March 15, 2017

Behind the Scenes of Accolade’s Health Assistant Model

By Accolade Marketing

How Accolade Health Assistants (HAs) and Registered Nurses help people get the right care at the right time.


đź“·Tax accountants help consumers make sense of tax laws and maximize returns. Lawyers help people handle complex challenges. Financial advisors help individuals make smart choices about investments and plan for retirement. And Accolade Health Assistants help individuals and their families navigate the complex world of healthcare - to make the best care decisions and improve their lives.

Supported by advanced technology, science, and a clinical team of nurses, doctors, pharmacists and behavioral health specialists, Accolade Health Assistants build long-term, trusted relationships with members of employer-sponsored health plans, advising on any healthcare-related question, from getting a new insurance card to preparing for major surgery.

But how does the Accolade model really work? We talked to Jackie P., formerly a Lead Accolade Health Assistant (HA) and now Accolade Solutions Consultant, and Amy S., a Registered Nurse who is now an Accolade Clinical Solutions Consultant, to get a behind-the-scenes look at how they provide support to members - their “clients” - on a daily basis.

How do you determine which members you will call and when to call them?

Jackie: The beauty of Accolade is the freedom we've been given to schedule our calls in ways that we know will be most effective. If I receive an email or voicemail indicating that a client is headed for surgery or testing, I'm going to place a priority call to that client. If, on the other hand, I don't have any emergent situations, I'm going to schedule my calls so that I have the best shot of reaching the providers when they tend to be at their desks and the clients when they tend to be most available.

Amy, RN: Whereas HAs like Jackie are focused on helping clients with benefits and claims, and with doing the legwork for denials, Accolade Registered Nurses - most of whom have at least 15 years of experience - have clinical processes that set a structure for calls to clients. We always follow our clients on a regular basis, but we are available whenever specific needs arise. For example, if a client finds herself with sudden symptoms and needs a diagnostic test, I'm going to be touching base with that client before each point of service. I will be making sure she is prepared for every treatment or test, that she knows what her options are, and that I help her become a true educated healthcare consumer.

How do Health Assistants decide when to bring a Registered Nurse in to consult on a client need?

Jackie: Our primary engagement platform makes this very easy. For example, if a client calls in with questions about infertility coverage, I'll be making a note of that in our system. The system will then alert me that it's time to bridge this client to someone within our maternity team. Beyond that, if I feel that a client would benefit from talking with a nurse about symptoms or concerns, I'm going to contact their assigned Registered Nurse. Clients who present behavioral health concerns or have questions about any educational testing benefits are immediately connected to our Behavioral Health Specialists since those medical policies and benefits can be tricky.

Basically, while a Health Assistant is in control of the call, she or he is never alone by any means. Even if I'm not bringing in my clinical partners to discuss programs, the system allows me to offer point solutions to the client, whether those solutions are from the customer's health plan, voluntary benefits, or the community itself. Our engagement platform is integrated with our customer's health plan so we know not only what the health plan benefits are, but also integrated into that are the employer group's voluntary benefits.

What happens when a client calls and you are on vacation?

Jackie: This is another benefit of our model here at Accolade. Not only is somebody else going to be just as knowledgeable about the benefits as I am, but the system has allowed me to capture notes that are really important to the client. When another HA assigned to the same employer “neighborhood” picks up that voicemail or email and goes into the client's record, he's going to know what I know. He's going to see what the conversation has been. It makes responding well easy on everybody.

Amy: We are very dedicated to our clients here. They become part of our family. If I know I'm going to be away, I will let the client know the name of a back-up CHA. If I'm out sick, the client will get a message telling him who to call for information. We don't leave anyone hanging.

Can clients call you as often as they wish?

Amy: They can and they do. Which is awesome!


đź“·What is the breakdown between inbound calls and outbound calls?

Jackie: With the HAs, the majority of calls tend to be inbound at the beginning. But once we begin a relationship with a client, it progresses to mostly outbound - reaching out to providers on the client's behalf or following up with the client. A significant portion of our day is dedicated to making outbound engagement calls.

Amy: With Registered Nurses, we are getting connected with clients directly from the Health Assistants, and we're also following up with clients on a regular basis throughout their spectrum of care.

How much time do you tend to spend with any one client?

Jackie: We may find that a client needs a lot of interaction in the beginning, but that her needs level off as she begins to navigate the system on her own, with the support of our education.

Amy: We really try to focus on changing behaviors and empowering clients to get the right care at the right time. The more we educate clients on how to use a system, the better off they ultimately are. If there's a health event, we could be speaking to one client 25 times in a single year. But when the need levels off, our interactions become less frequent. We still follow up and check in, but we do it with reasonable frequency. Our clients also know to call Accolade first when the need arises.

What topics tend to take the vast majority of your time?

Amy: Benefits questions take the vast majority of time for HAs. But that's one of the reasons why our model works so well. We treat each benefits question as a gateway, as an opportunity to get to know the client and to begin an education process.

