Impactful Health Advocacy Programs are Built on Analytics
Blue Health Intelligence
11/09/2018
Health advocacy programs blend the best in technology with human interaction to improve employee engagement and outcomes. Like traditional care management programs, health advocacy programs use machine learning technology to first analyze claims data and then generate recommendations for member care and support. However, these programs also seek to incorporate social and behavioral data into the analytics, and then encourage member interactions in which these analytics can be used effectively.
When a member contacts a call center, health advocates first build trust based on the member’s behavioral and social profile; the advocates then provide information and support. They also solicit additional data from members about social and behavioral barriers and motivators for care. Incorporating such information into analytic algorithms enables health advocates to provide more personalized counsel; support behavior change; and encourage more effective ways for members to access needed care.
BHI is currently working with a regional health plan that provides health advocacy solutions to more than a dozen large national employers. We have learned that data and analytics play a critical role in improving program success, by specifically:
- Developing prioritized lists of members and providers to target with high-yield interventions that lower costs and improve quality.
Health advocacy interventions should be directed at members and providers for whom there are the greatest opportunities to improve outcomes. Data and analytics can identify these individuals and opportunities.
- Shaping health advocacy programs to meet a variety of strategic objectives.
These include retaining high-value employees, managing high-cost members, preventing members from becoming high cost, and providing work-life balance. As employers explore possible goals, data analytics can be used to identify and stratify members by their past engagement trends, social determinants of health, family member composition, health status, and more.
- Identifying how employers can achieve a return on investment.
Through retrospective and predictive analyses, health plans can identify populations that are more apt to engage in high-touch programs. When a substantial number of these individuals comprise an employer’s workforce, it gives a plan a natural value-added service to offer during the sales cycle. If employers are already using health advocacy services, the same analytically driven approach can help plans show how a data-driven efforts and relevant benchmarks from other programs might help an employer save money and improve engagement.
- Enriching the member record during in-bound, one-on-one interactions.
Best-in-class programs train concierge staff to listen for contextual motivators and barriers to care, and note such information in the member record. The data then becomes integrated into a member’s record that can be updated in near real-time.
- Assessing program effectiveness and making ongoing improvements.
At intervals after program launch, BHI advises health plans to take a holistic look at their data and use analytics to continually refine which aspects of the program are and are not working.
In sum, health advocacy programs call for extensive data integration and the appropriate use of predictive modeling in real-time situations when members call a health plan for any reason. Understanding how to interpret patterns of use in claims data and how to conform disparate data — such as claims, electronic medical record, and census data — are critical to program success.
If your plan wants to launch a health advocacy program or improve the efficiency of an existing effort, choose an analytics partner with experience, such as BHI.
BHI Partners with a Regional Plan to Train its Health Advocates
When member service professionals become health advocates, they need to develop new skills in engaging members and building trust. Throughout 2018, a regional plan worked with BHI to assess, design, and deliver a comprehensive health advocacy training program.
The training included modules on trust, empathetic listening, plain language, turning structured assessments into conversations, presenting choices, and behavior change. Participants commented that the material was engaging, interesting, and provided plenty of ‘aha’ moments.
"This training is awesome," wrote one participant. "Even after many years of customer service training, I learned so much."