Patient Navigation Program Drops Emergency Department Utilization

A Medicaid accountable care organization (ACO) was able to cut emergency department utilization and increase care coordination through patient navigator interaction, a study published in The American Journal of Managed Care found.

Nearly 33 percent of US adults and 13 percent of children enrolled in Medicaid insurance programs experience obstacles when seeking care. Oftentimes, the obstacles derive from physical and economic barriers that hinder patient access to non–emergent care settings.

“Traditionally, EDs and systems of emergency care have not been designed to actively address barriers to care, the social conditions underlying many acute presentations, or patterns of frequent utilization for low-acuity conditions,” Salina Bakshi, MD, MPH, and Lucas C. Carlson, MD, MPH, lead authors of the study stated.

“To address these challenges, the ED Navigator Program was created in March 2018 by Mass General Brigham.”

Brigham and Women’s Hospital, Massachusetts General Hospital, and North Shore Medical Center were among the three hospitals that launched the ED Navigator Program to reduce care access barriers.

The patient navigators were responsible for promoting primary care engagement, facilitating care coordination, and identifying patient social needs.

They were also tasked with reviewing the patient record, preparing resource materials, and developing an engagement approach before meeting with the patient in the ED. 

Researchers examined the impact the patient navigation program had on healthcare utilization among a Medicaid ACO population.

Patients did show a positive response to the strengthened primary care engagement. Patient navigation in the ED was associated with a 52 percent greater likelihood of a completed follow-up primary care appointment.

The study findings showed that patient navigation also reduced the likelihood of revisiting an ED within 30 days by 32 percent.

However, interactions with a patient navigator did not influence patients with higher ED utilization. These patients often have chronic health and mental health conditions, low health literacy, and many social factors, such as those related to housing or transportation, which could contribute to their reoccurring ED visits, the researchers posited.

A single encounter with a patient navigator is unlikely to change well-established patterns of ED behavior, the researchers stated.

“Our model highlights that short-term care coordination programs are successful, particularly for patients with lower levels of baseline ED utilization, and can ultimately promote primary care engagement, as well as assistance with health-related social needs,” the researchers explained.

“We believe that these results can provide important insights to health systems as they consider cost-effective program options for care management to strengthen primary care engagement and address the social determinants of health.”

These findings underscore the importance of patient navigation and patient-centered care.

A study published earlier this year in the Journal of the American Board of Family Medicine found that patient navigators helped improve care access for low-income Hispanic patients who face significant disparity in primary care access.

Compared with other racial/ethnic and income groups, Hispanics are the least likely to have a primary care provider, with only about one-third of Latino patients having one.

“By providing navigators with additional support and training to connect clients to primary care, we may begin to see concomitant gains in disease prevention and management that we hoped to achieve under the ACA,” the research team concluded in JABFM.