Patient navigation can benefit both patients maneuvering complex health systems and the health systems themselves, which often experience a high return on investment from navigation services.
Medical advances in the 20th century brought a greater need for subspecialization. With new medical knowledge and the development of innovative treatments and technologies, physicians couldn’t be skilled in every area of medicine. Instead, they needed to narrow their focus to better serve patients. As a result, health systems must make a world of multifaceted specialists and subspecialists more integrated and accessible. Patient navigation proves to be an excellent solution not only for patients but also to health systems that invest in the programs.
Value for Patients
Patient navigation is a support strategy that assists in education, addresses barriers to care and enhances shared decision-making between patients and providers. Patient navigators walk alongside a patient from the initial outreach and prevention that takes place in the community through navigating survivorship and end-of-life care.
Sharon Gentry, MSN, RN, HON ONN-CG, AOCN, CBCN, serves as the Program Director of the Academy of Oncology Nurse & Patient Navigators (AONN), which currently includes more than 9,000 nurse and patient navigators. Gentry has helped grow more than 30 Navigator Networks throughout the country. She stresses the importance of patient navigation in the complex world of cancer treatment.
“Navigating the cancer continuum requires a team of professionals to communicate seamlessly and effectively,” Gentry says. “Silos in care can lead to complexities and mistrust instead of timely treatment. Oncology navigators guide patients through cancer with the goal of eliminating barriers and ensuring each patient has access to care, education on treatment, opportunities to participate in clinical trials, care coordination, psychosocial support and support for palliative care.”
Nonclinical licensed patient navigators have direct knowledge of the community to assist patients with overcoming obstacles to treatment, such as lack of transportation, childcare, medical leave and insurance coverage. Clinically licensed navigators coordinate all components of care plans. Both types of patient navigators can be a trustworthy resource to provide continuous support and assistance.
Navigators have become valuable to cancer care programs, but they aren’t limited to the oncology field. In fact, most patients with complex conditions can benefit from having a “point person” to guide them through chronic disease.
Healthcare Return on Investment for Systems
There are upfront costs for implementing a patient navigation program. However, several studies demonstrate a long-term payoff for health systems.
The MetroHealth Cancer Center in Ohio initiated a year-long pilot using two full-time navigators to decrease the patient no-show rate. In three months, the reduction in no-shows for patients receiving radiation therapy equaled a navigator’s annual salary. The overall return on investment was $5 for every $1 spent. High-risk hospital admissions were reduced by half, and readmissions and emergency room visits declined by a third.
The Intermountain Southwest Cancer Center in Utah realized annual cost savings of $277,953 by medical oncologists and a 24-minute reduction in clinical visit time with newly diagnosed breast cancer patients when the patient had received an educational visit with a nurse navigator prior to meeting with the oncologist. Also, the medical oncologist was able to see an additional new clinic patient each day. The revenue generated from four oncologists seeing one new patient daily totalled $207,360. This plus the annual costs savings had the potential to bring in almost $500,000 to the system annually — more than covering the salary of a clinical patient navigator.
Other possible values of patient navigation include increased clinical trial participation and downstream revenue as well as decreases in oncology treatment times.
What Needs Improvement
To improve future programs, Gentry suggests clearly defining the role of patient navigators.
“The navigator should have a clear scope of practice that distinguishes his or her responsibilities from those of other providers,” Gentry says. “This clarification should be from the profession’s membership, not imposed by an outside regulator.”
Several key patient navigation organizations, collectively called the Professional Oncology Navigation Task Force, are drafting a document to provide clinical oncology navigators and patient navigators with clarification regarding the standards of professional practice. Clarification is a step toward recognition as a labor code and can structure insurance coverage of the service.
To supplement these efforts, healthcare systems could ensure their navigators are holding themselves accountable to evidence-based metrics, staying active in professional development, and having a navigation manager to tailor processes and programs that allow for optimal patient care. Also, moving out of the COVID-19 pandemic, future planning will help mobilize the patient navigator workforce to address national crises. Organizations could train navigators in ways to stay connected during a crisis, for instance.
The Future of Patient Navigation
COVID-19 negatively affected patient navigation, as financial support for navigation programs was stopped and many navigators were furloughed.
While it may be difficult to reassemble navigation teams after cutbacks, the pandemic also reaffirmed the value of navigation and its role in the future of patient care:
- Navigators with skills in community engagement gained trust of vulnerable communities during COVID-19 and addressed needs in the community.
- The pandemic caused delays in screening and even treatment for people with cancer, which means an significant influx of new patients in the coming months. Oncology navigators and social workers will be essential to manage the patient volume.
- Navigation proved to be a core, evidence-based strategy to address health inequities in communities.
“As medicine, especially oncology, has grown more complex over time, the need for navigators has grown with it,” Gentry says. “Patient navigation will continue to foster a positive working atmosphere, one of mutual respect, dignity, diversity, ethical integrity and trust.”