Do you have “patient navigators” on your hospital patient access team, or roaming independently through the halls? Most folks are aware of patient advocates and the work they do, but over the last 20 years or so, the rise of “patient navigators” to help families and individuals deal with the complexities of medical care has been building. Some hospitals like Seattle Children’s, have a formal program for patient navigators.  We take a look with an eye on cost and if it can be a help to the hospital revenue cycle.

Patient Navigators are increasingly helping people find their way through the changing healthcare system.

When it comes to finding your way through evolving healthcare systems, “Patent Navigators” are showing up to help people achieve the best outcomes.

There are different names for people working in the field ranging from healthcare navigators to assistors to patient advocates who may have a slightly different focus with some overlap in the services provided.  Pathfinders Medical Advocacy and Consulting, has published one take on the difference. One difference, according to Founder & CEO Linda Adler, is that advocates are generally private individuals while navigators work within the system.

But boundaries are not always that clear in the research we found. “A healthcare navigator is “an individual or organization that’s trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms,” according to HealthCare.gov. “These individuals and organizations are required to be unbiased. Their services are free to consumers.”

According to the PatientNavigator.com blog, “The original concept of patient navigation was pioneered in 1990 by Dr. Harold P. Freeman, a surgical oncologist at Harlem Hospital, for the purpose of eliminating barriers to timely cancer screening, diagnosis, treatment, and supportive care. Many individuals in medically underserved or minority communities were at risk because of financial, communication, health care system and cultural barriers to care. In 2005, U.S. policymakers came together to support the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005 (Public Law 109-18). With unanimous support in Congress, and under the leadership of Senator Robert Menendez (D-NJ), the Act authorized the Secretary of Health and Human Services to make grants through 2010 for the development of patient navigator programs. A total of $25 million was awarded over five years to develop community-based navigation programs.”

Patient Navigators Impact on the hospital revenue cycle

Accenture studied the impact of Patient Navigators at three health systems and found striking positive results.

For families, navigators can be a God send, and medical professionals have seen clear results as well.  “Over the years, data from Dr. Freeman’s programs and others began to prove how valuable navigation could be to improve cancer diagnosis and treatment outcomes. For example, studies found that patient five-year survival rates went from 39 percent (prior to the development of the patient navigator program) to 70 percent for breast cancer patients at Harlem Hospital.”

A more recent study by Accenture detailed in Healthcare Business & Technology, found that “hospital patients were also more likely to receive primary care services that helped them stay healthy – specifically, screening colonoscopies. Thanks to information they received from navigators, 13% more patients underwent a colonoscopy to look for early signs of colon cancer.”  More benefits uncovered include:

  • Patient navigators allow clinical staff to focus on caring for patients.
  • Patient navigators keep clinical staff from burning out.
  • Patient navigators help reduce no-show rates for facilities because, “they directly address many of the underlying issues that cause patients to miss appointments for tests and procedures.”

Navigators may also be called “assistors” and there are educational resources available from the government.  Centers for Medicare & Medicaid Services (CMS) has prepared a PDF guide for a quick overview for Assistors on how to access and register in the Marketplace Learning Management System (MLMS). The MLMS is specifically designed to provide both one-time and continuous online training.

Patient Engagement HIT has a related article where “healthcare navigators” are called “patient care navigators”. The editors write that, “Non-clinical lay people make effective patient care navigators, offering a low-cost solution for offering care coordination services to aging cancer patients trying to access quality treatment, according to a recent study published in JAMA Oncology.” The study was done at The University of Alabama at Birmingham (UAB) Health System Cancer Community Network (CCN)  to test the theory that lay navigators would both help patients and help lower costs. To test this theory, the researchers created the “Patient Care Connect Program” (PCCP) at the UAB Cancer Community network, employing non-clinical laypeople as patient care navigators throughout its network, including at two academic and ten community cancer care centers in Alabama, Georgia, Florida, Tennessee, and Mississippi.

The study found that, “there was a significant decline in costs and resource use for navigated geriatric patients with cancer within the PCCP compared with matched non-navigated patients. Overall, cost reductions were driven by substantial declines in hospitalizations and clinic-based services. This model has the potential to reach the Triple Aim2 of improved health care, better health, and lower costs and significantly enhanced healthcare delivery in the United States as health systems transition to value- based health care.”

Patient Navigators in Cleveland

From a study entitled, “The Emerging Field of Patient Navigation: A Golden Opportunity to Improve Healthcare”, by The Center for Health Affairs

Meanwhile, in Cleveland, Ohio, the Center for Health Affairs has released a study predicting that “in the coming years, navigation will grow and evolve as more providers realize the value navigators bring to the healthcare team. Their role will become even more important as medical care becomes more advanced.”

It looks like Patient Navigators are on the rise, and the main question for hospital revenue cycle strategy is when and where to plug them in.  Kelly Michelson, MD, an attending physician in the pediatric intensive care unit at Ann & Robert H. Lurie Children’s Hospital of Chicago, wrote a thoughtful piece in Patient Engagement HIT.  She is cautiously optimistic about Patient Navigators in the healthcare system while raising the following points for consideration:

  • It isn’t clear, for example, who makes the ideal navigator. Many programs use nurses or social workers, but spiritual care providers (also known as chaplains), or even former patients may also be a good fit.
  • Do we need “to add more people to already large complex health care teams, or simply better use existing non-physician health care providers”?
  • Many medical teams do not include essential psychosocial support providers, like social workers and spiritual care providers.
  • Patient navigators aren’t a substitute for better communication between physicians and their patients or families and each other.