Navigating the health care maze

Advocacy services save time, money, headaches

Gregory Smith
AP

Judy Sherer of Norcross, Ga., displays a photo of metal shavings left in her shoulder by a previous doctor.

NORCROSS, Ga. — After three surgeries, Judy Sherer still had chronic pain in her left shoulder. She'd lost faith in her doctors, and in despair tried a new health benefit offered by her employer.

The service, Health Advocate, is a call-in center that helps customers find the right doctor, haggle over insurance coverage and manage other medical system headaches.

An advocate helped Sherer find a new surgeon, who found metal shavings left in her shoulder by a previous doctor. The advocate also negotiated the charge for her physical therapy down to $40 per visit from the $200 she was told initially.

"It saved me a ton of money," said Sherer, 63, of Norcross. "I'm very, very pleased."

Health Advocate is one of a growing number of U.S. companies offering some form of advocacy services to medical consumers. Revolution Health, a Web-based medical consumer services company overseen by AOL co-founder Steve Case, has been considering getting into the same business.

"It's a really interesting industry that's just taking off," said Carol Fischer, a spokeswoman for Pennsylvania-based Health Advocate, a 12 million-member organization.

Currently, the health advocacy business is an industry with about $50 million to $75 million in annual revenue but only about a dozen companies of any significant size, said Richard Rakowski, a principal of Intersection

LLC, a Connecticut-based investment and development firm that has researched the field.

But those numbers have grown from a few years ago, and it might be on track to become a $1 billion industry based on demand for the service, Rakowski said.

More than ever, people need help negotiating the system, said Jessica Greene, a University of Oregon health policy analyst. "We're asking consumers to make more complicated decisions, but the numeracy and health literacy skills of many consumers are not at the level needed to handle this new responsibility," she said.

Though some consumers are savvy enough to beat a billing overcharge or probe doctors' litigation histories, they don't have the time for such labors, experts said.

Indeed, the largest customers of health advocacy services are companies, not individuals. "The employers are interested because it means their employees are not on the phone taking care of doctors' visits" during work hours, Fischer said.

The companies grouped into the health advocacy business range from small regional firms operating out of home offices to companies with national call centers the size of football fields. Health Advocate claims to be the largest. Founded in 2001, it has more than 3,500 companies, unions and other organizations as clients, including Johnson & Johnson, American Express and Home Depot.