2. Health Advocacy: The heart of what we do...
Benefits Gateway
Member Engagement Platform
Health Information
Dashboards
Identify & Close Gaps in Care
Health Advocacy
Chronic Care
Solutions
Personalized
Health Communications
Wellness Program
Financial Fitness
We have a full spectrum of innovative health and wellness solutions but it all starts with Health Advocacy, it is the heart of what we do.
We know that engagement is key to a successful health and wellness strategy.
Health Advocate has a proven high-touch health concierge service that not only drives higher engagement, but uses data and technology to simplify and personalize the healthcare experience for your employees.
Medical Decision Support
Biometric Screening
EAP+Work/Life
Nurseline &
Telemedicine
Remote Device Integration
Data Analytics
Predictive Modeling
Risk Scoring

3. The only solution that provides complete, 360° support
Expert Medical Opinions
Research centers of excellence
Care Coordination
Transition of care
Administrative Support
Transfer medical records
Resolve medical bill errors
There are a lot of niche vendors out there today who focus on one aspect of the healthcare experience (tools to help with costs, vendors to help with second opinions, others to help manage chronic conditions and yet another vendor if you have a billing issue).
When someone has a clinical issue they need to understand their options and will need ongoing help to manager their health/issue.
The healthcare system is fragmented enough – do they really need numerous places to call for healthcare support?
Health Advocate provides 360 degrees of support. We are Medical experts and experts in complex claims and benefit issues. One place to call for all your healthcare needs.
Clinical Decision Support
Explain medical diagnoses
Research latest treatments
Find the Right Doctors
Locate Specialists

4. Analyze data to identify gaps in care
Leveraging Data
Our comprehensive clinical model
Apply data in personal member interactions and via member dashboards to close care gaps
Proprietary algorithms leverage data to drive member and group health improvement
Analyze data to identify gaps in care
In addition to our high touch expert services, we also leverage data to drive improvements in member and group health/wellness.
We have one of the leading medical claims analysis capabilities in the sector. We import data from every major healthcare carrier and other sources (pharmacy, labs, etc.) and analyze it to identify “gaps in care.” We then utilize this data to power our interactions with members to drive behavioral change.
MOST IMPORTANTLY—it is our “trusted” compassionate personal health advocates who apply this data science in live interactions and via member dashboards. We have found that we are able to close over 50% of the identified gaps in care in a population.

5. Our in-house team guides members to the right care at the right time
Personal Health Advocates
Registered Nurses
Claims/ Billing Experts
Benefit Specialists
Supported by Board Certified Medical Directors

6. Backed by established Clinical Guidelines
Led by Health Advocate’s team of experienced medical doctors, our Clinical Guidelines are continuously updated with the latest evidence-based standards from a wide range of trusted sources.
Medical
Academia
Government
Medical Associations

7. Our Clinical Guidelines In Action
Informs Health Advocate programs including Wellness, Chronic Care Solutions and Personalized Health Communications, among others
Combined with data to generate recommendations and alerts in Health Advocate’s member website and app for preventive care and disease management
Provides Personal Health Advocates with up-to-date standards for enhanced clinical and administrative support across spectrum of medical specialties

8. Care Coordination

9. Care coordination
Coordinate clinical services related to all aspects of a member’s care
During and after a hospital stay
Transitions of care
Facilitate communication between providers, carriers, vendors
Connect members with community and eldercare resources
Coordinating clinical services related to all aspects of a member’s care. During and after a hospital stay and transitions of care.
For example, if a member calls about a loved one in the hospital, our nurse will communicate with the case manager or discharge planner at the hospital to help the member understand what comes next.
Facilitating communication between providers, carriers and vendors. In our experience, confusion can arise when there are multiple parties involved in a member’s care whether inpatient or outpatient. Sometimes these parties haven’t communicated or have communicated but there are lingering questions. We help get the questions answered.
Connecting members with community and eldercare resources. There are often untapped resources that do not necessarily involve insurance coverage. We will research and provide information about what’s available to support someone in need. Members call about their parents and are seeking eldercare resources, for example, and that can be overwhelming.

10. Clinical Decision Support

11. Support for every medical condition
Our Clinical Team
Answers questions about diagnoses, medical conditions, treatments and tests
Develops questions to ask the doctor
Reviews treatment options based on the latest, evidence-based practices
Researches current literature to identify new treatment opportunities/cutting-edge services
Provides consumer-focused health information and information members need to make the right decisions about their care
How it Works
Clinical Team clarifies the diagnosis and helps the member understand next steps
Member calls after receiving a complicated medical diagnosis
Researches the most advanced approaches to care
Explains the benefits and risks of each option
Locates leading providers and schedules appointments
Follows up during all phases of care

12. Clinical Decision Support In Action
James suffered with back pain for years and tried multiple treatments with little success.
His specialist recently recommended surgery.
James called Health Advocate.

