Breaking Down Barriers to Care:
Employee Benefits Advocate Program
In partnership with the Patient Advocate Foundation (PAF), this Florida Alliance program is an innovative, employer-based benefit that connects employees and their spouses/dependents to trained advocates who guide the plan members through a cancer, complex chronic condition or rare disease diagnosis and treatment journey, providing support with benefits education, financial and emotional stress, and access and adherence to care.
The Employee Benefits Advocate (EBA) program evolved from Our Award-Winning Cancer Navigation Program.
The Pharmacy Benefit Management Institute (PBMI) awarded its 2020 Care Management Strategies Excellence Award to the Florida Alliance for Healthcare Value and the Patient Advocate Foundation for the Cancer Navigation Program.
Piloted in 2018 and fully scaled to employer members in 2019, the Cancer Navigation Program was developed in response to input from our employer members about (1) the ever-growing costs associated with employees’ cancer treatements, (2) the increasing frustration of employee cancer patients with understanding how best to access the complex system of care and (3) the lack of knowledge of their own benefits plans. The Florida Alliance formed a partnership with the Patient Advocate Foundation (PAF), a national 501(c)(3) non-profit charitable organization that provides direct services to patients with chronic, life threatening, and debilitating diseases to help access care. The results of the pilot were so encouraging that the Pharmacy Benefit Management Institute (PBMI) awarded its 2020 Care Management Strategies Excellence Award to the Florida Alliance and PAF for the Cancer Navigation Program. Results included:
- 94% of participants reported that the program increased their understanding of the details of their healthcare plan benefit
- 100% of participants reported that the program helped them get the fullest benefit of value from their healthcare plan
- 100% of participants reported that they better understood costs associated with treatment and care
- 100% of participants reported that the program increased their awareness of local community resources
- 100% of participants would recommend the program to a fellow employee
Additionally, a quarter of the program participants (25%) reported that the program helped minimize their time away from work.
The expanded focus of the Employee Benefits Advocate (EBA) program includes complex chronic conditions and rare diseases and will continue to be implemented in partnership with PAF. The vast majority of illnesses, including cancer, are categorized under the broad categories of chronic health and rare disease diagnoses. As with the Cancer Navigation Program, the EBA Program will be offered only to employees, their spouses and/or their dependents enrolled in a participating employer’s sponsored benefits plan. The PAF advocate (formerly referred to as navigator) will continue to be thoroughly trained in the employers’ benefits packages to immediately assist with meeting the identified needs of the employee and/or plan member. The advocate will work to increase understanding of their healthcare and other benefits such as short-term disability and the Family Medical Leave Act (FMLA) as well as to ensure optimization of the benefits available to them. Guidance also includes making connections to local/community financial and support resources, such as transportation, as well as national resources.
Why Expand the Program to Include Complex Chronic Conditions and Rare Diseases?
In 2020, the Florida Alliance analyzed reported needs from our employer members and determined that the program should also assist individuals with complex chronic conditions and rare diseases. Most high-cost claimants fall into these categories along with cancer patients, and the Florida Alliance believes the EBA Program is an effective strategy to address high-cost claimants. We also learned from the April 2020 Milliman Research Report “How do individuals with behavioral health conditions contribute to physical and total healthcare spending?” that behavioral health, as a potentially complex chronic condition, must be addressed.
Additionally, the statistics on chronic and rare disease health impacts personally and in the workplace are alarming. According to the Center for Disease Control’s (CDC) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP):
- 90% of the nation’s $3.8 trillion in annual healthcare expenditures are spent on people with chronic and mental conditions.
- Six in ten Americans live with at least one chronic disease such as heart disease, diabetes, obesity, and arthritis.
- Chronic diseases are the leading causes of death and disability in the United States.
- Depression alone is estimated to cause 200 million lost workdays each year at a cost to employers of $17 to $44 billion.
- Conversely, currently there are 25-30 million people living with a rare disease, with approximately 7,000 known rare disease conditions. There may often be no well-known path for clinical treatment, financial assistance, and local community resources. Those employees, spouses and/or dependents with a rare disease face unique challenges and need a uniquely qualified Advocate to assist them in their treatment journey.
Evaluation of the Employee Benefits Advocate Program is generously funded in part by Genentech, Inc.