There are many aspects to getting quality medical care. There is the medical care itself, such as diagnosis and treatment. There is the billing and payment aspect, which follows all medical care. And there is one aspect of good health care that is sometimes not recognized until it presents its challenges: navigating one’s way through the system.
Health and patient navigators are the experts who help patients experience the best of the healthcare system by helping them navigate it successfully.
(These roles are different from a health insurance navigator. Health insurance navigators help people find suitable health insurance through public health insurance exchanges created by the Affordable Care Act.)
Capabilities and Responsibilities for a Patient Advocate
Developing lists of provider options and referral capabilitiesCoordinating second (and third) opinionsAccompanying patients to doctors’ appointmentsHospital bedside monitoring with a focus on patient safetyMedication reviews and coordination to minimize conflicts and non-adherenceResearching diagnosis or treatment optionsFacilitating communication among patients, caregivers, and doctorsNote-taking during appointments and hospital staysResearching clinical trial possibilitiesTranslating medical records and doctors’ orders into plain language to make them more patient-friendly and easier to followDeveloping lists of questions for patients to ask their providersCoordinating doctors’ appointments and lab visitsCoordinating with other professionals who help patients, such as social workers, nursing home or assisted living administrators, and othersDeveloping care plans, especially for people with multiple health challengesReviewing medical bills, then negotiating to lower those billsGetting permission for treatment that insurance companies may, at first, reject
Who Hires a Health or Patient Navigator or Advocate?
Someone who has recently been diagnosed with a difficult disease or conditionA patient who needs help coordinating the recommendations of many doctors (for several medical problems)A spouse who is called on to assist his or her loved one, but finds it difficult to set aside emotions to help make objective decisionsAn older person who may be forgetful or get confused (or is afraid he or she will become forgetful or confused) by his or her providers and medical needsSomeone helping an older relative who needs assistance, especially when they are tasked with caregiving or being a proxy for a loved one who lives in another placeA parent who needs help coordinating care for his or her child, especially when the child has major or multiple health problems
Qualifications Needed
Not all patient navigators have a healthcare background, although many do. Some have assisted relatives or friends get through difficult medical circumstances. Others have learned to navigate the healthcare system on their own, for their own disease or condition, and want to help others do the same.
Few patient advocates or navigators are employed by someone else. Most work as individuals, running their own navigation consultancies or businesses. To address self-employment issues, having the mindset of an entrepreneur is a plus. The Patient Advocate Certification Board provides certification. There are a handful of organizations and universities offering other certificate programs in patient advocacy or navigation.
How Patient Advocates or Navigators Work
Most patient advocates are independent, working in private practice (their own businesses) for one or more patients at a time. They are hired by the patient or the patient’s caregiver.
They are paid directly for their services by the patient or a caregiver or sometimes by a trustee or third party but rarely (if ever) by a reimbursement model like insurance. They may charge by the hour or by the project for a finite set of responsibilities. They may have an office for meetings or they may work with patients at home. Each navigator handles his or her work differently.
Organizations and Trade Groups
The Alliance of Professional Health Advocates is an organization that supports advocates and navigators as they start, grow and market their private advocacy practices The National Association of Health Advocacy Consultants