13. His Clinical Team:
Reviewed the diagnosis and available treatment options for James’ condition
Answered questions about the procedure
Presented getting a second opinion as an option
Help James formulate questions to ask his doctor
Results
James went to a physiatrist for an evaluation, who suggested a trial of physical therapy
After 6 weeks of physical therapy his back pain had markedly improved
He enrolled in a local health club at his doctor’s recommendation

14. Find the Right Doctors

15. We find the right doctors
Check sanctions or licensing issues; verify board certification based on the American Board of Medical Specialties
We research and identify leading in-network providers using our MEDIS volumetric data-driven tool
Assess experience and contact providers to confirm they perform required care
Members call for help finding a doctor
Contact members to discuss provider and treatment options
Facilitate any necessary referrals or authorizations
Coordinate services with treating physicians/ health plans
Confirm network status and accepting new patients
Follow Up

16. MEDInsights (MEDIS)
Machine Learning approach to identify quality physicians based on experience and outcomes
Proprietary, Health Advocate Volumetric algorithm integrates CMS and commercial data
Data-driven tool compares physicians based on best practices, not against “average performance”
Efficiency factors include number of procedures performed, length of stay and readmission rates
Supported by Health Advocate’s clinical staff
Quality scores are built on vast, newly-available Center of Medicare data sets
Scores are generated and heavily weighted on procedure volume (but also length of stay and readmissions), as studies have suggested that increased volume is associated with better outcomes
All doctors who have billed Medicare are in the dataset, which comes out to roughly 90% of physicians.
Scores are developed from an algorithm that compares each physician with the most efficient outcome possible, unlike most score generators which score based on the average of the dataset

17. Second Opinions/ Expert Medical Opinions

18. We find the right experts for medical second opinions
Research and identify top experts and Centers of Excellence nationwide
Research questions about diagnosis, treatments and available support systems
Review quality assessments (if applicable to member’s condition)
Arrange for the transfer of medical records, test and lab results; arrange face-to-face appointments
Intake to assess members’ needs and preferences
Examples of resources our clinical team uses to research experts: National Cancer Institute (NCI) and National Institutes of Health (NIH) databases
We offer second opinions as a standard feature of our clinical advocacy service. When a member requests a second opinion, the nurse starts with a clinical assessment to assess the members needs and preferences. The assessment includes clarifying which tests/procedures/provider evaluations have been completed to that point.
We will research top academic centers and/or Centers of Excellence which are actively engaged in education, research and clinical care. These centers may have technology, resources or therapies that are not available elsewhere. We may also research pertinent literature to identify providers who are at the forefront of treating a particular condition.
We will review quality assessments if available and relevant to the condition.
We will arrange for transfer of medical records and assist with coordinating in-person consultations.
Our relationship with Cleveland Clinic through their myConsult online second opinion program is an additional feature of our second opinion program involving chart review and remote opinion.
Interact with providers, health plan case managers and medical directors

19. Medical Second Opinion In Action
Fran needed surgery to repair an abdominal aortic aneurysm, and was concerned about the complexity of the procedure and lengthy recovery time.
She called Health Advocate.
Her Health Advocate clinical team researched a newer, less invasive procedure with a shorter recovery time. They discussed her needs with a top-notch surgeon and helped schedule the procedure.
Following the procedure, Fran was able to resume normal activities just three days later.

20. Cleveland Clinic MyConsult® Online Medical Second Opinions
METRICS
Cleveland Clinic MyConsult® Online Medical Second Opinions
Additional feature of our Second Opinion Program
Access to Cleveland Clinic’s world-renowned doctors for remote chart-based second opinions
Includes Health Advocate’s expertise in collecting medical records, imaging studies, laboratory reports and pathology specimens
MyConsult Outcomes
Diagnosis
Agree: 75%
With changes: 15%
Disagree: 10%
Treatment Recommendations
No changes: 38%
Minor changes: 22%
Moderate changes: 24%
Major changes: 16%

21. MyConsult Second Opinion In Action
After being in remission for 5 years, symptoms of Lisa’s long-term Crohn’s disease returned with a vengeance.
She discussed her options with her doctor, who recommended colorectal surgery.
Lisa called Health Advocate.
Lisa’s Health Advocate clinical team connected her to Cleveland Clinic’s MyConsult Online Second Opinion Program, and facilitated the transfer of her medical records.

22. After reviewing Lisa’s medical records, the Cleveland Clinic specialist didn’t think Crohn’s was the cause of her symptoms — he believed she was suffering from indeterminate ulcerative colitis.
He recommended that Lisa visit a top gastroenterologist in her home town, who decided to try a different medication therapy. Because of this slight change, Lisa saw an immediate improvement in her health.
Over a year later, Lisa felt great and had returned to her active lifestyle.
Despite living a great distance from Cleveland Clinic, Lisa didn't have to travel to get expert advice.

23. Administrative Support

24. We take the hassle out of healthcare
We take on frustrating, time-consuming administrative problems that often accompany medical issues.
Resolve claims and billing issues
Explain benefits coverage and coordinate benefits
Facilitate any necessary pre-authorizations for care, DME, medications
Review medical bills to identify and correct duplicate or erroneous charges
Research ways to reduce prescription drug and other costs
Negotiate payment arrangements

25. Administrative Support In Action
After going to the ER for an asthma attack, Donna received a bill she didn’t understand.
She called Health Advocate.
Our experts:
Walked Donna through the bill and explained the charges
Educated her about care options other than the ER

26. Asking the “Hidden Question”
But we didn’t stop there. We asked:
“Are you currently working with a doctor?”
Donna had just relocated and had not had time to find a new doctor. So we:
Researched and located an in-network provider
Scheduled the earliest appointment
Provided information about the Chronic Care Support program for help managing her asthma

27. Making a Difference

28. Impacting the lives of our members every day
You have been a true Godsend who prevented me from going under. Thank you.
Thank you and the doctors who did the research. I feel good about the decision to have the procedure.
Your research into other alternative centers and your knowledge enabled me to calm down and focus.
You are the only one who calms me down and makes me feel that someone else cares besides myself.
Don't know how you did it, but you managed to untangle a major mess that gave me sleepless nights. 
This is exactly what we needed to know to make the decision.

29. Thank You! First Name Last Name, Title 000.000.0000