The Effect of a Customized Advocacy Product on Downstream Medical Expenditures and Utilization

Abstract

Background: The complexity of today’s healthcare system has led to the growth of an emerging healthcare function known as healthcare advocacy. A telephonic healthcare advocate or advisor can play an essential role in care coordination, a better understanding of health benefits, and ease in navigating the healthcare system. A healthcare advocate’s role may be filled by clinical staff (i.e., registered nurses), non-clinical staff, or both, with varying levels of training depending on the intended scope of service. Objective: With a higher number of employers seeking customized health advocacy programing, this study serves to determine if more favorable healthcare outcomes offset the additional operating costs associated with a more dedicated delivery system. Therefore, this study’s primary objective was to evaluate the impact of patient access to a customized health advocacy program on downstream medical costs and healthcare utilization compared to a control (CON) group without access to this service. The secondary aim was to provide information to employers on whether a higher investment in a more complex customized delivery model provides significant value compared to a less customized program. Methods: The study treatment (TRT) group included 89,372 individuals with access to a customized advocacy program for employees, while the CON group of 115,465 had access to a non-customized program. Key outcomes included total healthcare expenditures, hospital admissions, emergency room visits, and physician office visits 12 months after the advocacy start date compared to 6 months before the start date. Researchers evaluated the impact the customized advocacy intervention had on expenditures by comparing differences in pre- and post-expenditures between customized health advisor and non-customized health advisor groups after controlling for various demographic, socioeconomic, and health status characteristics. Inverse propensity score weighting helped minimize differences in characteristics between the TRT and CON groups. Results: With the customized advocacy product, healthcare expenditures increased by only $2.03 per member per month (PMPM) compared with a $26.35 PMPM larger increase for controls with a non-customized product. Also, customized health advisor participants experienced reduced hospital admissions and ER visits compared with the CON group. Conclusions: Study participants with access to customized healthcare advocacy services experienced significant healthcare cost savings, along with fewer ER visits, and reduced inpatient admissions compared with the CON group. Thus, these findings suggest that healthcare advocacy programs justify the increased delivery cost and can lead to reduced healthcare costs and utilization, along with the potential to improve health outcomes and quality of life.