I am very excited about being a Health Advocate right now, or as some of my colleagues refer to themselves, a Patient Advocate. When I first learned about the world of private professional health advocates and decided “yes …this is how I can bring my 25 years of healthcare experience to directly help patients and their families” it was 2009 and the field was in its infancy. In fact, the National Association of Healthcare Advocacy Consultants (NAHAC), the national professional organization of health and patient advocates, was officially formed that same year as was the Alliance of Professional Health Advocates (APHA). APHA was created as a private for-profit company with marketing and business prowess to support individuals who want to start private professional health advocacy practices, make them successful as businesses, be listed and found by potential clients and share information among its member health advocates on pertinent issues and concerns.

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By 2012 when I started my practice and discovered NAHAC, health advocacy was a well-established field on the west coast and sections of the east coast, but just barely beginning in the Midwest. I joined APHA immediately as a resource to help me learn how to establish a successful practice. It has been my biggest source of referrals through the directory listing for member advocates. Trisha Torrey, its founder, feels that her role in making this profession the best it can be is to be an unflagging booster, rather than being an advocate herself, including being one of the key people to lead the certification standards efforts of PACB to fruition as outlined below. I was excited to join the Board of NAHAC as the field grew in many other parts of the country. As professional advocates, our ability to bring our skills to bear helping patients and their families navigate through complex issues makes us more and more valuable. These days, patient safety concerns are more frequently publicized, insurance choices are more challenging, the aging population has a more complex mix of diagnoses, and mental health is an increasingly important factor across all ages and socioeconomic factors. Our knowledge and skills as health advocates are in higher demand than ever and we are able to have a bigger impact on behalf of our clients.

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I recently attended the first annual International Conference on Patient Advocacy (ICOPA), lucky for me held near my home near Chicago, Illinois. Led by several of the leading organizations in the field of health advocacy (PACB - described below, APHA, and NShore Patient Advocates, a Chicago-based advocacy company), the excitement in the air was palpable. The conference took place over the span of two and a half days and was well attended by close to 200 individuals, almost all of whom were advocates. A few were considering pursuing this as their career and wanted to hear more about what we do while some had been in the field for 10 to 15 years, formally or informally. Some advocates had clinical backgrounds as nurses, physicians, social workers, case managers, counselors or other clinical providers. Others had been involved in the healthcare field from the insurance or healthcare systems or administration side.any had ended up as professional advocates because of their efforts to help close friends or family members which led them to want to do the same for others. Some have training in business or have pursued certification from one of several national programs in the field. Many, in an effort to bolster their qualifications to their client base, have sat for standardized certification exams that are either specific to patient or health advocacy such as the relatively new Board Certified Patient Advocate Certification (BCPA) or the long-standing Certified Senior Advisor (CSA) which overlaps in some areas with patient advocacy.

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Some patient advocates are independent private professionals while others are employed by organizations such as hospitals, insurance companies or associations that focus on diseases or specific health care areas (cancer, heart disease, mental health).

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Topics at the conference highlighted why patient advocacy is needed now more than ever. Among the key areas where patient or health advocates are increasingly of high value to their clients are:

• Improving communications and transitions, thereby reducing the likelihood of error
• Improving understanding of options in care and benefits, especially given changes being implemented in Medicare effective January 2020
• Understanding the crossover between psychosocial factors and medical factors

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The conference offered multiple informational sessions that discussed medical error, the increased focus on bringing it to light and trying to reduce it. The Medical Director of a major system in the Chicago area and Wisconsin talked about how his organization is working to instill a systemic cultural change in an effort to reduce attitude, approach, and in the end, get error rate to zero. As patient advocates, we are often in the right place at the right time as an extra set of eyes and ears helping to reduce errors and facilitate communication. If handled in the appropriate manner, my experience is that all levels of professionals in the provider organization welcome our involvement because we help ensure that the patient understands what needs to happen and that the provider gets accurate and timely information. This is especially true in transitions from one shift, unit or setting to another.

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ICOPA also offered the opportunity for those of us who work with older adults to learn about Medicare plan options and upcoming changes effective January 2020 in Medicare home care payment plans which may make it more difficult for clients to access home care as easily as they have in the past. Medicare will begin to pay for home care on a per-case basis rather than a per-service basis as the Federal government tries to make home care providers share the cost risk the way that hospitals have had to for years. This will potentially create incentives for home care companies to cut services that our clients actually need, making it important for us to be vigilant and make sure that this does not occur.

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Other sessions at the conference talked about innovative ways to work with other resources to meet client’s needs, such as providing guardianship services. In addition, there was a broad-based panel with seven organizations representing leaders in this field talking about where patient advocacy is going. That was really exciting for me because I realized that I have been involved in patient advocacy for seven years! And things have evolved and grown a great deal during this period of time!

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As I have seen this profession grow, I have wanted to be a part of solidifying and supporting this development on a national scale beyond what I give to my own clients as part of my practice each day. I serve as the Vice President of the Board of the Patient Advocate Certification Board (PACB) another sponsor of the conference. PACB was formed several years ago bringing together the knowledge of several organizations to create a national exam and a process that will certify patient (or health) advocates using statistically reliable methodology. The people involved with PACB, including myself, have been in the field for many years. We have just completed our second year of offering a national exam certifying individuals who demonstrate their competency across 7 domains. It was gratifying to see how many who attended the ICOPA conference have already become Board Certified Patient Advocates (BCPAs) or plan to sit for the next exam cycle. The results from our September/October 2019 exam increased that number of BCPAs to 632.

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There are many different health advocates, even in my own geographic area, each of us doing things just a little bit differently. While we may overlap in terms of what we do and how we do it, we also have different areas of expertise. It is part of our ethical responsibility to understand the boundaries of our skills, knowledge and experience and to bring in other resources when the situation calls for it. This can even be done via telephone or video conference if need be. I do this all the time and value my ever-expanding network of colleagues for that reason!

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It is exciting every time that health advocates get to meet and share ideas, whether at regional/local peer group meetings or at national/international conferences like the ICOPA conference that I described above. At the end of the conference we all agreed that we want to keep getting together like this to share the knowledge that benefit our practices and, most important of all, our clients. Health Advocacy has arrived and has plenty of opportunities to grow!

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My best to you and yours on the cusp of a hopeful New Year!

Lee