Helpers Cloud Health Services Insurance, Private and Hospital Aides Have Varied Goals

By Toland, Bill | Pittsburgh Post-Gazette (Pittsburgh, PA), March 25, 2012 | Go to article overview

Helpers Cloud Health Services Insurance, Private and Hospital Aides Have Varied Goals


Toland, Bill, Pittsburgh Post-Gazette (Pittsburgh, PA)


Health care can be a tangle of red tape and frustrating dead ends, both on the clinical side and on the insurance end of things. But now, with the emergence of "health concierges" and "health care navigators" -- telephonic nurses and aides who walk customers through the intricacies of America's jumbled health system -- customers can feel they have somebody on their side.

At the same time, the proliferation of these advocates means it's getting harder to know who's working for -- or with, or against -- whom.

Health insurers Highmark Inc. and UPMC Health Plan offer their own services -- Highmark's is called myCare Navigator while UPMC offers health care concierge services. For-profit insurers have them, too -- Aetna has "care advocate teams."

Hospitals also have in-house advocates that help patients during their stay, especially those patients with serious diseases or chronic conditions.

And then there are the private advocates who work for the patients alone, charging an hourly rate for their services -- which typically include settling billing disputes between doctor and insurer.

Independent physicians, meanwhile, are concerned that the insurer- based navigators are trying to steer customers to providers of choice, and also that patients may be bewildered by the number and variety of advocates now available to work on their behalf.

Which, somewhat ironically, is the exact opposite of what advocates hope to accomplish.

"I think it's fair to say that we have a complex health care system now," said Cecil Wilson, immediate past president of the American Medical Association. "The [navigator's] attempt is to take some of the bewilderment out of the system."

So concerned are some physicians about the various "navigators" that the American Medical Association took up the issue at a recent policy meeting in New Orleans late last year. The association approved a resolution calling on the AMA and the American College of Surgeons to "ensure that patient navigators are free of bias, do not have any role in directing referrals and do not usurp the physician's role in and responsibility for patient education or treatment planning."

The resolution also says navigators should "refrain from any activity that could be construed as clinical in nature" -- such as making specialist or pharmaceutical recommendations, or interpreting test results.

"Navigating the health care world can be challenging. Successful patient navigation programs can help to eliminate some complexity patients face, and barriers to care," said Jennifer Hanscom, chief operating officer of the Washington State Medical Association.

But "as the field of patient navigators develops, the WSMA would like to see some clear definitions or standards of training requirements," she said.

One of the pioneers in the young field of patient advocacy is Health Advocate Inc., which turns 10 this year and was founded by former health insurance executives. Based in Plymouth Meeting, Pa., Health Advocate is the company that operates and fields phones calls for Highmark's new, free myCare Navigator hot line.

The company was created when Executive Vice President Martin Rosen and his co-founders realized there was no good answer to the question: "Who's the go-to person to help the individual navigate issues?"

Given the overwhelming range of issues a policyholder has to deal with, "what dawned on us was that [there] are instances where things fall through the cracks," Mr. Rosen said.

While Highmark is now a client, most of his clients are businesses and unions, which hire Health Advocate to assist employees solve health-related problems. …

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