For Registered Nurses, on the other hand, a lot of time is spent discussing co-morbid conditions and barriers preventing better health outcomes. A client may be obese, be diagnosed with diabetes, and complain of back pain. He may also be facing financial and social issues that have prevented him from seeking care. It can take a while to sort through all of these factors, but as we take that time, we're also forming that trusting relationship that helps us to help our clients.

What is the Accolade “Learn2 Model,” and how is it helping clients?

Amy: Amy: When people are going through a health crisis, they're often not at their best. They're cranky and stressed and sometimes needing a place to target their anger; it's not unusual for their health benefits to become the focus of their unhappiness. The Learn2 Model teaches us to listen and to figure out just what is making the client angry…and just what we can do to help. We stay on the line. We listen. We help. And that conversation often leads to a breakthrough moment of trust between us and the client.

What are some of the most satisfying interactions you've had as part of your job?

Jackie: I had a client call in who had received a $2,000 lab bill, and she was understandably upset. We got to talking. I learned that she was in a pain management program, in drug tests four to five times a year. She didn't have $2,000 in her pocket. I called the lab. The lab asked if this $2,000 was a hardship. The client said, yes, it was a hardship. The balance on that lab bill was then reduced to $0, thanks to a clause in the health insurance policy. It was pretty amazing to be there and relieve this client of that cost.

And there are so many cases when we're able to redirect people to the right care. As an example, a lot of people immediately want to head to the ER for health issues. The Health Assistant will get the member to a nurse who's able to guide them to a primary care doctor or Urgent Care clinic instead of the emergency room. Those are satisfying interactions, too.

Amy: There was a claim for a very expensive wheelchair for a child, but there was nothing in the record that would have flagged her as being special needs. We called and asked that fearless question, "Is there anything else that might be different about your daughter?" Well, we learned, the daughter had been born a quadruple amputee. No legs or arms. Her mom hadn't thought to say anything about that because the child runs around and is, in so many ways, a normal child. Once we knew the whole story, the claim was able to reprocess correctly.

What is your favorite part of the job?

Jackie: I like that I don't have to follow some script and get this piece of information out from the client the first time we talk and then this piece of information out the second time we talk. Accolade really trusts my judgment, trusts me to ask the questions when they're appropriate without risking that relationship and making it feel like I'm reading a script off of a prompt.

Amy: I was a nurse for 25 years. Before this, I worked in hands-on clinical settings from medical - surgical, kidney/liver transplant, ICU, burn unit ... I can honestly say, in the last four years, I've impacted more lives more positively than in my entire nursing career.

What are some of the Accolade resources you take advantage of to serve members?

Jackie: We have a logistics team here. Even if we're helping our clients manage their diabetes and they're having trouble paying for their syringes or their testing supplies or something and there isn't a point solution available, we don't just say, "Sorry, this is what you've got to pay." We go the extra mile to see if there are any community resources in their area that can help our clients with their lives.

Amy: We also have so many different ways to communicate. We like to talk to our clients or individuals on the phone because it's personal. That doesn't always work for everybody, because they're working. They're busy. They have lives. So we have mobile messaging, we have email. Someone can shoot us a voicemail or email or a message and we can start working on the issue and we can connect at whatever point is convenient for that individual.

When does the CHA's role end and the client need get turned over to the medical community beyond Accolade?

Amy: That's a really good question because it's a logical question. Our model is so unique here. Our relationship with the client is separate from the relationship with the provider. That being said, we are able to fortify the relationship clients have with their providers. Once I talk to you, I'm your person. Once you talk to Jackie, she's your person. We're your team and that doesn't change. There's never quite a handoff to the doctor because it's always the doctor's treatment plan. We might help the client develop questions to ask the doctor to make sure that the treatment plan is clarified. We want to be sure the client has and understands all of their options.

Jackie: We also know that clients will call us when they need us again. We'll be there.

Any final points about the model you would like to make?

Jackie: I think it's important to note that one of the reasons we are so fearless in asking questions here is that we have everything on a single platform at Accolade. Whether we are emailing or texting or leaving a voicemail, whether we are looking at benefits histories or medical needs or family concerns—we Accolade HAs and Registered Nurses see everything at once, thanks to our single information platform.

Amy: Just to reiterate what Jackie said: If an individual calls me and I bring up her name, I can instantly see the conditions on that first screen. I can see who's in the family; I can see how many times we've interacted with them; I can see their different medications. I can see any ongoing issues, and I can see if there's open tasks for the HA. I can help treat the whole family because everything I need to know is right there, in that same platform. It's not like we have to guess, we don't have to memorize anything. There's a whole lot of technology that goes into that that we kind of take for granted. When you've worked here for a while, it seems like magic because it works so well. But, of course, it isn't.

Learn more about Accolade Health Assistants: