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Listen, simplify, improve: Aetna One Advocate builds on member response

October 11, 2018 | Health Insurance

Digital tools have proven to be valuable advancements in helping consumers manage and improve their health. Still, for some — when health is more complicated — nothing beats personal interaction with a trusted advisor who can listen, help simplify and inform health care decisions.

Earlier this year, combined clinical and service support through Aetna One® Advocate (A1A) was introduced to large, self-insured customers specifically to provide members with a single, trusted advisor when they needed one.

“We do not expect consumers to be experts in all facets of the health care system — from cost to policy to procedures — to effectively manage their health,” says Jason Clement, vice president of Aetna One Advocate. “Rather, we are combining our collective expertise behind the scenes to give consumers a simpler, seamless experience provided by innovations in both digital technologies as well as in one-on-one support.”

The A1A program is designed to ease members’ burdens of managing their health and their benefits. In addition to a robust collection of personalized and mobile tools, A1A members also have a dedicated advocate who reaches out to members about their health and whom members can reach directly as well. With a swivel of a chair, the advocate can access the expertise of a co-located, multidisciplinary team of nurses, pharmacists, dieticians, doctors, social workers, and network specialists. Together this team collects, reviews and connects information end to end to help members access care and get the most from their benefit plans.

“More than just answering questions, the team gets to know the members and considers many factors including personal preferences and goals, barriers, cost, site of care, and community resources,” Clement says. “Several members have told us they were surprised by the depth of support and delighted to have someone proactively looking out for their best interests.”

By building relationships with members, advocates help address customary issues such as improving medication adherence and coordinating member care plans, including disability. Many times, however, the advocates provide members with help they didn’t know they needed or had. For example, one member called to compare the cost of lab tests. The advocate noticed that the lab order indicated the tests as diagnostic rather than preventive wellness, which would be covered by the health plan. The advocate called the provider, who confirmed the order was not accurate and provided a new one, resulting in more than $150 in unexpected savings for the member. Another advocate helped a member qualify and enroll in a clinical trial that he believed was not possible.

Investing in what we don’t know to do better

To learn more about what concerns members, frustrates them, delights them and most importantly what’s missing, Aetna has enlisted the capabilities of Topbox, makers of cloud-based customer experience analytics software. Topbox technology will analyze and deliver a unified view of all member interactions, from contact center calls, emails chats, feedback on the website and surveys.

“The unstructured data contained in all these organic conversations represents a wealth of information on customers’ expectations, and how to better meet them. Topbox will help identify recurring service requests or concerns, and pinpoint their root causes, so that Aetna can address them and continue to improve the overall customer experience of the A1A program,” says Chris Tranquill, CEO of Topbox.

Improving the health care journey

Learning more directly from members about their health care journey across Aetna business areas and local health care communities will help Aetna improve and deliver new digital capabilities and one-on-one support. Transforming the health care system and experience for members requires transformation in member support. Investing in building ongoing relationship with members and customized solutions informed by analytics, access and expert knowledge is essential to make planning for and accessing health care easy and most effective for members.