Why Healthcare Advocacy Is Important

Today’s complex healthcare system is increasingly fragmented. Patients see multiple specialists and scramble to keep track of treatment plans. Confusing medical bills and insurance coverage pose challenges to even the most informed patients. Healthcare advocacy can play a vital role in easing the burden patients experience while navigating the healthcare system.

An Online Master of Health Administration degree (MHA) can be an excellent choice for anyone interested in advocacy in health care. It provides aspiring advocates with cutting-edge analytical skills they can leverage to help patients understand the various facets of their care. 

Issues Healthcare Advocacy Can Address 

Managing health care can be challenging at the best of times. Older adults with cognitive impairment and people battling symptoms of exhaustion often find that navigating one’s own health care is daunting. As a result, these patients put health care on the back burner at a detriment to their own personal wellness.

Patients and their caregivers may spend a lot of time pouring over insurance forms or other documents written in jargon they find difficult to follow. Many misunderstand or misinterpret diagnoses and treatment options. Such misunderstandings can result in inefficient or substandard medical care. For example, patients may undergo duplicate diagnostic tests, miss appointments, or take the wrong medication dosage, which can lead to physical, mental, and financial harm.

Hard-to-interpret health insurance coverage sometimes results in patients not taking full advantage of available resources. Other times, patients mistakenly pay inaccurate medical bills containing errors or charges that were actually covered by their health insurance plans.

While the national conversation on health care has focused on ways to address these problems, many patients need individual guidance. This is why healthcare advocacy is important; it empowers patients to make informed decisions that protect their health and wellness. 

What Is a Healthcare Advocate? 

Healthcare advocates give patients and their families direct, customized assistance in navigating the healthcare system. A healthcare advocate’s role entails:

• Helping patients access health care
• Educating patients so they can make well-informed healthcare decisions
• Guiding patients through their medical care, insurance questions, and administrative and legal tasks

How do patients and healthcare advocates connect? Sometimes patients and their families hire independent healthcare advocates or individuals who work for advocacy organizations. Employers, insurance companies, and hospitals may also offer patients healthcare advocates.

Types of Healthcare Advocacy               

The healthcare system’s many layers have created a need for several types of healthcare advocacy. In fact, more than 70 percent of Americans believe the healthcare system fails to meet their needs, according to the Harris Poll. While the inaccessibility and high cost of care were cited, the primary reason for the failure is the healthcare system’s confusing logistics. 

Healthcare advocates offer a range of services designed to empower patients and help them navigate these complex logistics. The following types of healthcare advocacy each serve an important role:

Medical Care Navigation

Medical care navigation services include:

• Communicating with healthcare providers
• Setting, coordinating, and attending appointments
• Speaking up about patient rights
• Identifying health resources and making referrals
• Explaining confusing medical information
• Clarifying diagnoses and conditions
• Coordinating care between specialists

Medical Billing Navigation

Services that help patients navigate medical billing can include:

• Reviewing medical bills for accuracy
• Negotiating bills with providers
• Getting billing errors adjusted

Health Insurance Navigation

Assistance in navigating health insurance may include:

• Figuring out the coverage guaranteed by insurance plans, Medicare benefits, and veteran benefits
• Explaining copays and coinsurance to patients
• Investigating in-network and out-of-network provider options
• Advising patients on selecting health plans and insurance policies
• Researching additional potential benefits such as long-term care insurance
• Informing patients about the wellness benefits of preventive care and the use of telehealth

Placement Navigation

Services that help patients find placements include:

• Assisting patients getting admitted into or discharged from hospitals
• Coordinating patient transfers to nursing homes, assisted living, or rehabilitation centers

Navigation of Older Adult Services

Navigation of older adult services includes assistance with:

• Home care
• Transportation
• Meals
• Housing

Legal Navigation

Legal navigation services include:

• Assisting patients with legal concerns and issues
• Advocating for patients who received poor care at a medical facility
• Helping patients with disability filings

Why Is Patient Advocacy Important? 

Examining healthcare policy and patient support roles makes it easy to understand why patient advocacy is important in health care. Large-scale advocacy focuses on changing the system, while advocacy on an individual level endeavors to speak on the patient’s behalf and seek positive outcomes.

Healthcare Advocacy on a Large Scale   

Healthcare advocacy on a large scale guides lawmakers and leaders who form healthcare policy. It supports a well-informed decision-making process regarding programs that affect healthcare providers, patients, and healthcare environments. 

