If you’rereading this article, you’re likely considering offering care management and patient advocacy to your employees. Congratulations! You want to help your employees, but at the same time, it needs to be budget-friendly.
The process to add patient advocacy and care management is relatively simple. However, like most things in the health insurance industry, it’s not easy
Here is the process:
First, the employee will call the patient advocate or the care manager and discuss their upcoming procedure. The nursewill then walk through the plan details, any member responsibilities, and explain the pre-certification and pre-authorization process.
Since most employees might not know the difference between a copay, a coinsurance, and a deductible, there are a lot of details and information to share in addition to explaining how the process works.
The care advocate will also identify alternative ways to engage the patient before, during, and after treatment. Ideally, if your employee is going to the highest quality facility, you will want your plan designed so there is little to no out-of-pocket costs.
I know this can sometimes be a little unsettling for employers, who don’t want to be responsible for choosing a provider for their employee. The cost savings is so significant that it is generally extremely worthwhile for you to do just that. In our plans, we always allow the employee to make the final decision of where they get care. We do; however, incent them to choose the highest quality provider.
You may save your employees $2,000, $3,000, or $4,000 that they don’t have, while as the employer, you can save many multiples of that, depending on the procedure.
One of the concerns I often hear is that employers don’t want to be responsible for choosing who or where their employee seeks care. However, if you already offer a PPO, HMO, or EPO network, you are already choosing who your employee goes to see, so there is no different or additional legal liability for you.
Even though care management companies tend to be reasonably priced, they are still a small fixed cost and may seem like a lot of work. However, providing care management to your employees will generally multiply your ROI by driving high quality care at the lowest possible cost.
If you do use a care management company to increase the quality of the plan you offer, we highly encourage you to build the plan so that when employees and their dependents follow the guidance of the care manager, they have zero or very small out of pocket costs.
Doing so allows the advocates and care manager the most flexibility for using bundle pricing, direct contracting, reference-based pricing, or any of the myriad of second surgical opinion services or companies that bundle colonoscopies or complex imaging into pre-negotiated fees.
The care manager will also discuss any member responsibility with the employee and most are relieved to know how little out of pocket cost they will have while also receiving the best care.
All of this is handled out of your office and directedusing a well-crafted plan document. All you are required to do is make the decision on whether to offer patient advocacy in your plan, and they will do the rest. Once the care is delivered, the patient advocate will circle back to your employee to ensure they’re following their post-operative plan and at that time, all the bills are negotiated and finalized.