In a typical year, even the healthiest of Americans will navigate a wide variety of routine health care appointments and processes. But what about those moments when a health diagnosis becomes far more complex—a cancer treatment, a health scare with unknown causes, a complicated pregnancy? For these moments, Health Access Solutions members have a valuable resource through our partnership with Patient Advocates.
For more than 40 years, Patient Advocates has sought to educate, engage, and empower their members and clients to take ownership of their wellbeing so that they have the tools they need to navigate the health care system successfully and secure the best quality care. Patient Advocates has developed relationships with leading regional and national centers of health care excellence around the country so that when patients face a tough medical situation, they can do so with health care professionals who bring world-class care with a level of professionalism, compassion, and empathy that helps put the patients and their loved ones at ease.
To share more about Patient Advocates and the services they can provide for Health Access Solutions members, we spoke with Andrew Ward, Chief Executive Officer of Patient Advocates.
What types of medical situations do Patient Advocates most commonly help their members navigate?
Ward: Our most common starting point is helping patients get second opinions at Centers of Excellence (COE). These are the best hospitals in the country — they have the top specialists, most advanced treatments, and are recognized for providing exceptionally high standards of care and expertise in specific areas of care.
Recent studies have shown that about 20% of patients receive a distinctly different diagnosis when seeking a second opinion. For diagnoses such as cancer, cardiac, neurosurgery, spinal surgery, or high-risk pregnancies, the outcome of a second opinion is that, in many cases, patients learn either that surgery is not necessary or that there is an alternative, less invasive treatment. A few notable examples from some of our patients:
- A patient had been diagnosed locally with cancer and scheduled for surgery, but upon referral to a leading cancer center in Boston, the patient was found not to have cancer at all.
- A patient had their breast cancer identified locally, but after additional tests were performed in Boston, it was determined the cancer had started spreading to the patient's lymph nodes, completely changing the course of treatment.
- A mother with a high-risk pregnancy had been told that the unborn baby would require open heart surgery immediately upon birth. We referred the patient to Brigham & Women’s (B&W) for a second opinion. B&W, together with Boston Children's Hospital successfully delivered the baby and, after a few days of testing, determined the baby did not require surgery. The family was discharged, with the mother and baby remaining together the entire time.
While there are many stories like these, there have been countless cases where the original diagnosis was confirmed. By having additional testing done, however, the patient not only has the peace of mind knowing their plan of care is correct, but they also can opt to have their procedure take place at a world-class hospital facility, performed by a top specialist, in an environment that is safe, professional, and recognized for having the highest standard of care possible.
Importantly, if the patient has to travel for a second opinion, treatment can still be handled locally. With cancer cases for example, we may work with a provider in our COE program to determine the staging, treatment, and plan of care. Then, our nurses play a pivotal role in ensuring the treatment plan is communicated to the local oncologist and reviewed with the patient. They also maintain contact with both to ensure compliance with the plan and, if there’s any divergence from the plan, can communicate with the COE on the patients’ behalf.
When members face complex or unexpected diagnoses, how does Patient Advocates step in to guide them through the decision-making and treatment process?
Ward: When someone faces a serious diagnosis or health event, getting the right care quickly can make all the difference. But the challenge, especially in our current environment, is that the health care system runs slowly on cruise control.
That’s why we have a dedicated team of full-time Nurse Case Managers. They make the system run at the speed our patients not just need but deserve. Our nurses treat each patient as if it were someone in their own family and are there for them every step of the way. They advocate for each patient from the moment of their diagnosis, during their treatment, and throughout recovery to ensure their needs are met and that the health care system serves them.
The key to our case managers’ success is the broad range of experience—especially in hospital settings—they bring to the table for each patient. They know the ins and outs, the strengths and weaknesses, of the health care system from an insider perspective. They know how to expedite appointments and find the best specialists. They remove the burden from the patient and handle all of the tedious details that can make health care so frustrating: sending medical records, making referrals, scheduling appointments, coordinating between providers, arranging travel and lodging. Most importantly, they are doing what they love—they are nurses with a passion for helping patients and can do so without the confines of a hospital system or provider network.
Ultimately, Patient Advocates’ goal is to relieve the patient and their family of any burden so they can focus on what's most important: their health and wellbeing.
How does the advocacy provided by Patient Advocates help reduce overall health care expenses for members without compromising on quality of care?
Ward: We understand the health care landscape and have a team whose sole responsibility is helping patients ensure they receive the best value and care. We achieve this by partnering with hospitals and pre-negotiating rates for certain procedures where we know the patient will receive excellent care without the burden of high costs.
As an example, we have a direct arrangement with a local hospital for knee and hip replacements. Our price is $20,000; we have seen claims from other hospitals in the state for the same procedure at close to $53,000.
We believe that quality health care is the least expensive health care. Our long-term relationships with leading centers of health care excellence in the region enable us to help get our patients admitted quicker at costs that are lower than local alternatives.
How You Can Benefit
If you face a complex health care situation as a Health Access Solutions member, our support team can help and refer you to Patient Advocates for case management if appropriate. You can contact our team with questions at members@healthaccesssolutions.com or (800) 606-1135.