Lay navigators improve quality of cancer care, reduce costs

NASHVILLE, Tenn. — The integration of lay navigators at a 12-institution health network reduced the cost of cancer care while improving care quality and patient satisfaction, according to a presenter at the Association of Community Cancer Centers National Oncology Conference.

“Navigation will be a key element of future patient-centered, value-based health care redesign,” Gabrielle B. Rocque, MD, assistant professor in the division of hematology and oncology at The University of Alabama at Birmingham School of Medicine, said during her presentation.

Patient Care Connect — implemented across the UAB network, which includes a large academic center, small community practices and other practice types — initially was funded through a CMS Innovation Award received in 2012.

The awards encourage health systems and practices to think about innovative ways to achieve the triple aim of improving health, improving health care delivery and reducing costs.

Primary Care Connect was designed to achieve four key goals:

1. Reduce emergency room visits, unnecessary hospital days and ICU days;

2. Encourage evidence-based clinical pathways;

3. Encourage earlier adoption of hospice care, as well as reduce chemotherapy in the last 2 weeks of life; and

4. Provide the highest quality of life for people diagnosed with cancer.

Patients with any cancer diagnosis who were aged 65 years or older and had Medicare primary A or B insurance were eligible.

The navigators’ role was designed to empower patients to identify resources, recognize clinical symptoms, understand their disease and treatment, and engage in end-of-life discussions with their providers. They also aimed to eliminate barriers by linking patients with resources to get appointments, connecting patients to providers to address symptoms, and coordinating care between multiple providers.

“We really wanted to encourage patients to take an active role in their health care,” Rocque said. “Navigators can fix problems for patients, but we wanted to focus on the concept that of empowering patients to learn how to use the system and the resources that are available.”

Navigators underwent 80 hours of didactic training, 80 hours of practical skills training, and site orientation and shadowing in the clinical setting.

Eligible patients were identified through direct referrals, as well as mining of emergency room and hospital reports. The program preferentially navigated high-risk patients identified by cancer type, disease stage, comorbidities and distress scores. Navigation intensity increased for high-risk patients.

Patient Care Connect enrollment increased steadily over time, with 10,000 patients navigated and 88,000 patient contacts between March 2013 and December 2016.

Navigators had an average of 152 patients and 275 patient contacts per quarter.

The program resulted in a 6% reduction in ER visits, 8% reduction in hospitalizations and 10% reduction in ICU visits per quarter among navigated patients compared with matched controls.

This translated into an approximate $19 million savings to Medicare across the health system during each year of the project.

Navigators worked a typical 40-hour week and received average annual salaries of $35,000 to $40,000. Rocque estimated the return on investment between 8-to-1 and 10-to-1.

The program also included navigator-led advanced care planning and distress screening.

The patients who engaged in advanced care planning had lower health care utilization at the end of life and a trend toward lower chemotherapy use.

Distress screening revealed many nontreatment-related issues, such as fatigue, scheduling concerns and transportation challenges.

“The navigators were able to identify issues that, quite frankly, my patients would never tell me about when they come to the clinic,” Rocque said. “They were able to identify problems we were never seeing.” – by Mark Leiser

For more information:

Patient Care Connect: Lay navigators improve quality and reduce cost of care. Presented at: Association of Community Cancer Centers National Oncology Conference; Oct. 18-20, 2017; Nashville, Tenn.

Disclosu re: An HHS/CMS grant supported this study.