The Truth Behind a Nurse Advocacy Program

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People want someone to reach out to them, to make them feel wanted. So, it makes sense that employees want the same thing, especially when it comes to issues surrounding health. One answer to that call is the rise of nurse banks. But not all nurse lines are created equal - and you need to be aware of the differences.

 

Some nurse hotlines are used simply as a means of checking to see if insurance will cover a particular visit or procedure. These calls are inbound from the employee with little to no relationship formed - and that simply isn't going to move the needle. At CHC, we take the path of the nurse as the advocate, guiding the plan member on the best path possible to get the best outcome possible in a proactive manner. When properly executed, nurse advocates can be your plan's best friend in helping to control costs and outcomes. 

 


 

HOW A TRUE NURSE ADVOCACY SYSTEM WORKS. 

 

These days, employers of all sizes are investing in supportive resources to help guide employees on their own personal health journey, but how do you measure success? For one transportation employer, the route of advocacy was selected to help steer plan members to appropriate care. This particular employer has 823 plan members, and they engage with the nurse advocacy program an average of 170 times a month either through phone calls or emails. That equates to over 40 encounters with employees or family members a week. And, what are these calls about? They range from working with members on an individual basis and creating a plan that's personalized to your needs, whether it's diabetic management, substance abuse, weight loss, mental health or general health issues. 

 

Why are these nurse advocacy interactions important?  Employers generally offer them as a  free service available for employees their families as it can help lower their out of pocket expenses when it comes to minor medical problems that can be addressed over the phone, which in turn saves on a co-pay.  But it is so much more than that. An established relationship with a trusted advocate provides you with a sounding board that isn't rushing through your visit to see the next patient. That can't be achieved with the "call bank" approach. And it has a drastic impact on the bottom line for employers who choose this route. Nurse support helps educate, manage and counsel members on any health related need, and can even assist members with finding second opinions on a diagnosis. 

 

 Examples of interactions and savings using advocacy:

  • An employee looking to have gastric bypass turned to their nurse advocate to discuss pros and cons.  After multiple discussions, they decided to postpone the option of gastric bypass and with the help of their nurse has actually lost almost 30lbs in 3 months and has decided to forego surgery to the tune of $35,000. 
  • A spouse’s medication prices increased to $400, but after a nurse reached out to discuss this red flag they were able to try an alternative drug (with a price tag of $20) and still receive the same pharmaceutical benefit.
  • An employee was looking into another knee replacement and the nurse educated on other options for an alternative therapy procedure available under the health plan, thus potentially saving $10s of thousands for the employer and thousands for the benefits plan member. 


 

Are you ready to do explore how deploying nurse advocacy can provide some guidance - and guardrails - to your plan?