Health Care Today
You never imagined you would find yourself in this position. Your physician just told you that you need major surgery and lengthy follow-up treatment. Questions crowd your mind. You’re stunned and upset. Should you get a second opinion? Who’s the best doctor to perform the surgery? Are there other treatment options?

It’s exceptionally difficult to successfully navigate a major illness or injury that strikes you or your family. The task is made even more difficult by the current climate in health care where doctors have less time to spend talking with patients and your choices of treatment options, hospitals, and specialists are often dictated by your health insurance.

Notes M.F. Winegardner, MPAS, PA-C, a physician assistant in a radiology oncology practice in an article she wrote in 2004 for the Journal of the American Academy of Physician Assistants titled “Physician Assistant: Patient Advocate, ‘The medical industry…has experienced transformational change propelled by new technology and market-driven demands for cost-effectiveness…The old paradigm of patient-focused or disease focused treatment of illness has been replaced by a new paradigm of managed cost containment.”

Those trends and a growing demand by patients for quality management of health care, more information and personalized attention, and a true partnership with health care providers has sparked explosive growth in the field of patient advocate services not just in the United States, but in Canada and the U.K. as well.

Patient Advocate Services: Many Answers to the Same Question
The field of patient advocate services was relatively unknown as recently as five years ago. Hospitals and some physicians’ offices hired staff patient advocates to handle conflicts or patient concerns about service, explain policies, and arrange appointments within their practice or facility. Some states and non-profit foundations created offices dedicated to patient advocate services to educate people about their rights vis à vis their HMO or insurance company. But that was about all the field focused on.

In the past several years, the field of quality management health care and patient advocate services has grown exponentially. Enter the words “patient advocate services” into your Internet search engine today and you will be swamped with nearly 4 million mentions. But not all of these patient advocate services practioners offer the same services.

Fixing Insurance Problems
The largest percentage of patient advocate services organizations do not focus on the quality management of health care, but rather on doing battle with insurers on clients’ behalf. As the rules governing insurance have become more constricted and complicated, many find themselves faced with medical bills totaling tens of thousands of dollars after a hospital stay or treatment is determined not be covered.

In these cases, the patient advocate services firm will negotiate with the insurers in an effort to get them to pay all or a portion of the bills. Some firms perform their work pro bono, while others charge a fee for their efforts and expertise. Some also offer patients educational information on conditions and treatment options. The staff who work in these organizations come from a wide range of backgrounds, from nurses and lawyers to graduate and professional students.

Offering Help to Employers
Another group of patient advocate services firms focus their attention on employers. These organizations provide employers with health information materials and educational presentations to make employees better health care consumers. The goal is two-pronged—to empower employees to seek and receive the care they need and to control the employer’s overall health care costs by guiding employees toward the most appropriate and efficient types of care.

Many of these firms also help employers evaluate the insurance options available for their workforce. In general, these patient advocate services providers focus primarily on cost containment solutions for employers. They are staffed by physicians, nurses, and former insurance company specialists.

Someone to be There When You Can’t
Caring for elderly parents and relatives is stressful, time-consuming work. Many family members simply don’t have the time or expertise to handle the situation effectively. That’s the hole filled by another type of patient advocate services provider. They act, in essence, as family surrogates and provide a wide range of services: arranging and attending appointments with the patient; providing a second “set of ears” to listen to physicians’ recommendations and ask pertinent questions; educating patients and families about medical conditions and available treatments; and even finding palliative care to ease the end of life.

Many of these firms were started by people outside the health care field who went through difficult experiences with their own parents or family and most are small, regional companies.

A ‘Whole Person’ Approach to Patient Advocate Services
Almost all patient advocate services firms focus on people with serious or chronic illnesses. Very few look outside that box and offer a ‘whole person approach’ to patient advocacy, one that includes working with clients to develop a healthier lifestyle, gathering medical records into a single, secure electronic record that can provide life-saving medical information anywhere in the world, getting expedited access to the best physicians and hospitals, attending appointments with clients to ask questions and take notes, and offering detailed information about health issues and treatments, including alternative, integrative and complementary medicine.

One firm that does follow this model is PinnacleCare. PinnacleCare’s goal is help their Members and their families navigate the complexities of the U.S. medical system and gain uncomplicated access to the best the healthcare system offers. Explains Bruce Spector, the firm’s Chairman, “The need for PinnacleCare today is essential. We have a cost-driven healthcare system and a lot of consumers who want a better system. We have trusted advisors for every other important part of our lives, why not health care? Is our family's health care not important enough? Is the healthcare system so simple we don't need advisors? I think we all realize the answers to these questions. There is a clear and pressing need for the services PinnacleCare provides.”