Family Advocates: Personalized Service Your Employees Can Trust

Payton needed an advocate — somebody with the knowledge and the resources to help. After being a patient, he understands how meaningful advocacy can be during a time when it is needed the most.

“I had a nurse at the time who was reaching out to me and following up with me on a regular basis. They helped me with setting appointments and understanding what was covered on my policy,” Payton says. “And it just took me out of the middle and made things so much easier whenever I wasn't feeling well.”

Anthem’s innovative Total Health Connections program gives employees access to Family Advocates as a single point of contact for everything health-related. Family Advocates care for the whole person, incorporating physical, mental, social, and emotional needs. Internal studies show they also increase engagement in care, resulting in better health outcomes for employees and lowering costs for employers:*

• 2x engagement rate of high-cost claimants
• 20% more likely to have recommended cancer screenings
• 11% fewer avoidable ER visits
• 9% lower readmission rate for members with chronic conditions

What Family Advocates Do 

Family Advocates create personal connections through their one-on-one interactions and compassionate support. Payton, who now works as a Family Advocate for Anthem, knows what that connection can mean for personalized care and employee well-being.

“It goes from sympathy to empathy,” Payton says. “It’s what I love about my job, that I am given the resources so that I can act. It's not just, ‘Oh, I'm so sorry that you're going through that.’ I get to actually take steps that make a change and help make things easier for you.”

Family Advocates can help members :

• Find top-quality doctors.
• Set reminders about preventive care.
• Manage chronic conditions.
• Connect with clinical specialists.
• Get preapproval for urgent medical needs.
• Understand their health plans and benefits.

A Team Of Experts

In addition to their knowledge and insight, Anthem’s Family Advocates also have access to a team of experts (TOE) to serve their customers.

“We have more help to get us quicker answers, like for authorizations, claims adjustments, and things like that,” says Kayla, an Anthem Family Advocate. “It absolutely streamlines the process for getting those answers that we need.”

TOE, with its in-house team of clinicians, brings a diverse array of skills to aid Family Advocates in best serving their members and potentially saving many phone calls.

“We have what we call TOE chats where we can ask questions if we need something more specialized,” Family Advocate DeWayne says. “We don’t just work with medical. We work with dental, vision, pharmacy, and other more specialized products. The biggest difference the TOE makes is the scope.”

And Payton says members benefit from the team’s coordination and camaraderie. “I love that we're able to work so closely with those nurses as a Family Advocate,” Payton says. “They're right there, a message away. They are so quick to respond. It is never more than three or four minutes before they are right on it, giving you the answers that you are looking for.”

Family Advocates In Action

DeWayne recalls a time when a member had a complicated medical condition that made traveling difficult. The member lived several hours away from the hospital that would perform the procedure he needed. DeWayne and the Anthem TOE went to work to find solutions.

“Our family clinical side was figuring out how to transport him so he could get the treatment he needed,” DeWayne explains. “Coordinating all the benefits, the claims, the authorizations, the forms, and figuring out how that affected his insurance coverage — it was a process, but thankfully, we were able to rally for this member,” DeWayne says. “Even now, I still keep in touch with his family.”

The Benefits Of Advocacy

Family Advocates say they get deep satisfaction from helping members cut through the red tape and receive the best care possible.

“I really enjoy what I do because I get to make a difference in people’s lives,” Pryor says. “I’m able to build a genuine connection. It's not always clean, and it's not always perfect,” DeWayne says. “But it's always worth it.”

Businesses benefit from Anthem’s Family Advocate system on many fronts. Advocates can help employees through trying times, guiding them to care that leads to better outcomes, increasing cost-efficiency. Advocacy is the kind of robust benefit that helps attract and retain employees, improving your talent pool and saving on hiring costs.

* Anthem internal study, July 2021 through June 2023.