Advocating Health
Has anyone among our readers been a patient in the hospital recently? Has anyone been to a staff meeting in any hospital-based department when key members were absent because of the need to care for sick children or aging parents? I believe that we all go through sequential stages of fear, confusion, and exasperation as consumers of health care, regardless of the setting or our geographic locale. I am sure that P&T committee members can identify with the aforementioned circumstances. With that in mind, I would like to share some details about a new firm that is trying to tackle the difficulties that many of us face at various life stages.
Health Advocate, based in West Con-shohocken, Pennsylvania, was founded in the fall of 2001. The founders had the goal of helping employees focus on their work by assisting them with resolving health-related and benefits-related issues.1 Here is how the strategy works.
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According to the firm’s model and an employee with a problem concerning benefits can call a Health Advocate nurse, who is supported by a group of medical directors. After a brief conversation with the enrollee, the nurse can say, “You go back to work and we will try to resolve this issue for you.”
According to the chief medical officer and co-founder, Dr. Arthur Leibowitz, Health Advocate serves three principal types of clients:
- Approximately 33% of the clients enroll for clinical assistance because they need help in navigating the complexities of the health care system. For example, they might need help to understand a provider’s advice, or they might want a second opinion on a physician’s diagnosis.
- Another one-third of enrollees need help in understanding and accessing information about benefits, resolving claims issues, and finding the most efficient way to use their health plan.
- Enrollees in the last group need assistance in locating resources that are not covered by their employee health plans, such as adult day care, transportation, and related benefits.
According to the company’s literature, Health Advocate began enrolling clients in January 2002 and now has more than 50 employers with 80,000 enrollees and dependents under their auspices. The company bills its services through an Internal Revenue Service Section 125 voluntary benefit. Small companies might purchase services at an hourly rate, whereas larger companies are billed on a per-member/per-month basis.
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What does all of this have to do with members of P&T committees? I see Health Advocate intersecting with the work of our colleagues across the country in various creative and unique ways.
First, in its role as a clinical assistant, Health Advocate can give specialized medical and pharmacological advice to patients in many different settings. For example, patients with severe migraine headaches might call their Health Advocate contacts. Health Advocate could respond by directing these patients to a specialized headache center that is known to offer current migraine therapies.
Health Advocate also deciphers prescriptions for patients and guides them through the arcane preauthorization processes that exist in many managed care organizations. Yes, I know that it sounds silly, but deciphering prescriptions is an important problem in the U.S., and large employers are willing to pay top dollar to groups like Health Advocate to sort through this difficulty. order levitra
