How to Start a Patient or Other Health Advocates Business

An Entrepreneur's Approach to Patient Advocacy

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Patient advocacy is a new and upcoming career -- so new, in fact, that there are few rules for getting started. If you have already reviewed the possible patient advocacy career paths available, and none of them meets your wishes or needs, you may want to consider starting your own patient advocacy business as a self-employed patient advocate.

Here is some background information to help you start a patient advocate business:

About You

When someone starts a new business, they are choosing the life of an entrepreneur. Successful entrepreneurs have several attributes in common. Begin by being honest with yourself as you answer these questions:

Are you a self-starter? Are you willing to do what it takes without waiting for others to tell you what to do, or relying on others to get it done? Can you self-direct your work and focus on your goals?

Are you a networker? Rare is the business person who operates successfully in a vacuum. Others, whether they are your friends or your competitors or simply other business people from the Chamber of Commerce or business tip club, will be your greatest source of new clients or new resources. The ability to schmooze, both giving and receiving, will be one of the skills you'll need most.

Do you thrive on challenges? Are you rarely intimidated and do you have a thick skin? Are you patient and balanced?

Owning and running your own business means constant challenges. As a patient advocate, you'll be confronted with people who don't communicate well, people in pain, loved ones who have their own ideas, competitors, money people, medical personnel and others who will make balance and patience an important attribute for you, too.

Do you adapt to change in the marketplace easily? Can you size up the environment and make shifts to meet its needs? Being an entrepreneur means you must be able to first identify changes in your market and second, adjust quickly to those changes.

Are you a good listener? You'll need to listen to your clients, family members, medical professionals, insurance people, your financial, legal and marketing business advisors, and others. You'll need to understand their points-of-view and you'll need to know how to make sure they know they have been heard before you move forward with decisions.

Are you self-disciplined? Working for yourself means working harder and longer hours than you've ever worked for someone else. You won't have someone else telling you when to be in the office, or overseeing your schedule. You'll need to maintain your focus on your work, but you'll need to know when it's time to take a break, too.

Are you trustworthy? For some businesses, being trustworthy isn't as important as it is for a patient advocacy business.

You'll be telling people they can trust you with either their health, their finances, their lives, or all three. Can they?

Do you understand your weaknesses? You may be the best advocate in the world, but if you can't handle bookkeeping, you'll need to bring in a bookkeeper. There are many people who can help you with your business, but you'll need to know for yourself when it's time to delegate and pay them for helping you. When you know where your business problem spots are, you'll know to, and to whom to reach out for help.

Do you learn well from mistakes? In business, mistakes aren't necessarily failures. Sometimes they are the best way to learn what works and what doesn't. You don't have to make your own mistakes, because you can learn from others' mistakes, too, if you're paying attention. But that's the key -- you need to pay attention and adjust accordingly.

Do you have support from those around you? Family members must be willing to cope with your long hours and business focus, too.

According to the US Small Business Development Administration, 50% of businesses fail within their first year. Failure means they weren't able to keep enough money coming in to pay the bills and the payroll. Here are some questions to help you understand the financing needs of a new business.

Do you have enough money in the bank to pay your household bills for a year, or someone else who supports you and your household so paying bills doesn't have to be your focus? It's rare that a new business is profitable enough initially to pay the business bills, and pay the owner a paycheck even within the first few years.

Do you have a source for business loans and some personal equity to back them? Even rarer than making an early profit is the ability for a new business to borrow money in the businesses' name. More likely a lender will look for a personal guarantee from you. Make sure you have a good relationship with your banker, preferably one who understands your ability to make a business successful.

Do you have enough money to cover your cash flow needs? Cash flow isn't so much an amount of money as a description of how it comes in and pays out. For example, you may have $3000 worth of expenses each month, and you may be able to bill your clients $4000, but those clients won't pay you for at least a month or more after you send them their invoices. In the meantime, your bills will be due right away. A positive cash flow means you can cover those bills before you are actually paid by your clients for the work you have done.

Business taxes are a whole different animal from personal income taxes. Depending on the business structure you choose, you'll have a new set of rules to follow about showing income and proving deductions. Beyond the federal taxes you'll owe, your state will have requirements, too. You'll want to talk to a CPA to get more information about tax requirements.

Included in financing are insurance considerations, too. Even if you won't have a location where your clients visit you, you will need to be insured for your intellectual work like errors and omissions, or even malpractice for some forms of patient advocacy. You'll need an insurance adviser to provide that advice.

If you have trouble understanding financing, insurance, taxes and cash flow, you'll want to hire someone like an accountant who can help you manage these tasks. Not understanding them may cause your business to fail, even if you are the best patient advocate in the world.

