Steps to Becoming a Patient Advocate or Navigator

1
So You Want to Be a Patient Advocate?

African American woman with Senior man in wheelchair
Terry Vine/Blend Images/Getty Images

Are you a medical professional who is looking to shift your career in a different direction?

Are you a social worker who would like to apply your skills to the healthcare field?

Are you a parent or child or spouse who has navigated healthcare on behalf of a loved one and would like to do that kind of work for others?

Are you an entrepreneur looking for a growing market niche?

Are you a neighbor or friend with time on your hands which you'd like to apply to helping others, perhaps as a volunteer?

Are you interested in a career in the health field and are exploring possibilities?

If you answered "yes" to any of these questions, you may have the interest, skills, even the qualifications you need to become a patient advocate or navigator. Because there are so many aspects to patient advocacy, the range of backgrounds and interests of patient advocates is broad. That's good news if you're considering a job, career, or volunteer position as an advocate.

"Patient advocacy" is considered an up-and-coming career. Entrepreneur Magazine and US News & World Report have both identified advocacy as a career that is coming into its own.

Here you will find some background information for those who wish to provide advocacy services in any of the following ways:

  • Medical / Navigational Assistance (not the same as a Medical Assisting)
  • Insurance Assistance
  • Home Health Assistance
  • Elder or Geriatric Assistance

Most of the information in this article describes a one-on-one relationship between a patient and the advocate, although in some cases the advocate may also work with the patient's family or others involved in the patient's care, too.

2
What Makes a Good Patient Advocate?

Doctor hugging smiling woman in office
Henglein and Steets/Cultura/Getty Images

Advocates who will assist patients through diagnosis and treatment of disease – whether that means helping them coordinate with the medical professionals, working with them to make treatment choices, or even helping them find the right doctors to help them – may need a background in health and medicine, as a doctor, nurse or other medical profession.

Advocates who wish to provide medical, home health or eldercare forms of assistance will need to be people-oriented and have plenty of patience.

Those who wish to work with the elderly or with very young children will need the patience and appreciation of those age groups.

Those who prefer the insurance and billing aspects of advocacy will need to understand how payer reimbursements work, plus co-pays, co-insurances, and deductibles. An understanding of government payment systems such as Medicare and Medicaid, plus basic math skills are also important.

To be an entrepreneur patient advocate and start your own patient advocacy business, you'll need to understand business basics.

All types of advocacy require excellent communication skills, the ability to be empathetic (but not so empathetic as to lose focus), organizational skills, good time management, the ability to do research to solve problems, a creative side to help solve difficult problems, and the ability to get along with a variety of people, including patients, their families, and professionals.

In addition, the best patient advocates need to be politely assertive, and able to both provide respect and command respect from the many others involved in a patient's care.

3
Businesses and Organizations that Hire Patient Advocates to Work for Them

Couple consulting doctor
Portra Images/Taxi/Getty Images

There are a handful of types of patient advocacy employment.

Work for a hospital, rehab center, or other facility that hires patient advocates. Many have a customer-service type position. Some of these advocates have a background in social work or other forms of customer service. While they do trouble-shoot and solve problems for patients, many of their decisions must be made in favor of the facility and not necessarily in the best interest of the patient.

Work for an insurance company, usually an HMO (Health Maintenance Organization). Some of the managed care-type healthcare payer systems employ advocates. They may be called "patient advocates" or "case managers." These advocates manage navigation of the system for difficult medical cases. Their primary job is to save the payer money, but they may also be helpful to patients who are having trouble figuring out where to turn.

Work for a not-for-profit disease or condition organization. Those who work within these organizations are often patient advocates at heart, although their jobs may look more like fund-raising or patient education. This work may not be the classic one-patient, one-advocate model, but it's still a form of advocacy.

Work for a government entity. Patient advocates or case managers work for state health systems usually in a nursing, or social work/human resources capacity. Most of the support is provided to patients who rely on Medicare, Medicaid, or other state-run systems to pay for their healthcare.

Work for yourself. Start a patient advocacy business. Beyond needing patient advocacy skills, starting your own patient advocate business will call on additional attributes and skills that you may find wonderfully rewarding. There are specific steps to take related to building a successful patient advocacy business.

