Member advocacy may help improve health outcomes and lower cost of care

“How can you help my employees navigate the complexities of the health care system?”

It’s a question being asked by more and more employers who, besides looking for ways to better manage costs, are seeking a simpler experience for their employees — tailored to fit specific health needs.

An important part of the answer is strong advocacy support that offers personalized guidance when a question or need pops up around a health issue. Effective advocacy may mean increased satisfaction with a health plan and lower total cost of care — in some models, reduced medical spending of up to 4% per year.1

"Advocacy goes beyond basic customer service and really means understanding a member’s unique health journey and knowing how to help that specific person take the next best step as they navigate the health system,” said Rebecca Madsen, UnitedHealthcare chief consumer officer. “Advocacy helps a member make better decisions about their care and maximize the value of their benefits.”

Advocacy can start with personalized digital tools designed to help employees make more informed choices about how to use their plan and access the right care at the right time. It can continue with one-on-one guidance that goes beyond answering basic benefit questions to helping employees access clinical programs or other resources that may lead to better health. But that’s just the beginning.

Here are five more ways UnitedHealthcare is using advocacy initiatives to address common pain points for employees and their families: 

  1. Identifying social health issues – UnitedHealthcare recently expanded a capability that uses predictive analytics to identify members who may face social barriers to health, such as lack of access to affordable housing, nutritious food or high-speed internet. Members who may be experiencing these barriers, commonly called social determinants of health, are given the choice to tap into low- or no-cost community resources for help with things like childcare, affordable housing or career advancement.
  2. Approval-process support Some health services and procedures require prior authorization before care is delivered. To help with this, eligible UnitedHealthcare members have access to an online feature that enables them to track the approval process from start to finish — similar to how they might keep an eye on a package shipment. For some members, a separate capability may offer access to a nurse advocate in the event a prior authorization request is not accepted, offering personalized help to find a solution, such as an alternative treatment.
  3. Point-of-care insights – Quality and cost-transparency tools offer crucial information at key decision-making moments. Point of Care Assist integrates a patient’s health records with a provider’s electronic medical records, giving insights during appointments on care needs and an employee’s specific benefits. If that care includes a prescription, PreCheck MyScript can help a provider know which drugs are covered by an employee’s plan and their costs — so the provider and employee can make a more informed choice.
  4. Help with surprise bills – When there is a surprise charge for a service, an employee may have access to resolution support. For instance, eligible UnitedHealthcare members in employer-sponsored plans may have access to a program that has already helped create an average savings of more than 70% on out-of-network bills across more than 50,000 cases.
  5. Special needs assistance – For a family of a child with a complicated health situation, the Special Needs Initiative offers a single point of contact for navigating the health system. A care advisor can become a liaison between the family and a team of experts experienced in the unique challenges children with special needs may encounter. A similar program called Complex Care Concierge offers specialized support to adults with complicated diagnoses.

Advocacy can take many forms, but the main goals remain the same: simpler experiences, reduced costs and improved health outcomes for employees and their families.

For more information on the broad advocacy initiatives at UnitedHealthcare, visit

1 2019-2020 UnitedHealthcare employer study including 387 clients, 4.8 million members and over $19 billion in medical spend