Immediate Advocacy is Changing How Medicare Patients Navigate Care — Here’s How

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Patient advocacy is a key component in any comprehensive wellness plan, and knowledge of available resources may make the difference between remaining at home and returning to the hospital. April’s National Patient Advocacy Month provides the opportunity to bring attention to a benefit from the Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) for people who have Medicare.

Immediate Advocacy is a free service provided to people with Medicare by the two BFCC-QIOs—KEPRO and Livanta—that serve all 50 states and three territories.

When patients attempt to advocate for themselves or someone else, such as a family member, and run into a roadblock, Immediate Advocacy can be useful. One big advantage is it can solve eligible issues quickly, usually in less than two days. 

Through person and family engagement projects, BFCC-QIOs are encouraging patients to take active roles in their health care. Some recent, real-life examples of patient calls to BFCC-QIOs demonstrate how this process works.

In one case, a Medicare patient’s husband called KEPRO with concerns about his wife’s discharge from a skilled nursing facility (SNF). Through a care conference with the surgeon, it was determined he was capable of taking care of his wife with home health services. However, once his wife was home, he had questions. He called the BFCC-QIO to request help with understanding the plan of care and continued treatment options.

The clinical care coordinator (CCC) at KEPRO worked with the SNF social worker to schedule a three-way conference call with the home health agency, social worker and the patient’s husband. The meeting gave the patient’s husband a chance to ask follow-up questions to help both him and his wife better understand the plan of care. Now, they were comfortable with the next steps for continued treatment. The CCC followed up with the patient’s husband to reinforce his confidence going forward.

In another example, a Medicare patient entered the hospital for complications with diabetes, then unexpectedly ended up facing a leg amputation. After surgery, she was fitted for a prosthetic leg and learned there was a delay in the manufacture of her permanent prosthetic.

With her discharge pending, the patient called Livanta and requested Immediate Advocacy to assist with the challenges she anticipated after discharge. Now in a wheelchair, she needed to learn how to accomplish everyday tasks like getting into her front door and showering. A local volunteer service arranged to assist in personal daily activities and provide services such as meal preparation, grocery shopping and prescription pick-up. 

Durable medical equipment for the bathroom was ordered and delivered. Volunteers from the local Lions Club built a handicap ramp for easier home access. When the patient was referred to the regional Area Agency on Aging, she was assigned a case manager who helped her to better find and access health resources. 

Medicare patients who may be concerned about their health care or related medical services can call their BFCC-QIO and ask about Immediate Advocacy. Visit www.qioprogram.org for more information about Immediate Advocacy and BFCC-QIOs.