4
Patient Advocates Who Work Directly for Patients

GP placing hand on patient's shoulder in surgery
Mike Harrington/Riser/Getty Images

Sometimes the patient or his family is, in effect, the employer. The patient may hire an individual or a business to represent him through medical, insurance, or legal situations. Because the patient advocate works directly for the patient, the advocate's allegiance can be focused on the patient.

Work for a patient-focused organization. There are organizations that focus on healthcare, insurance, and payment system problems, even placement in rehab or nursing homes. They are private or not-for-profit organizations that work for a fee paid by the patient or his family. These organizations have begun to play a much larger role in the healthcare landscape and it won't be long before they become a part of the mainstream healthcare in the U.S.

Work for an individual patient, paid by the patient or by the patient's family. These advocates help those having trouble navigating the healthcare system who either can't get diagnosed or can't find the proper treatment. Some of these advocates work on insurance problems helping to find payment resources or helping patients navigate their payment systems. They may be hired by family members who live too far away to provide support to a sick loved one, or who need a caregiver for their loved one who is ill because they are away at work all day.

Most advocates who work for individuals are self-employed entrepreneurs. Some of these entrepreneurs are building advocacy businesses and may hire additional advocates to work with them, in order to serve more patients.

Many patients advocates are volunteers. They assist loved ones, family members or friends in roles as bedside advocates in hospitals, caregivers, researchers – or sometimes their most valuable role is simply to hold someone's hand or even transport them to appointments. Their compensation comes in the form of the satisfaction that comes from helping someone else.

5
Is There a Degree, Certification, or Credential Needed to Be a Patient Advocate?

Hispanic woman reading library reference book
Tanya Constantine/Blend Images/Getty Images

Because paid patient advocates are so new to healthcare, there are few formal degree or credentialing programs available. Most patient advocates are self-proclaimed, coming from backgrounds varying from nursing or other healthcare professions to social work or education. Some patient advocates have simply gained on-the-job experience helping a loved one navigate the system, and now they hope to expand that experience into a career helping others.

The existing health and patient advocacy programs are available mostly for those wishing to receive a master's degree, or for medical students who wish to add advocacy as an adjunct to their medical degrees. More recently, online programs have been developed, too.

Case managers may earn a credential which can be earned through a combination of education and testing. Most case managers have nursing degrees or social work degrees to begin with, then take a test that makes them eligible for jobs that require the case manager credential. Most are employed with managed care/HMO (health management organizations), or by government entities to work directly with patients.

Since 2008, several programs specifically called Patient Advocate Programs or Health Advocate programs, have begun to claim they bestow a certification for patient advocates. Many of the programs are excellent, but since there is no standardization, they can't promise a nationally (or internationally) recognized credential. You'll want to make yourself familiar with the pros and cons of these credentials.

6
What Else Do You Need to Know if You Want to Be a Patient Advocate?

Financial Advisor and Mature Couple
Lisa-Blue/E+/Getty Images

Patient advocacy is an up-and-coming career, and those who take the time to educate themselves and build their skills and experience will be rewarded with both a solid career and possibly an excellent income. So, what else do you need to know if you want to be a patient advocate?

Patient advocates who wish to be self-employed will want to understand what it takes to build a patient advocacy business, and readily know the answers to the questions potential patient-clients will ask. You may be the best advocate in the world, but if you can't answer these questions about your business, patients will move on to hire someone else.

Finally, because the concept of patient advocacy is so new, and because there are so many hurdles faced while trying to navigate the current American healthcare system, patient advocates may be surprised to learn they are not always welcome or received well by medical providers.

Those advocates who choose to work for hospitals and other facilities may find frustrated patients and pressure from their employers to cut their advocacy efforts short if it becomes too expensive to serve the patient.

Advocates who work directly for patients will find that their patients are grateful and relieved, but the medical and payer professionals may look at them with suspicion because they don't understand the advocate's roll.

These hurdles can often be overcome using excellent communication skills - which is why they are so necessary for professional advocates. They should not dissuade someone with the knowledge and willingness to be a patient advocate from giving this very rewarding career a try.

Continue Reading