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What Is the Role of a Patient Advocate?

October 05, 2021
A young male doctor points to the screen of a tablet explaining to an older male patient in a hospital gown what is on the screen.

The scope and importance of patient advocacy have expanded in recent years to become an integral component in many healthcare settings. Instead of being something that doctors or nurses would do for their patients when they can set aside a few minutes, patient advocacy has evolved into a career that many pursue today.

What Is a Patient Advocate?

The definition of a patient advocate has shifted over the years as the healthcare system evolves but is related to improving the patient experience. Today, patient advocates wear many hats. They help patients communicate with healthcare providers and ensure that patients can get and understand the information they need to make informed decisions. They also help patients coordinate their care, set up appointments for doctor visits and diagnostic tests, and navigate legal and financial matters.1

What Makes a Good Patient Advocate?

Good patient advocates often have a background in health and medicine. They are empathetic and have plenty of patience. Many are fluent in other languages and sensitive to cultural differences to help immigrants navigate the healthcare system.

Patient advocates who work with insurance companies and medical billing departments must understand payer reimbursement, Medicare and Medicaid, co-pays, co-insurance, deductibles, etc. If you want to start a patient advocacy business, you'll also need a solid grasp of business basics and client care.1

How has the Role of Patient Advocates Evolved?

While the role has existed in other countries for many years, it has only started to gain traction in the U.S. recently. The growing complexity of the healthcare system has increased the demand for patient advocates, and the role is evolving rapidly to cover more ground.

Traditionally, a friend or family member often takes on the role of a patient advocate. They have to gain medical knowledge and learn about the healthcare system so they can help the patient ask the right questions and get the appropriate care at the right time.

Increasingly, medical facilities are assigning staff members to act as patient advocates3. Some assume the role of a patient navigator, while others work more like customer service operatives. They help patients understand the processes within the facility and may need to handle litigious actions of distraught family members.

More recently, patient advocates are also hired by and work directly with patients and their families. They tend to cover a broader spectrum of services, such as obtaining medical records, asking questions, keeping notes, helping patients make decisions about their care, and negotiating medical bills.3

What Are the Key Responsibilities of a Patient Advocate?

While the duties of a patient advocate may vary, here are some typical responsibilities and the necessary skills required1,2,3,4:

  • Help patients understand their insurance coverage and financial responsibilities. Patient advocates may also negotiate payment plans with healthcare facilities on a patient's behalf. They must have a solid understanding of medical billing processes and how the healthcare system works.
  • Handle complaints from patients or their families and report the issues to higher authorities in the healthcare facility if appropriate. Patient advocates should have excellent communication, interpersonal and problem-solving skills to ensure that concerns are resolved to the patients' satisfaction.
  • Explain patient rights, which is often necessary when patients want to check out of a hospital against medical advice. The advocate must apply empathy and communication skills to convey the necessary information to help patients make the right decisions.
  • Work with billing and financial departments in a healthcare facility to ensure that patients are invoiced the correct amount. Since patient advocates may also act as an intermediary between the provider and the insurance company, they should understand how medical coding and billing work.
  • Help a patient's friends and families understand what's happening and what they can do, e.g., making arrangements to fill prescription drugs, arranging homecare, or getting medical equipment for home use. As such, patient advocates must be resourceful and have the ability to understand each patient's unique circumstances to make the right recommendations.

The Pros and Cons of Becoming a Patient Advocate

The fast-growing healthcare industry offers many opportunities for those who want to pursue a career in patient advocacy. Besides traditional healthcare settings, many patient advocates work for corporations to help employees navigate the healthcare system, so they can stay healthy and productive while the company saves on healthcare costs.

You can also build a career working for insurance companies, government entities, non-profit organizations, or even start your own patient advocacy business4. These opportunities are available across the nation, so you can find a location and setting that best fits your preferences.

However, a career as a patient advocate isn't for everyone. The fast-changing healthcare landscape can be challenging to navigate. You must be ready to invest the time and effort to stay current. You need to be flexible when dealing with the various parties involved in a patient's care. You must also be able to defuse situations when patients or their loved ones become emotional or frustrated.

The Evolving Trend in Patient Advocacy

While everyone in healthcare should advocate for patients, it's increasingly important to have a specific role for this purpose to ensure the delivery of high-quality patient-centric care. Thanks to advances in information technology and electronic recording-keeping, we can leverage and share patient health data5 efficiently to promote transparency, improve communication, facilitate collaboration among various parties, empower patients to have greater control of their own care and ultimately, improve patient experience and treatment outcomes.

Health Informatics and Patient Advocacy

Health informatics plays a central role in patient advocacy. Patient advocates who know how to use patient information to guide clinical decision-making and navigate administrative processes will excel in the complex healthcare environment.

Kent State University's online Master’s in Health Informatics program can help you build a solid foundation for achieving your career goal in the healthcare industry. Dig into real-life case studies presented by our practitioner faculty and collaborate online with your peers in small groups to focus on the issues that matter most when it comes to healthcare and technology. Learn more about the program by scheduling a call with an Admissions Advisor. If you’re ready to embark on a healthcare career that can change lives, start your application today.