Entrepreneurs pursuing patient advocacy trend

February 2, 2009

Health care has become so complicated that entrepreneurs are beginning to follow hospitals into the growing niche of guiding overwhelmed patients through the system.

Hospitals several years ago saw a need to help patients find rehabilitation centers, organize medical records across doctors' offices, and resolve disputes between patients and health care providers. Workers in the emerging field, who are called patient advocates, health care managers or patient coordinators, also work with doctors to help patients receive good care.

Now, companies like My Health Care Manager LLC, an Indianapolis startup, are getting into the game—and their influence is spilling out of hospitals across the spectrum of patient care.

My Health Care Manager grew out of CEO Alan Stanford's experiences arranging health care for his mother and in-laws.

"My wife and I saw that the health care system is indeed problematic and difficult to navigate. If you do not have anyone to help you, you are basically winging it," Stanford said.

In just three years, the company has grown to providing advocates for 50,000 people in central Indiana, specializing in elder care.

Entrepreneurship in the field is so new that Kathleen Strain, who just finished a term as president of the Indiana Society for Healthcare Consumer Advocacy, learned of the trend during a conference in 2007. All 63 members of the organization work for hospitals, but Strain said it would welcome independents.

"As a patient advocate, I want to see the best outcome for our patients," said Strain, who works at LaPorte Regional Health System in northwestern Indiana.

Most advocates have a nursing background. Nancy Hanley, who works for My Health Care Manager, has been a nurse for 31 years and now manages care for residents at The Stratford at WestClay, an active senior community in Carmel.

Hanley helps clients find the right doctors, signs them up for rehabilitation programs, and organizes their medical records into a single document. When a Stratford resident goes to the hospital, Hanley visits the patient regularly, works with physicians to coordinate care, and helps make any transition to rehabilitation as seamless as possible.

"We bridge that gap," Hanley said. "We coordinate with doctors to make sure our residents are getting the best level of care, and that we can speak out for them."

Both wings of patient advocacy say their job is to put the patient's interests first, no matter who's footing the bill.

St. Vincent Hospital introduced four of the positions to the oncology department in July. Amy Starling, St. Vincent executive director of oncology services, said the need for patient advocacy has grown because the medical industry is still under-computerized, with medical records and databases spread among different doctors' offices and hospitals.

"I think it's unfortunate that people are put in a situation where they have to pay to have that done," Starling said.

Observers like Bryan Brenner, CEO of Benefits Associates, an Indianapolis company that coordinates health and welfare benefits for companies across the country, think growth into private-sector advocacy reflects not only a need for better coordination, but also a new market for upscale health care consumers who want full-service help with every aspect of medical care.

"Americans have more desire than five years ago to actively manage their health care," Brenner said. "And it's difficult to do, because it takes a lot of coordination. There isn't one place to go to get information."

Hospital-based patient advocates may have the patient's best interests at heart, Brenner said, but their association usually ends with the hospital stay. And they can't help with things like selecting the right nursing home for a loved one, or coordinating a unified medical record for retirees who spend half the year in Florida.

Consumers are willing to pay for the help, and employers will, too, because they want employees to like their benefits, Brenner said.

Private patient advocates charge $75 to $150 an hour, said Stanford, the My Health Care Manager chief. His company charges $90 to $120 an hour.

Richard Frankel, an Indiana University professor of medicine at IUPUI and Regenstrief Institute research scientist, believes the growing role of patient advocates reflects a need for greater transparency on all levels of health care.

"You're trying to prevent bad things from happening. It doesn't matter who does the advocacy," said Frankel, who has spent 30 years studying how patients and doctors talk to each other. "It may mean that having a company represent an individual is actually a really good thing."

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