Broad healthcare advocacy encourages reforms that put the newest research into practice and cultivate better partnerships within the healthcare industry. It also strives to push for health policies that better account for factors such as poverty, as well as other social and economic circumstances that affect people’s health.

When successful, healthcare advocacy that influences public policy improves individual health, which reduces health disparities. Community health advocates take this even further by ensuring health equity among specific populations. Such advocacy aims to guide healthcare policy goals, get priority legislation passed, and secure the funding needed to support the new policies enacted.

In September 2022, for example, more than 100 members of the Oncology Nursing Society (ONS) attended their seventh annual ONS Capitol Hill Days advocacy event. They used their knowledge, experience, and passionate personal stories to influence U.S. representatives and senators, and as a result, Congress signed new pieces of legislation, including the following:

• Important changes to the Patient Care and Hospice Education and Training Act (PCHETA)
• Changes to the Cancer Drug Parity Act
• Passage of the Lymphedema Treatment Act, which requires insurance providers to cover the cost of patients’ compression garments

Advocacy groups like White Coats for Black Lives are pushing for initiatives to diversify healthcare faculty and dismantle systemic racism in health care. One project involves advocating for medical education training that combats discriminatory practices and implicit biases.

Healthcare Advocacy on an Individual Scale 

In addition to navigating the U.S. healthcare system’s ins and outs, patients often contend with the uncertainties that accompany illness. They may receive contradictory or confusing information. Additionally, patients’ decision-making abilities may be impaired due to their illnesses, misinformation, or confusion.

The physical, emotional, and economic burdens of shouldering one’s healthcare responsibilities alone can prove impractical. For example:

• Patients with dementia may not be able to adequately arrange their own transition to a memory care unit.
• Patients recovering from serious car accidents may have difficulty successfully coordinating their appointments for MRI scans and visits to specialists such as neurologists and orthopedic surgeons, particularly if they are struggling to think clearly or experiencing chronic pain.
• New parents may have trouble transporting their newborn infants to pediatric appointments just days after giving birth, especially if they lack access to childcare or adequate support at home.

While some patients have family members who can help, many do not. A trained healthcare advocate helps protect patients and ensures their needs are met.

Examples of Patient Advocacy in Healthcare 

Advocacy in health care comes in many forms. Managing medication, navigating personal preferences, and even concerns about the future can have very real consequences for patients. Consider the following patient advocacy scenarios and how a healthcare advocate may address them.

A Patient Faces Challenges to Medication Management 

Prior to the COVID-19 pandemic, a 75-year-old woman with a heart condition attended events at a local community center and had an active social life. Her activities and routines helped her keep up with her prescriptions. She remembered to go to the pharmacy when she went to choir practice; her afternoon visits with friends reminded her to take her evening meds. However, with the breakdown of her routines and growing isolation, she has started to lose control of her prescription management.

A healthcare advocate may arrange a conference call with the client and her doctors. After confirming the client’s medications and dosages, the advocate might research local pharmacies and advise her client about their hours and delivery options. She could arrange for her client to stock up on medicines that may take longer to refill due to the pandemic. From there, the advocate may regularly check in with her client, offering medication reminders and asking about any other needs.

A Cancer Patient Prefers No Further Hospital Stays 

A 35-year-old patient with cancer has a history of long hospital stays and does not want to return to the hospital, despite his worsening health. His family wants to honor his wish but feels ill-equipped to care for him at home.

After making a home visit and conducting a health assessment, a healthcare advocate may arrange for a hospice care agency to visit the patient’s home for immediate intervention. Next, the healthcare advocate might organize 24-hour caregivers and help the family manage his medication. In this way, the patient could live out his final days as he wishes, and his family would have the support they need so they can focus on saying goodbye to their loved one.

A Patient Deals with Conflicting Mammogram Feedback 

A month after a routine mammogram, a 40-year-old woman receives a call from the facility that took the scans. They tell her she needs additional exams but offer no clear answer as to why. She makes another appointment, but it is canceled due to equipment malfunction. A week later, she arrives for an additional mammogram. After the scans, she receives confusing information at the facility and leaves frustrated.

That evening, the facility calls and informs her she has a cyst and should follow up in half a year’s time. An hour later, the doctor calls informing her she needs another specialist to examine the cyst. The next day, another representative from the facility tells her she needs to see a surgeon.

At the client’s request, a healthcare advocate could accompany her to the next mammogram appointment. The healthcare advocate might research specialists in her client’s insurance network and help her schedule an appointment for a biopsy and a second opinion. Next, the healthcare advocate could work with the client to coordinate a medical team and treatment plan.

