Advocating for members throughout their health care journey

Navigating the health care system — whether it’s a short hospital stay or managing an ongoing condition — can be confusing and time-consuming for employees and their families.

It’s something UnitedHealthcare advocates like Christie Anderson understand firsthand. As a team leader in enhanced advocacy models, she helps to solve some of the more stressful situations for employees to their resolution. Anderson recently received an emotional call from a member who was delaying care. He thought he going to temporality lose coverage transitioning from his employer plan to Medicare for retirement.

To help clear up the confusion, Anderson reached out to his employer’s human resources department, serving as bridge to assist the member, who also did not speak English as a first language. Then she contacted the provider to schedule the appointment for him.

“The end-to-end care was so important. He didn’t know where to start. He was really grateful,” Anderson says.

At UnitedHealthcare, this is just one way advocacy initiatives help employees navigate the health system. The company’s advocacy solutions -- backed by clinical, behavioral and pharmacy services under one roof -- offers employers the expertise, data and insights needed to adapt and evolve their benefits plan strategy for their employee populations.

As part of the member experience, advocacy solutions deliver:

  • Proactive guidance though data and insights
  • Compassionate, empathic service in every interaction
  • Simplified experiences by streamlining the benefits experience

"Advocacy, at its most fundamental level, means really understanding a member’s journey and knowing who they are and what they are doing in their journey,” says Rebecca Madsen, Chief Consumer Officer with UnitedHealthcare. “Effective advocacy helps members make smarter decisions – unexpected and anticipated – about their health care and finances."

3 key takeaways about advocacy at UnitedHealthcare

  1. Advocacy solutions help guide members at each step including onboarding, coordinating care, wellness programs and support to help make more informed heath care and financial decisions.
  2. Cost and coverage drive 60% of a member’s experience.1
  3. Advocates go beyond customer service, helping to provide whole-person guidance across a broad number of health care needs, such as emotional health, clinical and complex care support, financial and benefits/claims.

Proactive guidance though data and insights

Taking an employee’s best interests in health and financial matters into account with proactive actions is essential when cost and coverage drive 60% of a member’s experience.2 Employees have a variety of ways to find care at lower costs — whether via Advocate4Me®, the UnitedHealthcare® app or® website with real-time cost estimates.

In addition, it’s important to let employees know in advance when they are about to make a decision that will cost more money, such as with out-of-network (OON) care, or to follow up after a situation like non-urgent ER usage to inform them about lower-cost alternatives.

For example, when a member calls a provider and an eligibility check occurs with UnitedHealthcare, a program will prompt member follow up if it shows the provider is OON. The member is also provided information on how the OON network status may affect their cost-sharing responsibility.

Even when employees visit network facilities, they may be treated, and charged more, by an OON provider outside of their control. That’s why tools like NaviguardTM  are an important part of a best-in-class member experience. The service is designed to help lower OON costs while giving employees someone to turn to if a surprise bills arrives. With Naviguard, members typically see about 70% savings off OON billed charges.

“Helping members avoid cost surprises is critical to the member experience,” says Geoff Bushman, Associate Director of Consumer Experience with UnitedHealthcare. “We’ve seen a staggering Net Promoter Score® gap for members who reported that what they paid for care was ‘expected’ versus ‘much more than expected.'”

Compassionate, empathic service in every interaction

The member experience starts early in a member’s health journey, with proactive onboarding beginning during plan enrollment. It helps set members up for success by evaluating whether their usual providers are network or OON. Medications are also reviewed for any comparable lower-cost alternatives based on their plan. 

For additional support, Advocate4Me uses predictive personalization to help connect employees to needed resources. Advocates are available through the phone, live chat, email or text.

Advocates go beyond customer service, providing whole-person guidance across a broad number of health care needs, such as emotional health, clinical and complex care support, financial and benefits/claims. They use a dashboard that offers a comprehensive view of the member, including their current health condition, history of calls, utilization of and the UnitedHealthcare app, utilization of the health system, clinical recommendations and health account information.

“Being able to quickly view the information for an HRA or FSA account, give more referral options more quickly and easily, and update communication methods very easily has been greatly appreciated by the UnitedHealthcare representatives on the floor,” says Samantha Flentje, a team leader in UnitedHealthcare’s enhanced advocacy program.

Proactive outreach by advocates can include when a member receives a prior authorization request for certain identified clinical codes for treatments or surgeries. Knowing those certain treatments and surgeries are often accompanied by ensuing claims for durable medical equipment (DME), medication and follow-up care, the advocate can begin to help provide information to the member  proactively to help steer them to quality, lower-cost options for those items and services they may need in the future. 

Next-level advocacy: Elite and Premier

UnitedHealthcare offers enhanced advocacy with Elite and Premier service and support models, which feature dedicated representatives for employee populations who can provide more personalized interactions.

Elite and Premier has been proven to help lower the total cost of care and result in better clinical outcomes for members. This approach involves:

  • Leveraging data from medical claims to catch chronic conditions sooner
  • Finding and addressing gaps in care
  • Identifying clinically effective treatments
  • Looking for lower-cost alternatives for medications
  • Seeking opportunities for better health and lower costs

Employers who have engaged enhanced advocacy services have seen7:

  • 2-4% medical total cost of care savings
  • 4% lower inpatient admissions
  • 10% lower ER visits
  • 18% increased clinical program engagement


Simplified experiences by streamlining the benefits experience

Supported by teams skilled in health care delivery, UnitedHealthcare’s end-to-end ownership of a whole-health portfolio — from health care benefits to care providers — helps to deliver integrated solutions for a simpler member experience.

Integrated medical benefits with specialty (dental, vision and financial protection), pharmacy and behavioral, may create opportunities to diagnose and manage chronic conditions sooner, help identify and deploy clinically effective treatments, intervene early in behavioral issues and more. Chronic conditions are the leading causes of death and disability in the U.S. --- driving $3.8 trillion in annual health care costs.And it’s estimated that unaddressed mental health issues such as depression and anxiety cost the U.S. economy $1 trillion in lost productivity each year.5

"Advocacy, at its most fundamental level, means really understanding a member’s journey and knowing who they are and what they are doing in their journey,”

— Rebecca Madsen, Chief Consumer Officer with UnitedHealthcare

Integrated benefits also bolster advocacy efforts in helping to create adherence to medical and cost decision-making to help drive greater engagement. In fact, employees accept 57% of clinical programs offered in Advocate4Me.6

“We have the integration of all the systems under the one roof. We believe there will be fewer gaps in care and coverage. We can see what’s going on with claims, clinical, pharmacy and more. This allows us to connect the dots and potentially get a member into a clinical program sooner, which may result in a better outcome,” Madsen says.

Building relationships one member at a time

Good advocacy means keeping the member front of mind with each interaction and continually making enhancements so that tools and resources are easier to use. From a member’s perspective, this may mean closing the loop when they’ve reached out for help or proactively providing timely information about a health or financial decision, and other support.

This also includes recognizing the COVID-19 pandemic’s effect on social determinants of health such as social support and income on the well-being of employees. To help assist, UnitedHealthcare has incorporated tools to help connect employees to social services in their communities. The advocate can access the tool if phrases such as “lost my home” or “lack of food” come up during a call.

“If you give people information and help them in a way that is not mandatory, they can act from a place of trust,” Madsen says. “That’s the bridge that advocacy provides. However, if you find us or don’t find us, we’re still here looking out for you.” 


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