50+ Lifestyles

Your Advocacy Connection – A New Way of Looking at Health Care

By Julie Arndt
GolderCare Solutions

We Solve Long Term Care Problems

When we launched GolderCare in 2008, we were focused primarily on asset protection with a layer of care advocacy. Little did we know then how the Affordable Care Act would impact the overwhelming need for patient advocacy in years to come. Last week I, along with two other members of our team, Kathy Nitz and Jamie Long, were speakers at the Annual Conference for the Professional Patient Advocacy Institute (PPAI) in Orlando Florida, sponsored by Dorland Health.

The first day was training for all. Seated in the back of the room, Kathy and I were with a room full of patient advocates from around the country who share a passion for assisting patients get the care they need when they need it. As I looked around the room at nurses, physician assistants, insurance coordinators, social workers, medical coders, and attorneys, I was stuck by the enormity of the situation in regards to our fragmented health care system. How did we go from going to the hospital, getting treatment and paying your bill in the 1950s to now, when you need someone with good navigation skills and who can “speak the language” to get something simple as a routine surgery scheduled?

One of the topics was “patient centered care.” We have been talking about this since the 1980s, but what does this really mean in terms of practical application? In a health care system that is truly working towards patient centered care, it should be personalized from the point of contact to resolution of the problem or issue. One example of this is trying to reach the correct person in the system to address your concerns. We all know about the electronic phone messages asking you to pick from a menu of options. This is pretty much a standard in our society, yet seemingly challenging to navigate when someone is either limited by a physical or mental impairment or perhaps is just dealing with an unusual amount of stress. There has to be a better way.

My 17 year old son was injured in the last football game of the season. The trainer and the surgeon with him on the sidelines told him to be at x-ray at our local hospital at 11:30 the next morning. If we would have done what we were simply told to do, we would have shown up at x-ray, and they would have looked at us stating they had no knowledge of what we were talking about and things would have stalled there. We were not in the computer, nor did we have a written order. What surgeon evaluates a patient at x-ray bedside anyway? [Actually ours would have ….he is great!]. Knowing this, we checked in at admitting and explained the situation. I had to repeat the verbal directive from the night before just twice before we got everyone on the same page. As we were sitting there, my son looked at me and said, “You know, I’m glad you are here. Dad is great, but doesn’t do so well working around the hospital.” This is the essence of patient advocacy…helping get access to the right care in the most efficient manner possible. The benefits are two-fold: happy patient getting care and efficient use of health care staff which helps keep health care cost down!

One of the speakers at PPAI was the President of Blue Cross of New York who shared some great statistics related to lowered cost of care while keeping customer satisfaction high. One of the ways they are doing this is by thinking out of the box and utilizing community services not traditionally partnered with by health insurance companies. They have patient advocates employed by the insurance company to help their patients navigate their care. Sounds great and is great, provided your assigned navigator is willing to guide you to the best option for your unique situation without consideration of cost to the insurance carrier, who just happens to be their employer. One could argue this is an inherent conflict of interest. To increase customer participation in this program, we challenged this speaker to consider an incentive plan/benefit for customers to hire their own patient advocate on the ground in their own community. We already know this is a sure fire way to increase appropriate
utilization and keep care cost down.

Coming home from Orlando, I find myself energized by the challenges we collectively face in the midst of health care reform. This is the time to be thinking out of the box and working together to ensure we are maximizing our options while keeping costs down. There appears to be infinite opportunities to approach old problems in new ways.

Julie Arndt is a licensed social worker working in the field of geriatrics for over twenty five years with expertise in medical case management and community based services.