Several questions have come my way recently about what kinds of job opportunities might exist for patient advocates.  I refer people to an article I’ve written elsewhere, but the real answer is – to be a true advocate, you must analyze who is paying for your services, and what your responsibility will be to them.

Finding an employer

In 2011, most of the job possibilities for patient advocates are found either with hospitals or insurance companies.  Hospitals have, for a long time, employed patient advocates, sometimes called patient representatives, who are tasked with helping patients.  And word comes that beginning in 2014 with healthcare reform, insurance companies will be required to have patient navigators on their staffs if they want to participate in insurance exchanges. Some have already begun to hire advocates.

But here’s the problem with those jobs.

Hospital patient advocates work for the hospital, not for the patient. They are part of the risk management group. The idea is to keep lawsuits at bay. To the extent that avoiding a lawsuit is helpful to both the patient AND the hospital, these hospital advocates may be able to help patients out.  However, complaints can be found all over the internet by people who thought they could get help for a loved one in the hospital, but found that impossible. (I suspect this upsets hospital advocates as much as it does the patients – but they need to protect their paychecks. We can’t blame them.)

Insurers will have a different goal, but will probably be no more helpful to patients.  Their goal will be to save themselves money.  Navigators will be available by phone to help patients, but they will be focused on the help they can provide that saves money.  Just like the myriad “find a doctor” websites being put online by health insurers – we can’t trust that an insurance advocate will be providing what the patient needs instead of what’s good for the insurer.  (Further, like hospital advocates, these insurance advocates will need to protect their paychecks, too.)

Case managers might be closer

In some parts of the country, there are large corporations which employ case managers.  Those case managers then work in hospitals, for nursing homes, sometimes for the state administering Medicaid plans or as advocates for the elderly, or in other areas where the government or a large corporation needs these case managers to help shepherd patients through the system.

Their work may be much closer to that of a private patient advocate;  but still in all, they derive their paycheck from someone besides the patient.  If they work for the hospital, their job is to facilitate and troubleshoot, but like the hospital’s patient advocate, they still get their paycheck from elsewhere, meaning, that must be their #1 concern – making things right for the employer.  If they work for the state, then their job is to save the system money.

Some case managers do work directly for the patient.  That patient (or a responsible party, like an adult child) pays for the advocates services, either directly to the advocate, or through a third-party advocacy company.  As long as the third party company isn’t trying to save someone else money (like themselves) or isn’t steering patients in certain directions (as in – they have a relationship with a nursing home that provides a kick-back – excuse me – commission- for referring patients), then yes, they are providing services similarly to a private patient advocate.

Non-profit advocacy

There are dozens (hundreds?) of non-profit groups that provide navigators, or some form of assistance, even with medical bills, to patients, especially when they have been newly diagnosed.  Many of those advocates are volunteers, and we have to appreciate that they are lending their time and their own experiences to others.  That said, they aren’t professionals, and they aren’t likely to have all the answers a patient needs.

Sometimes the employees of those charitable organizations are considered advocates, too – and they are – but they aren’t the ones who are holding individual patients’ hands.  Further, these groups are often supported by grant money or donations.  Much of their effort must then be focused on grant writing and fundraising.

Large corporations: Providing a benefit

One other possibility is a new concept, but it’s beginning to grow.  Some larger corporations have recognized that providing a patient advocate to some, if not all employees might actually save them money in the form of less lost work time, or less employee turnover, especially for their higher level executives.  Some will contract with patient advocates to provide such services to their employees.  In this case, the corporation actually pays the advocate for supplying services to the employee.  It’s win-win-win.

When the patient or caregiver writes the check

When the patient, or his or her caregiver (often, a spouse or adult child) is the responsible paying party, hiring a private advocate to focus entirely on the patient, then that is the purest form of professional patient advocacy.  The advocate is beholden only to that patient, and that patient’s welfare.

Conclusion

If you are considering patient advocacy as a career, then you need to be aware of the differences in advocacy, and then analyze your ability to be the kind of patient advocate you want to be.  If you don’t, then you may not end up in the career you thought you were developing.

If what you want to do is be a patient’s shepherd, to help them learn about and choose the right options for them, to handle and cope with details they feel too sick and tired to handle themselves, to provide them and their loved ones with peace-of-mind, to help them communicate more clearly with their providers – and so on – then you’ll need to carefully analyze any opportunities you seek, or that come your way.

If you are a patient or caregiver, you’ll want to take these possibilities into account as you determine who can best help with that shepherding and which one of these private professional patient advocates can provide you with your best opportunity for a good outcome – the healthcare you deserve.

Can a true advocate be paid by someone else?

It’s possible – but rare. Be sure to ask yourself that question should you find a specific opportunity that seems to be a good fit for you. Ask yourself:

If you are the patient, which type of advocate do you want helping you?

If you are the advocate, which type of help do you want to provide?

Because yes, like so much of American healthcare, in order to get to the root of the situation, you must follow-the-money.

Trisha Torrey blogs at AdvoConnection and is the author of You Bet Your Life! The 10 Mistakes Every Patient Makes (How to Fix Them to Get the Healthcare You Deserve).

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