Patient Advocacy and the Allegiance Factor

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As we prepare for Private Professional Patient Advocates Week next week, I’ve been asked by a handful of people what the difference is between a private patient advocate and any other health advocate.

It’s an important question, and the answer is actually quite simple.

The difference between a private patient advocate or navigator, and those found in hospitals, through insurance companies, or other places, is what I call The Advocate’s Allegiance Factor.  It’s based on who is producing the paycheck.

Private patient advocates are paid directly by the patient or the patient’s caregiver and have only one allegiance – to the patient.  The patient’s needs, whether they be medical, navigational, financial or locational – are the prime concern of the patient advocate. Period.

However…

If an advocate is employed by a hospital, her allegiance is to the hospital.  She works for the risk management department and her job is to keep the hospital out of hot water, which she MAY be able to do by helping the patient (or maybe not.) Her job is to keep lawsuits at bay and save the hospital money – which she does by helping patients (but only to an extent – and not if it interferes with the hospital’s needs.)

If an advocate works for an insurance company, then her allegiance is to the insurance company.  Insurers hire advocates to make recommendations that will save them money and help the patient, too.  As long as it benefits both – fine. But if not, do you see the insurer’s patient advocate making a recommendation to the patient that might very good for the patient, but expensive for the insurer?  Not a chance.

Medical home advocates are the same way – they are the same as the advocate who works for a hospital.  It’s great that they are available, and they are probably the closest to a private advocate, but they are still not working directly for the patient.

A private patient advocate’s ONLY interest is the patient and his or her well-being.  There is no one else trying to save the system money or keep themselves out of legal hot water.

Most patients and caregivers don’t understand these differences – yet.  They are still beating their heads against the walls trying to figure out why the hospital’s advocate is giving them the runaround, or why the insurance company’s advocate is sending them to a doctor who is arrogant and condescending.  They don’t realize that in both those scenarios, the help they get will be based on whether they can save someone else money, and not on their health.

To further understand the relationship of allegiance and advocacy, take a look at this description of the profession of private patient advocacy and navigation.

And now you better understand patient advocacy and the Allegiance Factor.

Of course, it begs the question, Can a True Patient Advocate Be Paid by Someone Else?

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Comments

  1. Carol Pickup  March 6, 2011

    I am a volunteer seniors advocate in Victoria, British Columbia and have really enjoyed your posts. My background is a retired nurse and about thirty years of locally elected service as a hospital trustee, school board trustee and a municipal councillor. I am not paid for my advocacy, so my total focus is the well-being of my clients.

    reply
  2. Cindi Gatton  March 10, 2015

    I think this topic is incredibly important for patient/consumers to appreciate – so important that I linked to this and wrote a bit more from my own blog. http://www.cindigatton.com/does-insurance-cover-that/

    reply
  3. Liwayway Pavino  March 2, 2016

    I ‘ve been working in Hospitals, Nursing Homes, Private Patient care ,social work, activities, billing and other patient care services and assisted patients and family members to understand and avail the services they need in problems they encountered. Learning about the HealthCare Advocacy as new field sparked my desire to pursue and to know more because I know I’ve been doing it, not knowing it’s now a new field of human health services. Thanks to my former Subacute Unit Director who shared me the news about the Health Care Advocacy. I want to have the right of complete ALLEGIANCE to the patients whom I will assist. I am in the crowd already, and surely want to attend a Certification/ Training to increase my knowledge in the vital areas of patients’ needs. Surely patient’s and families need Patient Advocates . Hospitals and medical practitioners will be relieved of times to explain and answer some queries of patients and families.

    reply
  4. anne Llewellyn  January 18, 2017

    I wanted to share a link to a Podcast I heard on NPR recently. It talked about conflict of interest and patient advocacy. Here is the link http://www.npr.org/2017/01/17/510301330/study-reveals-potential-conflict-of-interest-in-patient-advocacy-funding

    Take a minute to listen and let me know your thoughts.

    reply

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