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How care advocacy could lower medical cost growth in 2019

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Ingrid Stiver Senior Manager, Health Research Institute, PwC US March 14, 2019

Employers and health plans are offering care advocacy services to help employees manage their high deductible health plans (HDHPs), creating a dampening effect on medical cost trend for 2019.

Seventy-two percent of employers surveyed by PwC offered health advocacy services to their employees in 2018; in 2016, that percentage was 57 percent.

The background

  • Advocates collect important nonclinical data, such as socioeconomic factors, that help them influence care decisions, such as steering patients toward cost-effective primary care visits and preventive services.
  • The aim is to decrease utilization of ER visits and inpatient stays when they’re avoidable.
  • As health advocacy programs demonstrate their value through improved outcomes, increased employee satisfaction and significant cost savings, employers are doubling down on them as the next way to manage rising healthcare costs.
  • Providers are optimistic these organizations can help patients improve outcomes, improve the patient experience, and decrease costs by improving efficiency, according to a recent HRI survey.

The data

Physician sentiment on the potential of health advocates is positive
Physician sentiment on health advocates

Examples in action

  • Carolyn Young, chief actuary at Accolade, told HRI that when a member calls for help in finding a specialist, an Accolade health assistant will find out why the member wants to see a specialist, determine whether a primary care visit will suffice, conduct the search for the proper provider, help prepare the member for the appointment and, depending on the circumstance, follow up with the member after the appointment.
  • Health Care Services Corporation (HCSC), a not-for-profit health insurance company based in Chicago that operates Blue Cross Blue Shield plans in five states, has started a program for large, self-funded employers that supplies live advocates to help consumers estimate and compare costs, analyze treatment options and identify the most cost-effective treatment plans.
  • Third party health advocacy firms such as Accolade Inc., based in Plymouth Meeting, Pa., and Quantum Health Inc., based in Columbus, Ohio, offer treatment decision support, transparency tools, provider coordination, help with integrated behavioral health needs, and even logistical help, such as transportation support.
  • Employers who use these advocacy programs, such as King of Prussia, Pa.-based AmeriGas Partners L.P., a national retail propane marketer, have reported reductions in hospital admissions and average lengths of hospital stays, and cost savings in employee medical claims. Accolade says it has been able to achieve less than 1 percent medical cost trend for its customers annualized over the last three years.
  • Use of these programs, which are increasingly available to consumers, is critical to affecting overall cost trend. “The biggest challenge for employers with advocacy services is engagement—how do employers encourage employees to take advantage of this resource?” said Brian Marcotte, president and CEO of the National Business Group on Health, in an interview with HRI. “Once they are engaged, health advocacy services do a good job of helping employees understand their benefits and treatment options, navigate the health system and steer to more efficient, quality providers. But most people don’t touch the healthcare system often. When they do, they forget the health advocates are there to help.”

HRI impact analysis

Employers have increasingly relied on HDHPs to keep medical costs under control. But though HDHPs may reduce utilization, they also may deter necessary care for early diagnosis or management of chronic conditions.

With the healthcare system’s ever-expanding number of care options, limited price transparency and complexity, consumers often struggle to navigate the system and make the best use of their benefits. Patient advocacy services have existed for several decades but were primarily offered as an exclusive, concierge-type service available to only a select few. This is changing as employers and health plans see such services’ value for their employees and members. The services give patients personalized help on interacting with the system.

Contact us

Ingrid Stiver

Senior Manager, Health Research Institute, PwC US

Benjamin Isgur

Health Research Institute Leader, PwC US

Rick Judy

Principal, Health Industries, PwC US

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