A Patient Who Needs Cancer Treatment Asks About Fertility 

A 20-year-old woman needs chemotherapy and does not have immediate plans to have a child. However, she wants to ensure she will be fertile in the future. Her doctors tell her the treatment may damage her eggs, make them infertile, or prompt premature menopause.

A healthcare advocate could educate the client about potential treatment side effects. The healthcare advocate could then consult with the client, helping her form in-depth questions for the doctor. Next, the healthcare advocate might investigate local fertility treatment centers and set up an appointment for the client to learn about egg freezing and other options for conceiving a child in the future.

How to Become a Healthcare Advocate 

Healthcare advocates come from many backgrounds and have a wide range of experiences. Some of the most common backgrounds for healthcare advocates include:

• Nurses
• Social workers
• Hospital administrators
• Lawyers
• Patient care coordinators

However, many advocates join the field after experiencing illness personally or helping an ill family member in need. Regardless of what initially attracts people to the field, healthcare advocates need the right education, training, and skills to thrive in their positions.

Required Education and Training for Healthcare Advocates 

Healthcare advocacy encompasses many types of positions. Entry-level positions such as “experience ambassadors” who greet patients and serve as liaisons with healthcare providers may only need an associate’s or bachelor’s degree, alongside excellent communication skills and a certification in patient advocacy.

However, positions that call for expert navigation of the healthcare system and the ability to aggressively advocate for patient rights require more education and training. Those interested in how to become a healthcare advocate should consider the following degree programs and certifications:

Master’s Degrees in Health Education or Related Fields

An MHA degree offers graduates in-depth knowledge of the healthcare system’s internal workings. It also cultivates the type of problem-solving skills healthcare advocacy work demands and teaches the legal aspects of health care as well as the payment systems. These degrees can also prepare people to advocate for healthcare policy.

BCPA Certification

An advocate who becomes a Board Certified Patient Advocate demonstrates to potential employers and clients that they are competent and professional. To earn the certification, candidates must hold at least a bachelor’s degree, submit letters of recommendation, and pass the BCPA exam.

Key Skills of Healthcare Advocates 

The skills required to practice advocacy in health care may vary somewhat depending on the chosen area of specialization. For example, those who want to influence policy may need legal skills, while those who want to help patients understand diagnoses and medications can benefit from clinical skills.

Regardless of their focus area, anyone interested in healthcare advocacy should possess the following skills:

Communication Skills

The importance of exceptional communication in health care cannot be understated. Advocates must effectively communicate with patients and their families, healthcare providers, and insurance company representatives. They need to break down the complexities of the healthcare system, diagnoses, treatment plans, and insurance policies into simple terms for patients. They also need to speak persuasively and assertively when negotiating insurance claims on a patient’s behalf.

Emotionally charged situations may make it difficult for patients and their families to express themselves. As a result, healthcare advocates must pick up on body language and other nonverbal cues to get to the bottom of what patients are thinking and ask the right questions.

Empathy

Advocates work with people who are often dealing with tough situations. Their clients may be confronting pain, crises, and confusion. Effective healthcare advocates can consider the issues from their clients’ perspectives and empathize with their pain points. They also offer emotional support when appropriate.

Organizational Skills

Advocates must coordinate the many moving parts of each case they handle. This requires staying organized and managing their time well. It also involves paying close attention to details so they can catch errors in medical bills and insurance claims and keep track of their clients’ various conditions, medications, and doctors.

Research and Problem-Solving Skills

To address their clients’ needs, advocates often need to conduct research to get answers to questions, locate key information, and identify the right steps to take. Whether trying to help clients find medical coverage or dispute claim denials, healthcare advocates must think analytically and successfully gather the right information.

Specialized Skills

Some areas of advocacy call for specialized skill sets and knowledge. For example:

• Advocates specializing in older adult care should know about health conditions particular to older adults such as Alzheimer’s disease and dementia. They should also be well-versed in the different services older adults often need, such as residential home care, nursing home care, and live-in home care.
• Advocates specializing in billing and insurance need solid math skills alongside in-depth knowledge of payer reimbursements, deductibles, and how to appeal insurance claim denials.
• Those interested in medical advocacy should understand patient safety, know how to investigate clinical trial opportunities, and have care coordination skills.

What Does a Healthcare Advocate Do? 

While healthcare advocates may have areas of specialization, their cases often require them to work across the spectrum of advocacy services.

