Why do we need Health Care Advocates?
With the many changes taking place in the health care industry, such as the mandate to purchase insurance, privacy issues, and technological advances in care options, the system has become more complex and can be difficult for patients and their caregivers to navigate. This has created a growing demand for professionals with the knowledge and skills to support patients, advocate on their behalf, and help them navigate the health care environment. With the appropriate education in Health Care Advocacy and Navigation, health care professionals have a perfect opportunity to enhance their careers.
What is health care advocacy?
Health care advocacy (also known as patient advocacy) is considered one of the essential components to patient-centered health care. Health care advocates are knowledgeable about the health care system and patient rights. They have excellent communication skills and seek to partner with the health care team. They provide on-going support for patients to help educate them on the available resources and paths to better care, and can operate at various levels within the health care spectrum including:
- Institutional - Health Care advocates at this level work within a hospital or other institution to assist patients who are receiving care or treatment. Because they are employed by the hospital, these advocates come at no cost to patients and handle any questions, complaints, and grievances they may have with the hospital, staff and/or their treatment. A primary focus is to ensure the patient understands their treatment and discharge instructions for the best outcome and thereby reduce instances of re-admittance.
- Non-Profit - Non-profit health care advocates work for organizations at the federal, state, city, and community levels. Like institutional advocates, their services come free of charge to the patient. In addition, many non-profit advocacy organizations are specialized, working with people receiving treatment for a specific disease or illness, such as cancer or heart disease.
- For-Profit - Typically found in programs such as an employee assistance program, for-profit health care advocates work for an advocacy company and are usually contracted by the workplace. There is no charge to employees and services vary, with most services provided over the phone, and most recently, online. These third-party groups have fewer conflicts of interest when advocating for employees.
- Independent - Patients and their family members can hire private-pay health care advocates to further assist with health care related issues. Independent advocates often have extensive backgrounds in the health care field and transition into this area for private practice. They work very closely with the patient and/or their families to assist with their needs concerning their health care.
No matter which sphere the patient advocate operates in, the primary focus is to understand the patient's needs and provide the information necessary for the patient to help him/her make the best decisions regarding their health and health care. This leads to increased patient satisfaction, better outcomes, and lower health care costs.
Ten Skill Sets of Health Care Advocates
Today, whether it's the nurse, social worker, patient liaison, or service excellence coordinator, advocates round out the complete care package to help patients receive the best care realistically possible. Below are 10 skill sets that help health care advocates provide services to their patients.
Health Care advocates educate patients and their families by interfacing with providers and payers to ensure patients understand their diagnoses, prognoses, treatment options, and post treatment instructions.
- Promoting Patient Safety, Empowerment, and Rights
Advocates educate patients about their rights within the health care system, safety, procedures and treatments, discharge instructions, costs, and insurance coverage. Health care advocates are tasked with presenting this information in a transparent and meaningful way to help the patient fully understand their choices. This responsibility is a key component of being an advocate.
- A working knowledge of Medical Terminology and the Health Care System
Understanding the complex nature of health care requires attention to detail and an excellent grasp of medical terminology. Appropriate and thorough notation and documentation of issues expressed by patients regarding their care is essential. Fully understanding a patient's preferences and goals and being able to communicate them to providers is also important.
- Understanding how Health Care is Financed
A key responsibility of a health care advocate is helping patients navigate the stressful financial aspects of healthcare. This includes educating patients on reimbursement, billing, and financing options. Advocates also have extensive knowledge of insurance plans and their coverage options and limitations.
- Resolution and Follow Up
Through active listening, health care advocates find solutions to patient concerns and bring issues to the attention of providers and payers. This is especially important for patients with chronic health conditions or complex medical needs where care may need to be coordinated among multiple providers. Advocates work closely with both the patient and providers to ensure the patient continues to receive the best care and outcomes realistically possible.
- Professionalism in Maintaining and Ensuring Patient Confidence
Patient advocates understand the legal and ethical issues surrounding private health information. They operate at a high level of discretion regarding patient and family information, complaints, issues, and regulatory compliance. It is very important that health care advocates are trustworthy and have high ethical standards so they are trusted liaisons among patients, caregivers, and health care professionals, which leads to better and safer care.
- Being Proactive
Alerting hospital administrators about potential legal issues regarding unresolved complaints is one way health care advocates are proactive in the organizational environment. Health care advocates may also work as patient care coordinators ensuring all providers are informed about treatments, tests, and medications. In some instances, they may be able to review the patient's health records for accuracy and take necessary action to resolve any issues and quickly address patient concerns.
- Improving Systems and Policy
A hospital advocate works to decrease risk to the hospital by ensuring that patients' complaints and grievances are reported and acted upon in a timely manner - and that the hospital takes steps to prevent reoccurrence in the future. Patient advocates who enter into a policy career may also help to develop policies to improve systems, reduce overall health care costs and positively affect patient safety and outcomes.
- Relationship Building
Health care advocates may have clinical or administrative backgrounds in the health care system (e.g. former case managers, doctors, nurses) and can use their experiences to help patients navigate the bureaucracy of this complex environment. The patient advocate works to create trusting relationships between patients and providers which helps to reduce anxiety and fear and improve outcomes. They are vital members of the community and serve to empower patients.
- Professional Development
There is currently no certification or credentialing for patient advocacy in the U.S. However, there are ethical guidelines and parameters promoted by professional organizations such as the National Patient Advocate Foundation to drive industry standards, educate patients and health care workers, and partner with other state and federal organizations. In addition, programs that are aligned with these guidelines, such as the Health Care Advocacy and Navigation specialization within the MS in Health Care Administration program at Utica College, help health care professionals gain the depth of knowledge to grow and expand their career in this field. By enhancing job knowledge and professional credibility, health care advocates will continue to be a valuable asset to delivering the best patient outcomes.