Making the Business Case for Patient Navigation

Nurse navigators, as well as other patient navigators, play a vital role in cancer care that is not always visible or quantified. When an institution is able to measure the effect navigators have on their bottom line, it becomes easier to garner more resources and greater support for expanding their navigator programs.

In a brass-tacks presentation at the Second Annual Patient Navigation Initiative (PNI) conference in New York City on Feb. 5, Zenobia Brown, MD, MPH, Medical Director, Northwell Health discussed the business model that is driving patient navigation efforts in breast cancer care. She also explained how navigators can play a part in strengthening these services in their own institutions.

The PNI conference, organized by the Susan G. Komen Greater New York City affiliate (Komen NYC), was based on the premise that a more focused approach to navigation is required to reduce the number of late-stage diagnoses and high breast cancer mortality rates, particularly among African-American and Latina women.

Brown’s practical advice to attendees centered around how to make the best business case for expanding patient navigation. At Northwell Health, her navigator team grew from 10 to 45 people in one year. How? Follow the money, she recommends. Justify the benefits of the program in terms of quantifiable, sustainable outcomes.

“It can’t be just that the patients like it,” Brown said. “It has to be: patients like it, there’s a way to pay for it, and the outcomes are going to be better.”

Brown stressed that in today’s healthcare environment, with the increased need to justify pay for value-based care rather than fee for service, hospitals must have programs like patient navigation to be sustainable. A large part of patient navigation is preventing gaps in care. Navigators are often charged with ensuring that women have access to preventive care, for example. Mammograms can help catch cancer at an early stage, which would make it more easily treatable, which in turn translates to better survival rates and lower cost of care.

Transitional Care Management

Whenever there is a change in a woman’s care trajectory, there is a risk of something falling through a gap, said Brown. “When something falls through a gap, what happens? A bad outcome. Bad outcomes are expensive,” said Brown.

The money trail can be found in the transitions, said Brown, for example, hospitalizations. “If we control that time around the hospitalization, meaning the patient gets their medicine, they have access to their pills, they get their follow-up appointment with the oncologist, we’ve done a good job,” she said. If not, the patient could end up in emergent care, and with a worse outcome, and of course, increased cost of care.

There are many transitions in cancer care. Brown gave the example of a patient who has just been diagnosed, and the steps along the way where a patient could experience a gap in care.

“Tissue diagnosis, biopsy, rebiopsy, second opinions — did all the information get to the second opinion person? This report didn’t get in, the right referral didn’t get in to the specialty clinic … initiation of change from one chemotherapy to another. Side effects. Lots of different providers involved. Failure of clinical trial – if for some reason the patient can’t take the drug – they lose their whole care team. Now a whole new team needs to get to know this patient and their history. That’s a transition. Transition to palliative care. This is where things fall through the cracks and things get expensive,” Brown said.

A navigator’s job is to break down the barriers that keep patients from accessing appropriate care at the appropriate time, and with the appropriate resources.

Meeting the patient for an introductory in-person visit, following up 24 hours after discharge, connecting with their network, possibly seeing people at home, and identifying what they need are all part of a navigator’s role, Brown said.

She cited the Komen white paper that kicked off the Patient Navigation Initiative which reported that good navigation can lower the cost to the system by $600 per patient per year. Better navigation leads to better, lower-cost care.

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