We bring together the power of vast data and a broad scope of the health care system under our roof to help deliver better health outcomes for members.
Personalized and consistent omnichannel support helps members get the most from their benefits and delivers a better experience.
Our data and insights help us identify when members may make suboptimal choices, helping them avoid unnecessary costs.
Knowing that someone is looking out for them in every interaction, serving with empathy and a personal touch.
Because we manage multiple parts of the health care ecosystem, we can connect the dots across every touchpoint to streamline the benefits experience.
One person doesn’t have all the answers. A caller’s needs are anticipated leveraging deep analytics and we connect them with the right resource from our team-based model to help quickly resolve issues and find the help they need.
Provides plan, claims and coverage expertise with first contact resolution.
Provides financial and health advocacy through claims, wellness and health management expertise.
Provides health and clinical education, decision support, and expertise from a licensed RN.
Provides end-to-end service for Rx, including formulary guidance, lower cost alternative recommendations, home delivery, and claims and benefits management.
Provides expertise on behavioral health including provider selection, benefits explanation, and sensitive handling of mental health needs.
Provides complex issue resolution, support for longer term issues, and a focus on cost diversion (for Elite and Premier members only).
We continue to invest in even better advocacy solutions, now and for the future
Complex Care Concierge program helps members find support through life’s challenges
Barb’s* high blood pressure put her at risk for diabetes. This was exacerbated by the recent deaths of her father and two sons that left her overcome with grief, unable to maintain a regular diet and skipping doctor visits.
Eli* and his provider were planning for "top" surgery (double mastectomy for female-to-male transition) and had submitted a prior authorization. The procedure initially wasn’t approved because of a missing therapist letter (a necessary part of the clinical documentation). Eli called his Transgender Benefits Specialist.
At the age of four, Kassidy* was diagnosed with a rare condition causing muscle weakness and skeletal abnormalities. She had to rely on family to help her perform simple tasks. Her mother, Kaitlin*, recognized that a powered wheelchair would significantly improve Kassidy's quality of life and enable her to be more mobile, but the process wasn’t simple.
members in our enhanced advocacy products2
NPS for members in an enhanced advocacy product3
overall member satisfaction with Advocate4Me4
reduction in transfers, on average5
of clinical program enrollees are referred by Advocates4
program acceptance rate within enhanced advocacy3
increase in clinical program enrollment5
shifts of tier 3 prescriptions using PreCheck MyScript6
A proactive, highly-personalized experience helping members make informed choices and employers manage costs.
- Predictive Personalization
Robust data and technology to help guide members to the right resource.
- Proactive Outreach
Outbound calls and emails to educate members about their care options.
- Improved Engagement
Active referrals of members into appropriate clinical and wellness programs.
Increased employee engagement and a higher-touch experience, with a designated team of Advocates who are specifically trained on your company’s benefit plan and priorities.
- Everything in Core
All of the features from the Core plan are included.
- Virtual Customized Care Team
Advocacy, wellness, and clinical teams operate as a virtually connected team for members, with Advocates’ direct extensions and voicemail available to members.
- Expanded Advocate Role
Advocates offer enhanced services, including outbound call, and are empowered to engage an expert in real time.
Our most sophisticated package, with an integrated service team that includes dedicated Operations and Medical Directors, as well as clinicians who focus on quality and cost opportunities specific to your employee population.
- Everything in Elite
All of the features from the Elite plan are included.
- Integrated Customized Team
Team is integrated with Operations and Medical Directors leading real-time coordination (replaces the Elite virtual team).
- Medical Rounds
Clinicians conduct medical rounds to provide an escalated level of clinical engagement and oversight for acute and chronic members.
- Actionable Insights
Employer-specific analytics are generated daily to enable the team to actively support your employees’ care and provide them with a top-notch experience.