What is Member Advocacy?

Every health plan has a different strategy for how to best engage their members. Many health plans are prioritizing member experience and staff-wide digital adoption. But introducing digital health technology is just the beginning of how your organization can deliver the most value to members and employer groups.

With Member Advocacy, your health plan can proactively offer relevant and timely health and benefits information to your members, extending clinical reach and improving healthcare navigation.

Under a Member Advocacy model, health plans are encouraged to address member needs using integrated digital health technologies. Health plans can deliver greater value to members and employer groups by adopting a Member Advocacy model.

Under a Member Advocacy model, health plans are better enabled to:

While many of these components may sound familiar (and are related) to digital transformation, there are a few key differences. Digital transformation refers to technology integration across an organization. Member Advocacy is the service model that leverages the strengths of both technology and health plan resources to support, guide and inform members through their healthcare experience.

You can’t flip a switch and turn on Member Advocacy—it’s an iterative process that requires forethought and change management. Instead of seeing a Member Advocacy as an endpoint, we challenge you to use it as a mindset for mapping your health plan’s future. So how can your health plan embrace a Member Advocacy mindset?

Generally, health plans working with Wellframe take three basic steps to make the shift to Member Advocacy.

The first step towards Member Advocacy is leveraging digital tools to improve care management for high-risk members. High-risk members might have chronic conditions, such as diabetes, chronic kidney disease, or cancer. Using digital care management can reduce readmissions, increase member engagement, and lower PMPM costs. 

Care Managers can use digital care management tools to improve member communication, send surveys and assessments, and set important reminders for members. And members can manage their health and wellness more easily, and build relationships with their care teams.

Member Advocacy doesn’t stop at clinical support. Members also look to their health plans for guidance when navigating the healthcare system—and they expect plans to give them personalized recommendations based on their unique needs. Health plans can empower member service teams to better serve their populations through digital health technologies.

Under a traditional telephonic system, member interactions at health plans are often siloed. Care managers largely focus on outbound calling, while member services teams take inbound calls from members. There is no visibility of information or communication history between the teams. As a result, if a member speaks with a Care Manager and has a question related to their benefits, the Care Manager has to transfer them to a Member Service Representative. Then the member has to explain their situation again, and spend valuable time sitting on hold. Plus, members may need to recall or reiterate sensitive health information that they’re not comfortable sharing out loud.

A Member Advocacy model encourages plans to use technology to break down silos between clinical care management and member services, creating a more seamless member experience. These offerings could look like:

Finally, health plans can achieve Member Advocacy by unifying their teams and systems more deeply. Under Member Advocacy, staff and care teams can access and exchange member data, resources, and other information faster and more securely with digital technology. Knocking down internal communication siloes makes it easier to deliver coordinated and proactive support to members, and can help improve member satisfaction.

Member Advocacy goes beyond digital care management and member services alone. With a Member Advocacy mindset, your plan will deepen member engagement and have greater influence over their healthcare journeys. This means your members no longer have to call multiple 1-800 numbers multiple times or visit multiple websites to figure out what to do or how to get their questions answered. Instead, they have a single destination with information on health plan benefits, healthcare resources, and are supported by clinical resources and care management.

Member Advocacy also makes is easier to:

Member Advocacy supports members across the risk pyramid. Your members can do their own research with on-demand articles that cover a wide breadth of topics, including caregiver support, stress management, preparing for surgery and more—in addition to the information included in digital care programs. Members can also access personalized benefits resources and connections to the right staff member when they need it. 

If Member Advocacy seems like an intimidating mountain to climb, remember that you don’t have to do it alone. Choosing the right partner in digital transformation is the first step in empowering your team to implement a new service model.