BFCC-QIOs Fulfill Patient Advocate Role for People with Medicare and Their Caregivers

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Patient advocates help patients and their families access health care, manage insurance and make treatment plan decisions, among other forms of support. The Centers for Medicare & Medicaid Services’ (CMS) Quality Improvement Organization (QIO) Program’s Beneficiary and Family Centered Care – Quality Improvement Organizations (BFCC-QIOs) can be a valuable patient advocate for Medicare patients and their families.

KEPRO and Livanta, the two BFCC-QIOs covering all 50 U.S. states and three territories, can serve in a patient advocate role for another group of people — caregivers. Caregivers play a major role in the life of the people they look after, which are typically individuals with a chronic illness or disease, or impairments related to aging. Caregivers perform many different activities, including managing medications or talking to doctors and nurses on the patient's behalf. Assisting with health care can be confusing and frustrating for caregivers because it isn’t always obvious whom they should seek out for answers to questions and concerns.

"BFCC-QIOs offer a free service for people with Medicare that can be a tremendous help to caregivers — Immediate Advocacy." 

If someone doesn’t feel well, caregivers can help by making an appointment to see a primary care physician. But what happens if the caregiver is told by a pharmacist that a prescription can’t be filled? Or if the physician orders home health services that never start? What if promised medical equipment isn’t received? In these instances, caregivers can call the BFCC-QIO for the Medicare patient’s state or territory of residence to get answers.

BFCC-QIOs offer a free service for people with Medicare that can be a tremendous help to caregivers — Immediate Advocacy. It is a process that can be used to quickly address and resolve certain types of issues. Once the BFCC-QIO representative determines that a complaint can be addressed through Immediate Advocacy, he or she will ask the caregiver for permission to share his or her name and concern with the health care provider. The BFCC-QIO representative then informs the provider that there is a complaint that potentially can be resolved via Immediate Advocacy. If the provider agrees, the BFCC-QIO can begin the process, holding a conference call or a call on the caregiver’s behalf to resolve the complaint. The goal is a quick and agreeable resolution, usually within two business days.


Data Source: Analytic summary was prepared by the Beneficiary and Family Centered Care-Oversight Review Center (BFCC-ORC)

Immediate Advocacy is a valuable, free service for people with Medicare, which many people still don’t know about. According to the most recent BFCC-QIO annual reports, BFCC-QIOs resolved 5,377 Medicare beneficiary complaints between August 1, 2016 and July 31, 2017. BFCC-QIOs provide a range of services including complaint resolution, Immediate Advocacy, and appeals. Immediate Advocacy yields the highest degree of reported satisfaction. Table 1 shows the percent of Medicare beneficiaries who report being satisfied with the outcome of their BFCC-QIO service. Medicare beneficiaries who participated in Immediate Advocacy to address a complaint were more satisfied with their outcome than those who opted for the formal Complaint Resolution process.

All people with Medicare, their families and caregivers can learn more about Immediate Advocacy and locate their BFCC-QIO. The QIO Program’s BFCC National Coordinating Center recommends keeping this information with other important telephone numbers for future use.