Health Advocacy and Assistance Programs

Health Advocacy and Assistance Programs

Health advocacy and assistance programs help individuals navigate the healthcare world through interfacing health plans and administrators. Advocacy programs engage health consumers during times of need. Data-driven advocacy programs anticipate individual’s needs based on claims and circumstances since they store a lot of information about members. Opt-in advocacy and assistance programs encourage members who are qualified to reach out to the advocate for assistance any time they experience a health issue. Since there is limited ability to predict when such needs are likely to emerge so that it can be communicated throughout the year, hoping that the plan member, employee, or consumer will remember to contact the advocate when they face a health issue. Opt-in and data-driven advocacy programs have both advantages and disadvantages.

Opt-in advocacy and assistance programs are real-time and permit teachable movements where an individual can discuss with the healthcare advocate about the selection of a physician as well as address outstanding questions about the care program.As a result, the advocacy program promotes patient education.Another advantage is that these programs make connections across the spectrum of care. Rather than only ensuring that medical costs are correct, these programs connect members to management programs provided by the health plan. For example, a health advocate can seize the teachable moment and connect the member with a management program that would provide vital information such as educational information about the condition, proper use of medications, and management strategies.This connection offers members opportunities to save costs. A significant disadvantage associated with opt-in programs is patient safety. For example, in VITL systems, a member lacks a PIN or card number, and staff at a hospital can access any member’s account. He or she can press a button to indicate they are authorized to access a patient’s records.

The essential advantage associated with data-driven advocacy programs is the trust involved. A member’s information is protected per the Health Insurance Portability and Accountability Act requirements. Users must sign a release to allow advocates to represent them in dealings with hospitals, physicians, and health plans. Another advantage is that a member can check the physician’s credentials, training, and years of experience. The availability of public databases enables this process. This objective criterion defines the member’s view of an excellent physician. A key disadvantage linked to the data-driven program is administrative burdens since the patient’s data is stored in a query-based exchange tool where providers have to seek permission before accessing such data.


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