Helping Patients Act As Their Own Best Advocate

As patients and their loved ones become more actively involved in decisions about their medical care, they can get confused by the seemingly mysterious processes behind approvals and costs. Helping patients understand how prior authorization and their coverage works can empower them to more effectively navigate our complex, evolving healthcare system.

There are many potential benefits to "pulling back the curtain" that sometimes obscures these processes. Patients who are better informed can navigate the healthcare landscape more easily, and that usually means your practice can run more effectively, too. And when patients better understand how the various processes work, there's less miscommunication—and fewer calls and questions for your staff.

Most important, research shows that patients who are empowered to advocate for themselves not only feel better about the care they get, they're also more likely to get better. 

Educating patients often requires investing a little bit more time up front, but the odds are good that this investment will pay off. Asking a few questions in the exam room and maintaining a well-organized support staff can make a significant difference. Here's how:

Talking to Patients About the Cost of Care

Finding solutions for patients who are struggling financially may help improve their outcomes, as patients are less likely to comply with treatment recommendations if they can't afford them.

Additionally, many patients find it embarrassing to bring up cost issues with their medical team, and some worry that they'll receive less attention if they do. 

Putting your patients at ease and indicating your willingness to discuss their potential concerns increases the likelihood of a productive conversation about their treatment options.

Here are a few ways to begin the conversation:

- Asking patients about their insurance coverage. If they're unfamiliar with their plan, a good first step for them is to call their insurer or research their policy online. 

- Informing patients that financial assistance for medical costs may be availablein the form of government programs, medication assistance, or private programs. 

- Advising patients about less expensive treatment optionsand explaining that different treatment options can accomplish the same goals. Advances in technology have made it easier to weigh all the options and check costs.

- Explaining the role of companies that support the prior authorization processto help keep costs down while enabling the best possible care.

- Informing patients that your office is available to help them appeal a treatment decision by an insurer or care organization—and directing them to other resources, such as the  Patient Advocate Foundation, when you're not in a position to advocate for their needs.

Treatment goals, financial concerns, and insurance coverage may change over time, so keep the lines of communication with your patients open. That will facilitate ongoing discussions around costs.

Providing Patient-Education Materials

Printed patient-education materials aren't just helpful for treatment guidelines, they can also provide patients with information about treatment approvals and costs and give them something to refer to at home. Helpful topics include:

- Insurance. To advocate for themselves, patients must understand key points about insurance processes, coverage, and cost. Patients should also be clear on the meaning of terms such as copays and deductibles. Defining these terms can prevent miscommunication.

- Approvals, prior authorizations, and appeals. If patients know that certain treatments and medications require prior authorization, they'll be better prepared and less likely to get frustrated. They should also know how your office can assist with appeals, in case a request for a treatment is denied.

- Financial assistance. Informing your patients about government programs, medication assistance, or private programs can help ensure they get the care they need. For example, the Central Vermont Medical Center details its financial assistance program and points patients to other resources they may be able to use.

Transportation assistance. Securing transportation can sometimes be an obstacle for older, sicker patients. A list of county or church services that provide volunteer or free transportation to medical appointments can remove this obstacle to care.

Streamlining Patient Support

How can your support staff facilitate the process of benefits management? Best practices include:

- Identifying specific office personnel responsible for communicating with patients about approvals and costs. Designating a staff member can furnish real value to patients. That point person can refer patients to people (e.g., social workers) who can direct them to essential resources—such as copay and prescription assistance or clinical trials. 

- Informing patients about their main point of contact. For example, posting a sign at check-in or providing information online about who your patients can turn to for support can streamline the process. 

In summary, patients with better understanding of the healthcare system feel more empowered and tend to take more responsibility for their health. That's great for patients—and gratifying for the providers in charge of their care.