About Your Patient Advocate Business Customers or Clients

Who will hire you? Even more important, who will pay you to do your patient advocacy work? These people are called your target market, and your marketing and sales will be aimed directly at them.

You may think your market is older people who need help with Medicare. But if it is their children who actually hire you and pay you, then your real target market is the children, not the older person. Or, either the older person or the child may be a gatekeeper to the other. Yes, this is marketing-speak, but you'll need to understand to succeed in your patient advocacy business.

You'll want to brainstorm a good list of possibilities of people who may hire you for your patient advocacy skills. If you offer medical liaison services, your clients may be individuals, their family members, even their employer or insurer. If you offer insurance or billing reconciliation services, you may consider contacting gatekeepers or referrers who hear from their own clients about problems with billing. Lawyers, accountants, financial planners or insurance brokers may know of potential clients for you.

You'll also need to make plans to target your marketing outreach. Do you need a brochure? If so, how will you focus it? What about a website? Do you know how to build a website that's found easily by search engines? What should it say? Do you include pricing?

If you don't have a good understanding of target markets and marketing, including advertising, public relations, websites and other tools, you'll want to hire someone to help you do your marketing. Without marketing and customers, you'll have no business at all.

About Your Patient Advocacy Services

There are many types of patients advocate services, ranging from facilitating communications between medical professionals and patients, helping sort out insurance billing or medical billing, and helping patients in their homes.

In the perfect start-a-new-business world, you will have done some formal market research to determine exactly who will hire you and what they will pay you to do the work. More realistically, network with people you think could use your services - people as described above. And listen carefully to what they have to say about the services they might need, and what they might be willing to pay for those services.

Then make a list of patient advocacy services you can offer that you believe will be of interest to those who will hire you. You will be better off starting with a shorter list, then adjusting it to the services potential clients ask you about. That is one of the adjustments you may need as mentioned earlier.

You'll need to price that list of services. This will be more difficult and you may need to ask experts to help you. See below for a link to resources.

Have you found others who are offering the patient advocacy services you want to offer? Others who offer the same or similar services will be your competitors, and you'll need to keep tabs on your competitors. The best way to get this information is to begin asking questions of your network and from business advisors (see resources below.)

If you can't find others who offer the services you plan to offer, there may be a few reasons for that. One reason may be because you are the first! If you are, and you do it well, then expect others to follow soon. After all, imitation is the sincerest form of knowing you are doing something right.

Another reason there may be no competitors is because there isn't enough of a market. If you live in a rural area with no more than a few thousand people, or in an area of mostly younger people with few health challenges, there may not be enough business for you.

A third reason may be that someone has already tried offering your services, but they couldn't charge enough to make a go of it, or they didn't have the cash flow necessary to keep business afloat.

Making these determinations is part of the homework you must do to prepare to begin a business.

A way to be sure you've done the review you need is to know the answers to the questions you'll be asked by the people who may interview you to be a patient advocate.

Privacy Laws Will Play a Role

To be a successful patient advocate, you'll need a solid understanding of HIPAA laws, and the ability to instill enough trust that they are willing to make you their healthcare proxy or their financial agent, depending on the services they hire you for.

Of course, your ability to instill that trust will go a long way toward your marketing, too. With each client you work for, you'll find successes you can share with others -- with their permission of course. Further, they will share your successes with others, which amounts to WOM (word of mouth) advertising, the most effective and least expensive kind of marketing there is.

Ready to jump in? Once you've answered the questions about yourself, your finances and your patient advocate services, it will be time to take these important steps to get your business going:

A business plan is a must. Your business plan will be your road map to a successful patient advocacy business. It will spell out all your services, your financing, your marketing and your growth plans. It doesn't have to be a long, highly detailed document, but it does need to have all the necessary components.

You don't have to invent the components of a business plan. There are many lists and examples available to follow. But you do need to be very clear, just like you need clear directions to drive to a new location where you've never needed to navigate before.

You'll need to determine your business structure. Will you be a solopreneur, also known as a sole proprietorship? Maybe you and a partner want to get started in business? Or do you need to start a corporation like an S-Corp or an LLC or even an LLP? Your lawyer will be the person to help you make that determination.

What will you name your business? In some ways, naming a business is more difficult than naming a child. There are professionals who do nothing but choose business and product brand names, providing an indication of how important this step is.

There are a few business naming considerations ranging from researching what names are already being used and are trademarked, to not using your own name because if you ever want to sell the business it may have less value with your name attached. You will want to determine whether the domain name (URL or web address) is available, too. Take some time, and follow already determined steps to naming your business.

Even if you don't have any employees but yourself, you will need an employer identification number (EIN.) EINs are easy to obtain from the IRS website. You'll use your EIN for a number of things ranging from how you manage your taxes, to setting up your bank account. Note: If you are a sole-proprietor, you are not required to get an EIN, however, I advise it. When people hire you, you can give them your EIN for their paperwork instead of your social security number. As you know, it's always a good idea to keep your social security number as private as possible.

