How Health Advocacy Solutions Generate Group Health Insurance Savings

Aug 03,2022

Read Time 5 Minutes

As care evolves due to cost and technology, large employers look for solutions that meet their specific needs. They want more for their money and expect carriers and plans to help them address their challenges. One example of what carriers are doing is Empire’s whole-health advocacy solution, Total Health, Total You (THTY). Launched in 2018, THTY serves more than 100 employers and 4 million lives, helping people navigate a complex healthcare system to achieve better health outcomes and achieve long term cost of care savings.

The core competencies of THTY build healthcare experiences that meet the needs of employees and businesses, promote positive health and financial outcomes, and leverage Empire’s people, tools, and innovation. The THTY advocacy model integrates programs such as health coaching, condition management, and medical and behavioral healthcare management to target and engage 100% of your population. The goal is to support each individual’s journey to better health by identifying risk and aligning outreach and engagement. With a holistic approach to care management and member engagement, we aim to increase clinical compliance and proactively manage risk. 

 

So, what led us to an advocacy solution?


 

Four Forces Show Need For Advocacy Solutions

 

These emerging trends impact the health of individuals and the overall healthcare system — highlighting the need for a whole-health solution:

  1. Lifestyles and health habits have been dramatically impacted by COVID-19.
  2. The healthcare system is extremely complex and fragmented.
  3. We need to innovate how people access healthcare.
  4. Healthcare costs continue to increase.

These factors point to the need for a simple solution that combats system-wide complexity, proactively guides, coordinates care, and supports behavior change. Employers and employees both want employee wellness programs that transform the healthcare experience and deliver improved savings and outcomes. What if we took into consideration not just underlying conditions, but comprehensively looked at the total person — from their medical history to their future behavior, from how they live day-to-day to how we can help shape their future?

 

Companies like Empire ask this question and then help solve it by treating each individual as a population of one and putting that one person’s whole health needs at the center of at-risk identification and stratification model such as THTY. The cornerstone of this holistic approach is enhanced individual identification and stratification. We mine structured data (such as medical and pharmacy claims) and nonstructured data (such as consumer preferences, health status, and lifestyle), and leverage machine learning to create a highly accurate way of profiling individuals.

 

This approach brings together new kinds of data and sophisticated algorithms to build a richer understanding of risk. Those new insights are then applied to the whole person so clinical advocates can tailor the right interventions based on the individual’s level of risk/acuity, likelihood to engage, and preferred style of engagement.

 

People’s health needs are complicated. For example, they may have one serious health issue, such as diabetes. That is probably not all they face as adults. They may also have work stress or kids needing care. They may be caregivers for their parents or face financial or legal problems. All that affects their health, well-being, and productivity. THTY takes it all into consideration and delivers better outcomes at lower costs.

 

Doing all that means truly listening for the things that matter in people’s lives — and why they matter. It also means learning not just from data, but from human moments that make up each individual’s healthcare journey. And it means committing to make a real difference.


 

Advocacy: Providing Sustainable Value Year After Year

 

Our THTY whole-health advocacy solution is simple, intuitive, and personal. We are continuing to build on our advocacy solution and reimagining how people experience healthcare as technology and new market forces evolve.

 

In 2018, a THTY pilot study confirmed the value that our advocacy solution delivers to our clients and members. In our first white paper analysis of Empire’s advocacy model, Proving the power of advocacy-focused, personalized care, we examined how traditional care models fall short of addressing key needs of people and how Empire’s advocacy solution uses continuous analytics and machine learning to gain valuable insights. We are using this powerful data to improve how we identify, engage, and advocate for individuals every day.

 

Large employers learned how important advocacy solutions are for consumers in a complex and fragmented care system, but questions remained about how advocacy-focused care can be scaled and sustained. These questions were addressed with a second study performed in 2020. This second white paper analysis, Proving the value of an advocacy solution that is simple, intuitive, and personal, showed how THTY provides value that is sustainable and scalable. This study showed that THTY demonstrated sustainable multi-year value, including medical cost savings of $123 to $353 per member per year (PMPY) for clients with THTY from 2018 through 2020. These savings were due to decreased acute hospital admissions and emergency room visits for THTY members, when compared to the control population. The study also showed the program:

  • Reduced medical costs for high-cost chronic conditions, up to $5,422 PMPY for congestive heart failure. 
  • Achieved an increased care gap closure of 69%. 
  • Increased member satisfaction, with an average net promoter score of 70 and above.

The latest analysis in Proving the effectiveness of an advocacy solution to generate savings examines how Empire’s advocacy solution controls total medical and treatment costs for clients. Models such as Total Health, Total You are demonstrating sustainable, multi-year value though simplified, tailored, and timely health interventions, resulting in better health decisions and greater value to employers and employees.