Well, it has been a busy few weeks, to say the least. In case you missed it, I wanted to share an important recent article on the Society for Human Resource Management (SHRM) website titled Healthcare Advocates Help Employees Through Serious Diagnoses.
My colleague, Sue Lewis, who is ConsumerMedical’s Chief Strategy Officer, is quoted. She and other industry experts bring up some interesting points well worth highlighting.
I think one of the most important points all of us in healthcare must remember is that getting a diagnosis of a serious illness such as cancer is devastating. It poses challenges at home and work. Then, of course, are all those tough questions: What does this mean? What can I expect? Do I need a second opinion?
The good news is that I see more employers recognizing the issues their employees with serious illnesses face and acknowledging they need assistance and support. As Sue noted, the Business Group on Health reports that more than 70% of large employers now provide programs to help employees navigate the healthcare system after the diagnosis of a complex illness. Our company calls the people who support employees through the many decisions and steps of a serious diagnosis “medical allies.”
These doctors and nurses are the single points of contact who coordinate the many decisions — financial, medical, claims, etc. — necessary to support patients. Their multi-faceted role includes:
- Helping patients understand their disease
- Identifying treatment alternatives for their specific condition
- Assisting if patients aren’t satisfied with their current care plan
- Finding top physicians and surgeons in their network for their physician
- Saving employees and employers money
- Resolving claims issues, especially denials
There are other benefits to having clinical advocates, especially when it comes to second opinions. I’m going to hit you with some surprising data that demonstrates why second opinions are so important:
Approximately 1 in 20 adults in the U.S. are misdiagnosed each year, often leading to a wrong treatment path.
- There is up to 70% noncompliance with evidence-based clinical practice guidelines.
- Wasted healthcare spend costs $100 billion per year. (This last point comes from independent analysis we conducted this past summer.)
Keys to success
Whether your organization offers a clinical advocacy program or wants to ensure optimal results from an existing one, consider these eight “lessons learned” from the most successful programs I’ve seen.
- Make sure the program has a range of virtual options to meet members where there are, especially during the pandemic.
- Communicate well and often. Get creative where you put information — like the back of employee ID cards. Use company newsletters, intranet, texts, and videos to share stories of people helped.
- Look closely at benefit design. Rewards work — but so do participation requirements. Sue noted, “Some companies are offering incentives such as $400 to use a medical ally prior to surgery. Others require employees to call these services prior to surgery, or the employees are penalized $1,000 without a consultation because the data shows 30% of elective surgeries are unnecessary.”
- Don’t be afraid of requirements. When you have a great advocacy program, you will still get very high satisfaction rates; check your vendors and make sure that even with requirements, satisfaction is around 95%
- Know what conditions are covered. Will the program help not only with illnesses such as cancer but also rare conditions? For example, we just helped parents of an infant born with esophageal atresia (where the esophagus doesn’t connect to the stomach) get the advice needed to pursue a highly specialized, lifesaving surgery — even though they were based in the Middle East. Speaking of location…
- Is the program capable of supporting diverse and international populations? One of the most promising attributes of technology is that it will enable us to “democratize” patient access. This means ensuring capabilities like live interpretation, global medical record collection, and translation services are available whether the member is on an oil rig or in a remote, rural location.
- Are there multiple ways to get second opinions? How patients access information for medical opinions needs to be flexible and accommodating. Look for:
- Multi-modal consults: video, phone, written
- Live video (plus the option to connect with a multidisciplinary physician team, when appropriate)
- Asynchronous video (store-and-forward)
- Phone-based consults
- Written reports (included as a summary for any video consult to promote continuity of care and so patients may share findings with their loved ones)
- An easy-to-use mobile app or web portal so a participant can use any device to easily initiate and track a case
- Make sure your results are meaningful. If you have a clinical advocacy program, review your results. Are your satisfaction levels over 90%? Is your ROI at least 3:1?
Don’t Accept One-Size-Fits-All
One criticism I often hear when talking with employers is that some advocacy programs are rigid and take a one-size-fits-all approach. I encourage employers to look for flexible options. In the SHRM article, Sue noted that while programs can be offered on an hourly or case basis, more employers want to see these services aggregated into the benefit. Most importantly, make sure neither you nor your employee is exposed to additional costs when you add an advocacy program.
We’ve come a long way from the days when employees were left to fend for themselves following a diagnosis. We now know there’s a better way. We recognize that a diagnosis of a serious illness is scary and that employees need education, support, and guidance—advocacy and health literacy are a powerful combination. Make sure you and your employees have an ally to help them navigate their healthcare journey.