,” Bushman says. “But the overall goal of advocacy is to help guide members to make better decisions."

Integrated medical benefits with specialty (dental, vision and financial protection), pharmacy and behavioral may create opportunities to diagnose and manage chronic conditions sooner, help identify and deploy clinically effective treatments, intervene early in behavioral issues and more.

Chronic conditions are the leading causes of death and disability in the U.S. — driving $3.8 trillion in annual health care costs.³ And it’s estimated that unaddressed mental health issues such as depression and anxiety cost the U.S. economy $1 trillion in lost productivity each year.⁴

Integrated benefits also bolster advocacy efforts in helping to create adherence to medical and cost decision-making to help drive greater engagement. In fact, 39% of clinical program enrollees are referred by advocates.⁵

“Given that health care is the second largest expense for employers after salaries, companies have been looking for innovative ways to better support the health and well-being of their employees,” Madsen says.

Keeping the member at the center also means continually making enhancements so that tools and resources are easier to use. From a member’s perspective, this includes closing the loop when they’ve reached out for help or proactively providing timely information about a health or financial decision.

Another significant consideration is an increase in behavioral health issues as people struggle with stress and unexpected pressure due to the pandemic. More than half of consumers reported their mental health was affected during the pandemic.⁶ To help address this situation, UnitedHealthcare created a dedicated Behavioral Health Advocacy team with resources to help guide members to the care they need. Enhanced Advocacy models have dedicated nurse pods for behavioral health.

“We have the tools to help employees be more resilient ranging from self-help to in-person treatment,” says Trevor Porath, vice president of behavioral health solutions for UnitedHealthcare Employer & Individual. “We also want to be able to identify those who may need support sooner before it becomes a crisis. Our low severity solutions help employees build coping mechanisms for their stress and anxiety.”

In addition to recognizing the COVID-19 pandemic’s effect on mental health, another area to address for employees is how social determinants of health such as social support and income impact well-being of employees. After all, research showed that while the quality of clinical care accounts for about 20% of overall positive health, social determinants of health such as employment, family and social support, and community safety drive approximately 80% of health outcomes.⁷

Using predictive analytics to provide behind-the-scenes intelligence, UnitedHealthcare is able to identify employees who may be in need of support and proactively offer them help.

When an identified member calls in, the advocate receiving their call gets an alert, helping them to engage with the member and connect them to helpful resources and programs. If the identified member visits myuhc.com, their personalized homepage offers recommendations that guide them to the resources and support they may need.

“Your health is one of the most important things in your life,” Madsen says. “So we need to be attuned to the unique situations members may be facing and give our Advocacy teams the tools to help members more easily find the care and support they need.”