You may need a business license. This requirement changes according to the state you live in, or even the county or city your business will be located in. The best way to get this information is to call your local municipality's clerk (county clerk, city clerk, etc) and ask. There will be a fee, and rules about what you'll need to prove to get that license. You may need to have established a bank account, or a legal business structure in order to get your license.

If you will be using a DBA (doing business as) name instead of your own name (for example, if your name is Tom Smith, but you call your business Tom Smith's Advocacy) then you may need the business license before you get your EIN or your bank account. Again, this varies from location to location. If you call your municipality's clerk, or ask at the bank where you will set up your business accounts, they may be able to advise you on which steps to do first.

As part of your business plan, you'll need to develop a detailed marketing plan, too. A marketing plan helps you more clearly define your target audiences (customers or clients) and then lays out exactly how you will reach them. Will you list yourself in a directory of patient advocates? Will you advertise in your local newspaper? Will you write articles for a magazine?

While all the aspects of planning a business are important, if you don't have clear cut plans for reaching your target audiences, then you won't have enough business to stay in business. So be sure your marketing plan lists a variety of outreach strategies, including the most powerful marketing of all, word of mouth.

Networking with other patient advocates who do similar work to yours can be invaluable, too. Finding other advocates, whether they are competitors next door, or located across the country, can be a great way to improve your knowledge about your business, and may also be a great resource for answers to questions about your business or your work with individual patients.

Starting any kind of successful business is difficult, but starting a business that is a new type of service, like being a patient advocate, is even tougher. You won't have previous successes or other people's mistakes to learn from, and you'll be making up most of what you do as you go along.

Remember that one of the most important attributes of being a successful entrepreneur is to listen and take advice. Here are some of those resources and advisers who can help you establish your own patient advocate business:

State Assistance

Every state in the US recognizes how important small businesses are to its economic success and for that reason, every state offers support for starting small businesses. These resources should be among your first to access. You can find a list of state programs online, or call your local community college to ask about small business development resources.

SCORE

SCORE is the Service Corp of Retired Executives -- people who have retired from a career in business, and now volunteer to counsel others who want to build and succeed in their businesses. You can search for a SCORE mentor at its website.

SBA

Recognizing that small businesses are the future of the American economy, the federal government offers a great deal of support for small businesses through its Small Business Administration, the SBA. You can learn more about business plans, business loans, taxes, marketing and more from the SBA.

Your Bank

Check with your bank to see if they offer services for small businesses. Some banks focus on small businesses and entrepreneurs. Others offer small business loans. Still others offer business accounts, but not much support beyond that. Since you may need to have a good relationship established when it comes time to getting a business loan, establishing that relationship early in the process may be helpful to you.

CPA or Accountant

You'll need a Certified Public Accountant (CPA), an accountant or a bookkeeper to help you set up your cash flow and finances. Your CPA will also help you keep track of your tax deductions. Later, you'll want a CPA or accountant to do your taxes for you. If you have more confidence in your ability to handle bookkeeping, invoicing, payables and receivables, then you may find a software package like Quicken or Quickbooks or Microsoft Money can help you.

Lawyer

Early in the process of starting a business, a lawyer can help you put all the legal requirements, including your business structure, naming and trademarks, plus advising on the types of insurances you may need. As your business gets underway, your need to spend time with your lawyer will hopefully decrease, but establishing that relationship will serve you well should the need arise.

Marketing

There will be two types of marketing that can help you. General marketing advice will help you determine exactly who your target audiences are. More specific marketing advice will help you determine outreach to those specific target audiences. Look for help through any of the resources above (SCORE, SBA, state small business development offices).

You might also be interested in a book on the subject: The Health Advocate's Marketing Handbook.

Insurance

Depending on the type of health advocacy you wish to offer your patients or clients, you'll want to be sure to have the right insurances in place. Your business formation (sole proprietor, LLC, corporation) will also determine what kinds of insurance you need. You'll need business insurance as well as professional insurances like errors and omissions. If you work on medical information with your patients, you may need to have some sort of malpractice, or professional practice insurance, too. Because this area is so new and specialized, you'll need to stay current through a professional organization to get the most current information about insurance.

Network with Other Advocates

Other advocates, perhaps in other corners of the country, can support you in your efforts. They can mentor you, help you understand the hurdles and successes, and provide invaluable input for the unique questions you, as a new business person and advocate, will want to ask. You can find many of these fellow advocates online.

General Help for Starting a Business

There is quite a bit of help for starting a business and being self-employed. You might be interested in The Health Advocate's Start and Grow Your Own Practice Handbook

Or find great advice right here at About.com, including:

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