Stronger Care Through Advocacy: How Clinical Experts Support Your Employees

Why In-House Clinical Management Matters

Many healthcare advocacy solutions rely on third-party vendors for clinical support. However, external vendors may not offer the same depth of clinical review or collaboration among medical experts as an in-house advocacy and clinical model. Some lack internal tools or physician-led teams to guide complex care decisions or conduct peer-to-peer reviews with care providers. This can impact the quality and speed of care your employees receive.

Health partners like Anthem take a different approach. By managing all clinical functions in-house, they offer stronger clinical care coordination. This model brings together broad clinical expertise and condition-specific support, ensuring more seamless care, quicker responses, and better health outcomes for employees and their families. 

What An Integrated Clinical Team Offers

When clinical teams are built into the foundation of a health plan, employees benefit from high-level support and personalized care through whole-health employee programs. These integrated teams help in multiple areas of medical management:

• Utilization management (UM): In-house clinicians create and apply clinical guidelines, consult on specific cases, conduct peer-to-peer care provider conversations, and work with rapid response teams to expedite care and avoid treatment delays. Through the preauthorization process, our UM nurses are also able to identify members for engagement from case management before a claim comes in. 
• Case management (CM): Nurses and case managers partner with other clinicians like pharmacists, behavioral health teams, and medical directors to help employees navigate complex health challenges more efficiently.

A Whole-Health Approach To Specialized Care

A key advantage of in-house clinical care coordination is the ability to form highly specialized care teams for unique member scenarios. These services often go beyond what an individual’s primary care physician can provide — and they are offered at no additional cost to employees.

Examples of specialized support include:

• Cancer care: A member support team could include hematologists, oncologists, dietitians, behavioral health care providers, and certified oncology navigators. 
• Emerging diabetes risk: Teams could include nurses, bariatric surgeons, social workers, and health coaches — all working proactively in chronic condition management to prevent escalation.
• Neonatal and pediatric cardiac cases: Specialists like pediatric cardiologists, respiratory therapists, and pharmacists coordinate care from day one.

An integrated approach ensures members have access to expertise when they need it most.

Better Care, Lower Costs

By guiding employees to quality, lower-cost care options and facilitating faster clinical decision-making, in-house advocacy programs help reduce unnecessary spending. Employers also gain valuable data insights from real-time clinical engagement, leading to more effective employee well-being programs.

Health partners like Anthem combine employee health advocacy, collaboration among medical experts, and whole-health employee programs into one seamless model. This way, employers can improve employee health, manage healthcare costs, and create a stronger future for their teams.