Executive Summary

Like case managers, patient advocates work to improve population health. Their work includes taking care of a patient population for payers, employers, and unions.

• Registered nurses provide case management-type services while in the patient advocate role.

• The goal is to reduce hospitalizations and emergency room visits by being available 24/7 to answer any questions, concerns, and medical crises.

• Health care education and prevention are the main focus.


As health systems, payers, employers, and even unions look for case management-style models for improving their populations’ health, some are hiring RNs to serve in a patient advocate role.

For instance, the Electrical Workers Health and Welfare Trust Fund in Las Vegas has an RN patient advocate who provides a personal touch when working to improve members’ health.

Advocates — like case managers and care coaches — meet patients wherever they are, including in the hospital, at the union hall, or at events, says Candace Facio, RN, patient advocate and clinical manager with the Electrical Workers Health and Welfare Trust Fund. Facio speaks at conferences about increasing productivity and containing health care costs through advocacy and case management-type services.

“The Fund was looking for someone to take care of members on a more personal level,” Facio says. “We work hand-in-hand with a case management company.”

Facio is available by telephone 24/7 to her patients, who are members of the electrical union. They can meet with her in person or call her when they or she is out of town, she says.

While she attended a recent patient advocacy conference, Facio had to excuse herself a couple of times to answer calls from patients. “My thought is, if I can spend 15 minutes on the phone then it might prevent a hospitalization,” Facio says.

It worked: “I had a gentleman who had back surgery and couldn’t get his pain medications,” she recalls. “In 15 minutes, I talked with the vendor and pharmacy and found out where he could pick up his medications, making that process a little smoother for him.”

Some of the union’s members are enrolled in a patient medical home model, and Facio provides health coaching to them.

“On Mondays, Wednesdays, and Fridays, I do health coaching for diabetes, obesity, asthma, and depression,” Facio says. “The biggest one is obesity because a lot of chronic conditions fall under that.”

Facio also is involved in hospital rounds. She visits the hospital early in the morning and reviews the census to see if any of the fund’s members are there.

“I make sure things go smoothly, and I work with the hospital case manager,” she says. “I go through the prior authorization reports so if anyone has the potential of going into the hospital with surgery scheduled or a breast biopsy, I can reach out to them so they know who I am and they know they can call me if they have any questions.”

Members are happy with the service, and anecdotal evidence suggests Facio is making headway in helping members improve their health.

For instance, one diabetic patient’s A1C level was as high as 12.1 (normal levels are below 6). Within a year of health coaching, the patient lost 52 pounds and his A1C dropped to 5.8, she says.

“I have an asthma patient who lost enough weight to go hiking with friends in a higher altitude, which he couldn’t do before,” Facio says. “We got him into cardio rehab to deal with emphysema.”

Another severely asthmatic patient needed pulmonary rehab and was on a ventilator three or four times within two years. After receiving Facio’s health coaching, her asthma attacks stopped. “It’s been two and a half years and she’s had no ventilator and no major asthma attacks,” Facio says. “She has learned breathing exercises and what to watch for.”

For members who are coping with chronic diseases, Facio might set up a weekly or monthly in-person meeting or telephone call. These maintenance appointments will last 15-20 minutes by telephone or an hour in person.

“I ask them questions and provide a lot of motivation,” Facio says. “I’ve started a Facebook page for them with motivational and educational pieces they can find and read over — social media is a wonderful thing.”

Information about diabetes is very popular, she notes.

“I post things like ‘Here’s a quick 20-minute exercise you can do,’” Facio says. “I include things on chronic pain and back pain, reposting from diabetes or cancer websites, and they actually read these.”

Her case management work also takes her to patients’ doctors’ appointments to help patients remember all of the questions they want to ask. Facio will take notes during the appointment and then discuss it with patients later. And she goes to their pharmacies where she might meet with them to show them how to administer their shots, she says.

“I’ve gone to their houses, gone through the cabinets and said, ‘These probably are not the best items for you,’” Facio adds.

They know that she will answer their calls anytime, except when she’s on an airplane.

Despite her 24/7 accessibility rule, Facio says the members do not abuse it: “They might text me if it’s not an emergency.”

Sometimes, her work can be a real lifesaver, she says. For example, one night around 2:30 a.m., she was driving through the mountains while on vacation when she received a call from a member who became very winded within a few minutes of talking with her.

“I said, ‘Go to the ER, and I’ll tell them that you are on your way,’” she recalls.

The man took her advice, which was fortunate because he had acute appendicitis and was out of surgery by 6 a.m., she adds.