Profit-Driven Patient Advocacy and Legal Risks

This article is a report discussing the rise of for-profit patient advocacy organizations and their implications for managed care organizations. It outlines the traditional role of patient advocacy as a non-profit service aimed at supporting patients through the complexities of the healthcare system. The report explains how the introduction of profit motives in patient advocacy can compromise the loyalty of advocates to patients, leading to potential conflicts of interest and increased risks in patient-provider-payor relationships. It details the origins of patient advocacy, the shift towards profit-driven models, and the various business models that have emerged, including hourly billing and value-based compensation. The article also highlights the negative impacts of these new advocacy practices on healthcare claims, including increased out-of-network utilization and litigation, which can complicate compliance and escalate costs for managed care organizations. Overall, the report emphasizes the need for health plans to navigate the challenges posed by this evolving landscape.