Facilitation sits at the foundation of healthcare advocacy. Healthcare advocates do not make decisions for their clients; rather, they make them aware of their options. They cultivate a better understanding of the healthcare system by giving their clients background knowledge. They offer the type of support that helps patients get their questions answered and their problems addressed.

Ultimately, healthcare advocates strive to handle logistical issues, so patients and their families can focus on health and healing. They leverage their knowledge of the facts and the system to empower their clients and patients.

Healthcare Advocacy Careers 

All healthcare organizations’ members can advocate for patients. In fact, the work duties of social workers, nurses, and case managers involve patient advocacy. Nonetheless, the need for careers focused exclusively on patient advocacy has become clear.

Healthcare advocates work in a variety of settings:

Child Advocates

Child advocates work with children and teens who need access to health-related resources. They often work directly with foster parents and other caregivers to offer direction and support. Their duties may include:

• Educating children on their basic health needs
• Listening to children’s concerns and providing relevant information and support
• Helping foster parents and other caregivers with navigating the complexities associated with state-managed health care

Victim Advocates

Victim advocates are trained to support crime victims. In a healthcare setting, they offer a wide range of support to the victims of abuse and assault. Their duties and responsibilities may include the following:

• Supporting patients as they are treated for their injuries
• Helping victims find and access healthcare services
• Filling out paperwork
• Providing information about a patient’s legal rights and protections
• Serving as a liaison between the patient, healthcare providers, and law enforcement officials

Hospital Patient Advocates

Hospital patient advocates work as ombudsmen — supporting people who help address complaints and concerns — and serving patients within hospitals and other healthcare facilities. Their duties include:

• Determining patient eligibility for government programs
• Investigating the possibilities for third-party reimbursement
• Helping patients with applications and other steps to secure medical coverage
• Managing patient care plans that address preventive, physical, and mental health
• Making referrals to additional healthcare providers including physical therapists, nutritionists, and nurses
• Addressing patient grievances and complaints through mediation
• Providing crisis intervention

Private Case Managers

Private case managers provide direct patient advocacy and often act as liaisons. They interact with and facilitate communication between patients, families, doctors, healthcare facilities, hospitals, and insurance companies. Private case managers either work independently or for advocacy organizations that assign them to client cases.

Private case managers assist:

• Patients newly diagnosed with a disease
• Patients with scheduled surgeries
• Patients facing radiation and other cancer treatments

Private case managers may also advocate for patients who cannot get a diagnosis for their condition or cannot locate the necessary treatment on their own.

Government Patient Advocates

Government patient advocates work within state health systems. They access services from Medicaid and Medicare. They also handle some of the same case management support offered by direct case managers. They may also work in county health departments, where they play a crucial role in public health advocacy.

Much of the healthcare advocacy conducted at the government level occurs in hospitals and clinics managed by the U.S. Department of Veterans Affairs (VA). The Veterans Health Administration offers a Patient Advocacy Program, and they encourage patients to reach out to these advocates when they have questions or concerns they wish to address.

Empower Patients Through Healthcare Advocacy 

Healthcare advocacy can comfort, empower, and support patients during challenging times. Given the complex nature of today’s healthcare system, patients deserve people with expertise in their corner. Cultivating the skills and knowledge needed to guide and advocate for patients effectively requires the right education.

Learn more about how an Online Master of Health Administration from Tulane University prepares graduates to help patients navigate the healthcare system and promote their rights.

Recommended Readings:

Patient-Centered Care: Definition and Examples

What Is Quality Improvement in Health Care?

Mental Health Advocacy and Its Importance in Public Health

Sources:
American Academy of Physician Associates, The Harris Poll
American Medical Association, Health Care Advocacy
A Place for Mom, “Patient Advocates: What They Are and Ways to Use Them”
Elder, What Is Elder Care?
Indeed, “12 Advocate Jobs (With Job Descriptions and Types)”
Indeed, “Learn About Being a Patient Advocate”
John Hopkins Medicine, “The Power of a Health Care Advocate”
Memorial Sloan Kettering Cancer Center, Fertility Preservation: Options for Women Who Are Starting Cancer Treatment
ONS Voice, “Nursing Advocacy Creates Real Change in Health Policy”Patient Advocate, Patient Advocate Case Examples
Patient Advocate, Private Case Management
Patient Advocate Certification Board, What Is BCPA Certification
U.S. Department of Veterans Affairs, Patient Advocate
Verywell Health, “Health or Patient Advocate or Navigator Career”
Verywell Health, “How to Become a Patient Advocate or Navigator”
Verywell Health, “Patient Advocate or Navigator Degrees and Certificates”