Insurers offer health system navigation to patients
■ Two Pennsylvania Blues plans can help with such tasks as scheduling appointments, obtaining records and locating a specialist.
By Emily Berry — Posted March 19, 2012
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"Health care navigators," or "health care advocates," are becoming increasingly common. The terms describe people with very different job responsibilities but with at least one shared goal: eliminating hassles for patients.
Some of the latest entries to the patient advocacy and navigation field will work for insurers. Most notably, Highmark, a Pittsburgh-based Blue Shield plan that has nearly 5 million members, will provide a call-in service. Highmark hired Health Advocate, based in Plymouth Meeting, Pa., to provide myCare Navigator, a service available to all members.
Independence Blue Cross also has hired Health Advocate throughout Philadelphia. Health Advocate's work is limited to Independence Blue Cross' 4,500 employees, but Independence Blue Cross plans to offer the service to its members if the experiment goes well.
Most of Health Advocate's 8,200 clients are employers that offer the service to their workers as a benefit, said Martin Rosen, the company's co-founder, executive vice president and chief marketing officer.
Highmark's 4.8 million members may call a toll-free number for help with health care hassles such as finding a specialist, scheduling an appointment, transferring medical records and forwarding test results.
Highmark decided to offer the service in response to market research, which suggested that 92% of members wanted help with those types of tasks, said Steven Nelson, senior vice president of strategy, development and product.
The care navigators available to Highmark members will not help with more clinically oriented problems such as understanding a diagnosis and choosing a treatment plan. They will not sort through insurance-related problems like denied claims or confusion about out-of-pocket costs.
Health Advocate helps other clients manage such tasks. But Highmark employees, including case managers and customer service personnel, handle those needs, Nelson said.
Delegates of the American Medical Association discussed the role of patient navigators at their 2011 Interim Meeting held in November in New Orleans.
They approved policy that called on the AMA to work with the American College of Surgeons and other organizations 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, and act under the direction of the physician or physicians primarily responsible for each patient's care."
The policy states that patient navigators should "refrain from any activity that could be construed as clinical in nature," disclose any potential conflicts of interest, and communicate with patients' physicians directly.
Nelson said he expects to see the demand for patient navigators climb as the physician shortage worsens and parts of health system reform that have yet to take effect add layers of complexity.
Health reform is promoting primary care and patient-centered care, which has prompted Genesys Health System to offer patient navigators who work in primary care clinics. Genesys, based in Grand Blanc, Mich., is one of 32 Pioneer ACO sites selected by the U.S. Dept. of Health and Human Services.
As part of its HealthWorks program, Genesys has integrated health navigators into its efforts to improve care by managing chronic illness and promoting primary care services to patients before they become ill.
Trissa Torres, MD, MSPH, medical director for the Health Works program, said it makes sense for health navigators to work in a primary care office.
"From our perspective, the closer that function is to the primary care physician, the more effective it is," she said.