Sustainability Strategies for Navigation
Nurse navigators should consider sustainability strategies to ensure that their progress remains.
Jace Longnecker, BA, MBA, CCL
If one day for any reason you stopped going to your job as a navigator, would the people who follow you be able to pick up where you left off, or would they be stuck trying to reinvent the wheel? Are you building a legacy with your role so that those who come after you can stand on your shoulders and go even further than you, or are you setting them up for failure? Navigators need to start thinking of how we can sustain the progress we have worked so hard to attain.
Process Manuals as Living Documents
The way that you help patients overcome barriers to care may seem second nature to you, but you may well find that your common sense is quite uncommon, and the process is more complicated than you had imagined.
Experienced navigators need to write down our common processes. For example, you may refer all of your patients with head and neck cancer to a nutritionist as part of your care coordination. Write down exactly how you accomplish this, what information is required, and to whom the referral is sent. Include the referral form as an appendix, along with any common problems with the referrals and how you have overcome them. Be as detailed as possible, and try to make the language accessible so that anyone can read it.
Put together a binder of all of your processes, or make an electronic document if at all possible so that you can disseminate the knowledge efficiently to all who need it. Remember that process manuals are living documents. Be prepared to make changes as they come.
Navigators need to start thinking of how we can sustain the progress we have worked so hard to attain.
Resource Database in the Cloud
There seems to be a ubiquitous binder in every case manager, navigator, and social worker's shelf full of notes about resources that may or may not actually work. These binders often contain outdated information, making the binder an unreliable waste of space even though it may contain some useful resources.
Our team came up with a simple but effective replacement for the binder; we created a spreadsheet database. It wasn't the most elegant solution, but it was free, and we were able to distribute it across our entire state instantly.
First, we vet all of the resources before placing them in our approved resource list. We exclude resources that do not return our calls or emails. As we communicate with the resource agencies, we confirm and record eligibility information. For continuity's sake, we commit to vet the resources as a team every 6 months. It is surprising how many resources can become defunct within that time span.
Second, we take the approved resource list and enter all of the relevant information onto uniform factsheets created for each resource. The template includes space for contact information, eligibility requirements, nature of assistance offered, and any special notes that could be relevant to the navigator or patient. The factsheets are saved in an electronic folder.
Third, we enter the basic information created for each resource into a spreadsheet, organized across 3 columns: (1) resource name hyperlinked to its respective factsheet, (2) location, and (3) resource type, for example, transportation, support, non-medical bills, and housing. We restrict the resource types to 20 unique terms to make it easier for the navigator to sort the terms for the patient’s specific needs when looking for resources.
Fourth, we use zip software to combine the spreadsheet and resources into a single folder, making sure that all patient health information is deleted from the resource files to prevent violating HIPAA. We upload to a cloud service like Dropbox or Google Drive, enable sharing options, and send the link to all personnel who should access it.
If your hospital system employs database programmers, by all means, use them to create a more refined version, but always take the time to vet the resources periodically. This database can be an invaluable tool to your team and serve them well in case you are absent.
Manuals and databases sustain navigation by improving continuity, but revenue-generating programs will sustain navigation on many different levels. You could hire more staff, prove your monetary worth to corporate leaders, and give your patients better access to care.
Demonstrating Your Value
- Document your navigation procedures in a way that they can be easily disseminated
- Compile a centrally accessible list of patient resources by location and type
- Record all of the successful cases helped by deploying revenue-generating strategies
One of the strengths of navigation is that we can anticipate problems before they occur and arrange for the appropriate screening. In Georgia, we can screen patients with breast and cervical cancer who are self-pay for eligibility for the Women's Health Medicaid program. We also screen Medicare patients for eligibility for QMB (Medicaid’s Qualified Medicare Beneficiary program), as well as for the “Extra Help” program for individuals who need assistance paying for Medicare’s Part D drug coverage. See if your hospital offers any COBRA premium assistance programs to help the recently unemployed maintain their coverage for treatment. Copay and pharmacy replacement programs can also bring in revenue.
Availability of these programs will depend on your location. Sometimes our own organization's systems are so large and disconnected that they don't share patient insurance information. Share the information with your organization's billers. Sometimes you are referred insured patients that supposedly are not covered for certain services; make the call to the insurance company yourself with the proper ICD-10 and CPT codes to confirm this. I have found many times that patients are covered—by confirming coverage, we retain paying patients.
Keep a record of all of the successful cases you have helped, using these revenue-generating strategies and programs. It is a win—win for both your organization and the patient, who in many cases gains better access to care.
These simple and free strategies will help you to sustain your navigation program, build your legacy, and demonstrate that your team is beneficial to your organization.
Jace Longnecker, BA, MBA, CCL, is a lay navigator at Northside Hospital in Atlanta.