Patient Care Navigators Increase Care Quality, Decrease Costs

Non-clinical laypeople 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.

Patient care navigators “empower patients to engage in their health care and navigate them through the increasingly complex health care system,” the research team from the University of Alabama at Birmingham Health System explained. “Navigation programs can improve access to care, enhance coordination of care, and overcome barriers to timely, high-quality health care.”

Although not a requirement, care navigator programs traditionally employ nursing or other clinical staff to carry out these duties, making them an expensive investment for hospitals. The researchers argue that non-clinical laypeople can carry out care navigation duties, potentially opening up a cost-savings opportunity.

To test this theory, the researchers created the Patient Care Connect Program at the UAB Cancer Community network, employing non-clinical laypeople as patient care navigators throughout its network, including at two academic and 10 community cancer care centers in Alabama, Georgia, Florida, Tennessee, and Mississippi.

Navigators were required to hold a bachelor’s degree, but were not nurses or social workers. With an average caseload of 152 patients, navigators were expected to respond to practical, informational, financial, familial, emotional, spiritual, and physical concerns.

The study, which ran between January 2012 and December 2015, analyzed Medicare costs, components of the costs, and service utilization such as emergency department visits, hospitalizations, and ICU admissions. The researchers investigated both a test and control group, both consisting of 6200 patients.

Ultimately, this program yielded a 1:10 return on investment, with average costs for patients receiving layperson navigation declining by $781.29 per patient per quarter. That created a total cost savings of $19 million annually across the network.

The largest cost reductions in the study were for inpatient care and outpatient care, each declining by $294 and $275 per patient per quarter, respectively.

Patients with layperson care navigators also utilized certain services less frequently than those without navigators. ER visits declined by six percent, hospitalizations by 7.9 percent, and ICU admissions by 10.6 percent.

According to the researchers, the high return on investment was likely a result of the patient population that the navigators focused on. By targeting high-risk and high-cost patients, the navigators were able to mitigate a host of healthcare issues, opening the door to several cost savings opportunities.

Additionally, employing laypeople instead of clinicians allowed the navigators to focus more on patients’ non-clinical needs.

“Unlike physicians and nursing staff, navigators are not limited by the traditional model of clinic-based care. They engage patients during clinical encounters with health care professionals and between appointments through frequent telephone communication,” the researchers said.

“This patient-centered, preventive, proactive approach has the potential to lead to increased patient activation and earlier management of symptoms, decreasing the likelihood of unplanned admissions or inefficient care.”

And by making patient care navigation programs more cost-effective, hospitals can expand these services to even more patients. This not only benefits patients in health systems like UAB, but patients in medically underserved areas.

“The combination of reduced use of resources and increased hospice use achieved by the PCCP is consistent with other medical home, care transition, and palliative and supportive care interventions, which provide more appropriate support for patients with cancer, including those approaching the end of life,” the researchers found.

“The PCCP is a model of navigation that supports patients throughout the cancer care continuum and may be a mechanism to extend palliative and supportive care more fully into the community, particularly in rural areas that lack palliative care resources.”

Additionally, this model presents an opportunity to help not only increase the quality of care cancer patients receive, but also create cost savings. Unique patient care strategies will be important as the healthcare industry continues to work toward low-cost, high-quality healthcare solutions.

“This model has the potential to reach the Triple Aim of improved health care, better health, and lower costs and significantly enhanced health care delivery in the United States as health systems transition to value-based health care,” the researchers concluded.