Advocacy programs aid in health care navigation

Springfield company Employee Benefit Design has enlisted the services of Pennsylvania-based Health Advocate Inc. to offer clients the option of adding advocacy to their employee benefit packages.

Advocacy in health care assists people in disease management, communicating with health care providers and making sure that patients are getting the care they need and are following doctors’ orders.

Health Advocate provides a range of services to clients, acting as an independent ambassador for patients struggling to deal with a new diagnosis or an insurance claim to locating a specialist in an unfamiliar city.

“Typically when an employee has claims issues or problems, they are trying to solve them between the hours of eight and five, which takes away from productive time with their employer,” said Dan Ruggeri of Employee Benefit Design.

Ruggeri said that because EBD is a member of the United Benefit Advisors group, a national association of 130 independent health care companies, the firm is able to provide this service to clients at a cost of $1.50 per employee per month.

That fee covers not only the employee but also dependents, parents and in-laws.

Many employers are moving toward consumer-driven health care plans, which Ruggeri said are designed to give employees more responsibility for their health care and rewarding them for using benefits well. Services such as those provided by Health Advocate fit well with consumer-driven health care, in that they can help consumers make more informed choices about medical needs and care.

Health Advocate allows callers to speak directly with a registered nurse who can provide advice on treating minor injuries or educate patients on a new diagnosis. Education gives patients more knowledge before they visit their physician, allowing them to make the most of the time they have with their providers.

“The average physician does not have the time that they would like to spend with each patient,” Ruggeri said. “Say, for instance, that someone is diagnosed with Type I diabetes. There are probably only four or five things that you need to know about that disease, but you have limited time with that doctor, so you had better be prepared with all of the questions you need answered so that you can lead a better lifestyle with that particular disease,” he said.

Advocacy in health care is an idea that seems to be catching on.

Founded in fourth-quarter 2001, Health Advocate has seen steady growth since enrolling its first clients in 2002.

“In four short years, we have grown to over 1,050 clients – employers, unions, third-party administrators and insurers, including some of the nation’s largest companies, as well as a wide range of local and regional organizations,” said Carol Fischer, director of communications for Health Advocate.

Some of the company’s better-known clients include Viacom, Lowe’s Home Improvement Center, Home Depot, Jones of New York, The Washington Post and 19 universities around the country.

Local hospitals recognize the importance of patient advocacy programs; both St. John’s and CoxHealth have programs similar to Health Advocate.

In July, CoxHealth instituted a pilot program, the Cox Lung Cancer Program, which, if successful, could pioneer future programs designed to aid cancer patients.

“Our goals are to get patients diagnosed in earlier stages, decrease their waiting time from diagnosis to treatment and, of course, to get a better outcome for patients in terms of survival,” said Karen Hahn, lung cancer program coordinator at CoxHealth’s Hulston Cancer Center.

Through the program, Hahn makes appointments for patients, coordinates their care with the necessary specialists, and follows up with them to ensure that they understand and are following their prescribed treatment plan. To date, 40 patients are enrolled in the program.

“We are just trying to make sure that they get the best, most efficient care possible,” Hahn said. “Overall, feedback has been very positive. Some patients use the service more than others, but I think they all appreciate having a person to talk to about their treatment.”

St. John’s Health Systems has employed case management services to better facilitate patient care for the past 10 years.

“Case management is designed to assist the patient and their health care team in achieving optimal health care management,” said Ann Cave, executive director of St. John’s Health Plans Medical Management. “St John’s case managers collaborate with the patients, physicians and the multidisciplinary team to carry out the physician’s health care plan.”

Case managers provide referrals to disease management programs, telephone support, coordination of primary care specialists and educational services.

Ruggeri said that having services such as those offered by Health Advocate can help keep insurance costs down by preventing unnecessary repeat doctor visits and clearing up confusion about prescription medications.