Less than one year ago, the Health Care Service Corporation (HCSC) launched the Health Advocacy Solutions (HAS) program that features a multidisciplinary healthcare team. These pods of healthcare workers are comprehensively serving member needs while reducing costs for all involved—up to $500 per episode of care.
While HCSC admits that multidisciplinary teams are not a new concept, having the team share the same physical space is fairly new. Currently, HAS services 700,000 members and expects that number to jump to 1 million by early 2020.
“The Health Advocacy Solutions program is so much more than just a unique physical layout for our teams—it’s a collaborative way of thinking that moves call center staff away from merely resolving customer problems and more toward becoming true advocates for members,” Tom Meier, vice president of market solutions at HCSC, told FierceHealthcare.
What a typical HAS call might look like
The Health Advocacy Solutions (HAS) team contacted a man for his post-hospital discharge follow-up. On the call, they discussed his medications, scheduled physician and physical therapy visits, and talked about his benefit claims. A few times during the call, the man expressed concerns about his wife, who was his caregiver and seemed to be stressed out and in poor health. The HAS advocate then asked to speak with his wife.
After talking about her husband, the advocate asked the woman about her stress and health. The advocate enrolled the wife in case management, identified stressors, connected her to the employee assistance program and placed a referral for a social worker to reach out to her about financial stressors. They also assisted the member in signing up for the employer’s benefits website and weight management program. Follow-up calls to the woman revealed that she was seeing a therapist about stress management, and had joined a gym and lost some weight.
So far, 63% of members who have called into the HAS program and learned about their care options have redirected their care, saving anywhere between $300 and $500 per episode of redirected care.
So, how do the pods work?
Each HAS is a six-person team consisting of three clinical and three nonclinical employees. They feature a variety of specialists including registered nurses, social workers and health and behavioral advocates. The idea is that in one phone call—with the help of the Customer Advocate Portal of data—the team can work together to coordinate complex care. The call can also be used to schedule appointments, talk about claims or replace insurance cards.
On average, an HAS call takes 14 minutes, which is longer than an average insurance company call but is often answering more than one question. Clinicians and benefits managers on the call have been cross-trained to answer basic questions. But if the question is more complex, they will bring in one of their pod partners who specializes in the area. Part of HAS is the technology that allows both nonclinical and clinical staff to have visibility into each other's systems, allowing for more “first-call resolution” experiences for members.
The teams use artificial intelligence to identify the member at the moment the call comes in. AI is also used to provide real-time feedback to staff members in order to improve the quality of their customer service.
HCSC wants to make sure that even with technology, the program doesn’t lose its “old-fashioned personal touch,” as Meier refers to it. So staff members make welcome calls to members, educate them on benefits and send handwritten cards out to members after interacting with them. For example, the Chicago HAS team has sent out more than 6,000 cards since August.
HAS is being utilized by all types of members in all stages of life, from setting up healthcare benefits for a newborn to coordinating complex medical care for seniors.
“However, we anticipate that we will see significantly more millennials participating in Health Advocacy Solutions in the future,” Meier said. “While millennials typically rely heavily on technology and digital solutions, there is a growing body of research that indicates they value having a more personalized experience, particularly when it involves complex explanations, such as health benefits.”
In addition, HAS pods are saving patients money, HCSC has found.
Meier says that advocates are trained to empower and explore lower-cost alternatives for members such as less-expensive procedures, generic medications or government resources. Plus, during these calls, members are reminded to go to annual screenings and physicals, as catching and treating a health issue early can be more cost effective.
Payers and employers are saving money as well. Through HAS, group employers have saved about $42 per employee per month, which adds up to more than $40 million in total thus far. One way HAS saves money is through volume. Calls may be longer, but fewer calls are coming in. Second, educated patients are usually more cost effective. Finally, HAS is able to coordinate care for members, which can streamline the process, identify problems early and save time and money.
The only challenge with HAS is that this type of high-level customer advocacy requires a great deal of training for employees. The onboard training is between two and four weeks long plus precasting for clinical staff and eight weeks for nonclinical staff. Then, both teams participate in two additional months of training known as the Health Advocacy Solutions Academy.
“We focus on building relationships with our members; gaining trust and empathy and how to use them to help our members; exploring social determinant of health barriers; listening for key trigger words and associated responses; learning when to bring in a specific clinician for support; motivational interviewing; managing a difficult call; and deep training on client-specific nuances,” Meier said.
Over the course of the year, employers have expressed excitement at the unprecedented level of employee engagement. Plus, they are pleased with the financial savings per employee. For some of the larger customers, the ROI adds up to millions of dollars of savings in a year.
HCSC operates as Blue Cross and Blue Shield in Illinois, Montana, New Mexico, Oklahoma and Texas.