Role of Professional Advocate vs. Case Manager: What’s the Difference? with Teri Dreher, RN, iRNPA, CCM, Board Certified Patient Advocate and Owner/CEO NShore Patient Advocates, LLC

Role of Professional Advocate vs. Case Manager: What’s the Difference?

By Teri Dreher, RN, iRNPA, CCM, Board Certified Patient Advocate | Owner/CEO NShore Patient Advocates, LLC

Everybody needs a patient advocate. That’s the message the American Heart Association conveyed in their publication Heart Insight (Caswell, 2015). Indeed, with America’s increasingly complicated healthcare system, more and more inpatient case managers are finding that what the AHA said is true, and as a result, they are turning to patient advocates to help manage post-discharge care of patients with complex comorbidities who are at high-risk for readmission. Community-based private professional RN Patient Advocates are experts in community resources and oversight the same way hospital case managers are experts at case management in the acute care setting. In fact, community-based RN Patient Advocates have a very similar role that community-based RN care mangers do. It is not “reinventing the wheel” as some have posited. Both professions have patient advocacy as a core value but there are some subtle but important distinctions that are important to patient centric care models. Understanding these will help both work more collaboratively for the patient’s benefit as well as the hospital’s on several levels.

A good professional patient advocate empowers individuals or families to make informed choices by educating them about the patient’s medical conditions, asking physicians questions the patient wouldn’t know to ask and researching a patient’s full range of treatment options. They also act as a liaison between patients and providers, looking out for a patient while they are receiving treatment and ensure that insurance and billing disputes get resolved quickly. Since all of these are tasks that community care managers are involved in, let’s take a look at some of the differences and similarities between the two professions.

First of all, the field of professional patient advocacy has only officially been in existence for about 10 years, whereas case/care management is a much more mature field that has existed for over 25 years. Professional advocacy has been growing due to an increasing sense of consumer alarm over high rates of medical error, frustration and confusion over our rapidly changing healthcare system. Quite frankly, patients hire this group to advocate and fight on their behalf; someone to stand in the gap and make certain their personal interests are protected. To advocate essentially means to represent the needs of another. Patients understand the allegiance factor that separates case managers who work for institutions from those who are privately paid by the patients themselves. Yes, community care managers are often privately paid as well, although in many cases, professional advocates get involved when patients do not only need someone to manage their healthcare, but advocate strongly on their behalf, either with insurance companies, vetting the best providers for rare disorders or even standing up for them in ethical challenges within hospitals. We do essentially the same thing that any good nurse or social worker does for Continue to page 20