How health plans benefit from patient advocacy

April 29, 2020
Josie Rasberry

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Patient advocacy serves to help patients navigate the complexities of the healthcare system and work on the patients’ behalf to solve healthcare problems; but it can also be beneficial to health plans. When health plans include patient advocacy tools in their services, they end up saving money in the long run, gain higher member satisfaction, and reduce the workload on their service team.

Below are four ways patient advocacy actually helps health plans.

Cost containment.

When a member doesn’t do research on a non-emergency procedure and goes to the most expensive hospital for that procedure, it ends up being costly not only for them but for their health plan. If a member doesn’t know their in-network options and has an emergency, they may panic and go to an out-of-network emergency clinic, which ends up costing more for them and their health plan. Through patient advocacy services such as health education and navigation, members quickly and easily discover the most affordable care options that lead to the best outcomes for their life. When members are smarter health care consumers, they save themselves and their health plan money.

Higher member satisfaction and engagement.

In a study of 510 insured adults, 22% said that the patient advocacy attribute they value most is objectivity through a neutral advocate company or service. These same survey respondents also indicated that they’d be willing to recommend their health plan if it added advocacy services. Adding a third-party bill negotiation service led to a 17.6% average NPS growth and adding any patient advocacy services resulted in a 16.5% average NPS growth for health plans.

Fewer HIPAA concerns.

By using a trusted third-party advocacy service, health plans have more insulation from privacy issues. Patient advocacy also encourages patients to take control of their health information and to be educated on their rights when it comes to their information. When patients are active participants in their own safety, this helps to mitigate HIPAA violations that could have occurred and involved health plans.

Lower workload on customer service teams.

There are several health plans who pride themselves on having fast and courteous customer service, but this isn’t the case for every company. Even for the ones who are quick to respond, there are situations where members call with questions that health plans are unable to answer, or they can’t take the extra time to help a member with a complex issue. This is why a third-party patient advocacy service is a great way to get members the extra help they need. Patient advocates at a third-party service take the time to fully understand a member’s situation and will reach out to multiple resources to find the best solution for the individual. Many patient advocacy services also offer tools that members can use to solve problems on their own rather than calling their health plan’s customer service team.  

As the U.S. healthcare system grows more complex and the demand for patient advocacy from members increases, it will become more and more imperative for health plans to utilize third-party patient advocacy services. When done well, patient advocacy can reduce costs, increase member satisfaction, and improve operations for health plans.

Download The Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

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