For patients undergoing bariatric surgery, the actual operation is just one part of a multi-step process. At California’s famed Cedars-Sinai Medical Center, for example, the process includes nine steps — from attending a weight loss surgery seminar and consultation at the start of the process to attending follow-up appointments after the procedure.
Before entering the operating room, the patient must work with a dietician and other behavioral specialists to develop healthy habits, meet with a psychologist or social worker to undergo a readiness assessment, undergo multiple preoperative tests to detect potential disqualifying conditions, be approved by a multidisciplinary screening committee, receive authorization from the insurance company covering the procedure, obtain clearance from the primary care physician, attend a class about what to expect during and after surgery, and meet with the surgeon, who may then prescribe one more round of tests.
It's a lot to manage. To provide further guidance throughout the nine steps, Cedars-Sinai provides someone called a “patient navigator.”
“Weight loss surgery requires a commitment to lifestyle changes, including what you eat and how often you exercise. We help you set the groundwork, so you're mentally and physically prepared for life after bariatric surgery,” Cedars-Sinai says on its Patient Guide to Bariatric Surgery webpage. “The entire process, from consultation to surgery, generally takes about six months to complete. It often depends on you and your insurance requirements.”
Not everyone considering a surgical procedure receives the kind of guidance Cedars-Sinai provides its bariatric surgery patients, even though such health advocacy services are beneficial not only to patients but also to healthcare providers and businesses that offer employer-sponsored health plans. And because health advocacy benefits so many, it may seem obvious to suggest that most organizations should make it a component of their Total Rewards programs.
There’s certainly a need.
Complexity and a Practical Solution
A 2018 study by Harvard Business Review “found the health care system is so complex that more than half (52%) of consumers are unable to navigate it on their own, triggering avoidable customer service calls and more costly care.”
In an article titled “U.S. Health Plans Can Save Billions by Helping Patients Navigate the System,” the publication goes on to state:
“Consumers with low health system literacy are three times more likely to contact customer service. Our estimates found health insurers and employers spend $26 more on administration fees for every consumer with low health system literacy. This translates into a total cost of $4.82 billion, which would be even higher if accounting for medical cost.
“We found that consumers with low literacy struggle to make informed decisions about everything from the health plan types they choose and the premiums they pay to the doctors they see and the procedures they have done. It is worth noting this issue has nothing to do with education level: Roughly half (48%) of low-literacy consumers are college educated and nearly all (97%) have at least a high school diploma.”
The authors of the Harvard Business Review article were focused on the need to “eliminate systemic complexity in health care,” but that’s a lot easier said than done. The reality is that navigating health care remains complex and will be for the foreseeable future.
Johns Hopkins Medicine is among the growing number of esteemed medical institutions recommending health advocacy, as it explains in “The Power of a Health Care Advocate.” While stressing the importance of having someone they trust — “a spouse, relative, friend or caregiver” — help patients manage their healthcare needs, Johns Hopkins also addresses the question, “Should I hire a professional health care advocate?” Here’s its answer:
“The complexity of the health care system has given rise to a new professional: the patient advocate. This person is often a nurse, social worker, geriatric care manager or other health care professional who can help you navigate the health care system, including dealing with clinicians, understanding your condition and treatment options, and even helping with health insurance issues.
“Hiring and professional could be a good option if you don’t have a personal health advocate. Several organizations provide advocate training and lists of advocates on their sites, including the Professional Patient Advocate Institute, the Alliance of Professional Health Advocates, and the National Association of Healthcare Advocacy Consultants. However, be aware that there are no state licensing requirements or national accreditation or certification tests for patient advocates, so ask for references and assess an individual’s experience and history carefully.”
Advocacy as an Employee Benefit
Whatever their generation — from Gen Z members and millennials who are more likely to delay medical appointments and consult with friends or online sources for treatment advice to Baby Boomers and Gen-Xers focused on treating or preventing such conditions as diabetes or arthritis as they approach retirement — employees are apt to need and value the services of a plan-provided health advocate.
In fact, amid challenging labor conditions and a competitive employment market still grappling with the pandemic-induced Great Resignation, health advocacy is likely to be regarded as a critical as part of the employer-provided-healthcare consumer experience. Providing this service is an employee benefit point solution that can help employers attract and retain a high-performing workforce while limiting healthcare spend.
"These services drive value, and we're seeing a higher quality of care for the patient and savings on average of $17,000 per customer," Shawna Dodds, vice president of product development at health insurer Cigna, told the Society for Human Resource Management (SHRM) for an October 2022 article, “Health Care Advocates Help Employees Through Serious Diagnosis.”
According to SHRM, members of a Cigna-provided group health plan who are undergoing cancer treatment are eligible to receive:
- Support understanding the cancer diagnosis;
- Help coordinating physicians and treatment plans;
- Guidance on who to call if they are unsatisfied or not receiving the right care;
- Assistance navigating a denied claim and how to file an appeal;
- Help ordering medical supplies and finding the best prices and financial aid for prescriptions;
- Post-discharge follow-up and more.
Cigna is far from alone in offering employee health advocacy as part of a group plan. Sue Lewis, Chief Strategy Officer of ConsumerMedical, told SHRM in the fall of 2020 that “between 40 percent and 70 percent of employers of all different sizes already offer a service like this,” and she said that four of the five major insurers that contracted with her company offered such services.
And, of course, health advocacy services apply to more than bariatric and cancer treatment. Among the many other health issues an advocate can help navigate are fertility, menopause and mental/behavioral health.
What Your Peers and Competitors Offer
As we approach open enrollment and HR departments scramble to complete their benefits and Total Rewards design, it helps to know what peers and competitors are offering. Based on a survey of more than 2,500 employers across industries, regions and sizes, Alera Group’s 2022 Healthcare and Employee Benefits Benchmarking Report provides valuable statistics and analysis.
In the Health and Productivity section, for example, you’ll see that 47 percent of respondents said they include employee health advocate/navigator services, while 42 percent offered second-opinion services for review of diagnoses and treatment advice.
To learn more about your peers’ and competitors benefit offerings and their policies regarding the workplace, work-from-home arrangements, vaccine requirements and more, click on the link below to obtain the report.
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About the Author
Senior Total Wellbeing and Engagement Consultant
Boston Benefit Partners, an Alera Group Company
Liz Euglow joined the Boston Benefit Partners team in 2018 to assist clients in building and growing their total wellbeing and engagement programs by leveraging data and aligning strategies with core HR and business values. She previously worked at Marsh & McLennan Agency, partnering with employers and their HR teams while leveraging data analytics to build lasting and effective health management and wellbeing programs.
The information contained herein should be understood to be general insurance and employee benefits brokerage information only and does not constitute advice for any particular situation or fact pattern and cannot be relied upon as such. Statements concerning financial, regulatory or legal matters are based on general observations as an insurance and employee benefits broker and may not be relied upon as ﬁnancial, regulatory or legal advice. This document is owned by Alera Group, Inc., and its contents may not be reproduced, in whole or in part, without the written permission of Alera Group, Inc.