HEALTH CARE

Patients getting outside advice

Advocates can play important role helping navigate systems, care.

By David Markiewicz dmarkiewicz@ajc.com

Carl Friedrich Sr. had just gotten the diagnosis — stage four prostate cancer — and his head was spinning.

“I had hundreds of questions,” the 68-year-old Peachtree City resident recalled of the moment last June.

For answers, he turned in part to a private patient advocate he later hired, Cindi Gatton. Among other things, she helped him decide which hospital to go to for treatment and how best to shoulder the costs of chemotherapy and other services.

“I couldn’t have gotten channeled to the best care possible if it weren’t for her,” said Friedrich.

Private patient advocates like Gatton represent a small and little-known niche in health care. There aren’t many in Georgia, and estimates are that there are only a few hundred nationally. But clients say they can play an important role, helping patients navigate a complex and confusing system, saving them time, money and aggravation.

For a fee, which can run roughly $50 to $200 an hour, advocates can not only help research and negotiate bills and insurance issues, but also sit in during doctor’s office visits where they might take notes and assist physician-patient communication. They can also provide counsel afterwards.

Advocates are not yet professionally licensed — a sticking point — although their organization is trying to establish professional

certification standards. While they do not offer medical advice, they can fill information gaps when family and friends and interested parties including insurers and hospitals can’t.

There are other types of patient advocates, some of which do not charge a fee. For example, the Patient Advocate Foundation, a national nonprofit, does not charge patients for its services, and there are other groups focusing on specific diseases that also offer free help with medical matters. personalized and customized service and work independently for the client, not unlike a lawyer hired to handle an individual’s legal case compared to a public defender. Insurers and hospitals may have counselors available to help patients with concerns, too. Piedmont Healthcare, for example, has 125 to 150 advocates with titles like case manager and patient navigator, as well as a few dozen others who work for a specific service such as cancer or transplant.

Private advocates say counselors for insurers and others don’t work exclusively for the patient, however.

“It’s making sure people know all their options so they can make informed decisions. It’s about patient empowerment,” said Gatton. Sixty percent of her clients come to her because of a financial issue, she said, such as billing conflicts, but the rest are for medical concerns like locating a doctor to get a second opinion.

Gatton describes her advocacy work as a third career, and said she came to it after helping her brother deal with a terminal illness. Then she studied patient advocacy at the University of Wisconsin-Madison, one of a small number of colleges with a program in the field.

Gatton, who works for herself, said she has 10 or fewer clients at a time who she works with for periods that can range from a week to six months, depending on the duration of the patient’s issues. Clients find her through her website, through an online patient advocate directory or through referrals.

Some employers contract with outside companies that provide patient advocacy services to employees as a work fringe benefit. Printpack, an Atlanta-based maker of flexible packaging with more than 800 employees at two locations in Georgia and 3,500 in the U.S., works with Health Advocate, a Pennsylvania-headquartered health care advocacy and assistance firm with more than 10,000 clients nationwide.

Printpack employees and family members can get online and phone assistance with medical claims as well as other health care guidance and support from a Health Advocate representative at no cost to them. The advocates make doctor’s appointments and provide other services such as wellness coaching as part of a larger wellness program, said Natasha Moore, wellness program manager at Printpack.

Health Advocate executive vice president Marty Rosen said that for employers the service can lead to higher employee productivity since workers won’t be spending time haggling over medical bills, and that they can save health care costs by getting workers to pay only what they should.

Bruce Elliott, manager of compensation and benefits at the Society for Human Resource Management, doesn’t expect many employers to turn to advocate services, though, because they would see them as redundant and an extra cost, he said. Some insurance companies already offer elements of those services to workers at big corporate clients.

Many private advocates also contract locally with employers who pay for services on behalf of their employees and dependents.

In the individual market, though, “There are many people who are sick and need people to do empowerment for them,” said Trisha Torrey, founder and director of the Alliance of Professional Health Advocates. “It’s about making sure patients get the best out of the system.”

While patients contact advocates themselves, frequently someone does it on their behalf. Often, it’s the adult children of elderly parents, typically when they live far from each other. Friedrich’s son, who lives in the New York area, reached out to Gatton, for example.

“The second my father got the diagnosis, it became clear to me that I needed someone to guide and instruct the decision-making process (concerning his care),” said Carl Friedrich Jr.

He found Gatton online and, “She knew exactly which buttons to press.”