Patient navigation reduces costs of care for patients with cancer in statewide health plan
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Patient navigation programs have historically been difficult to implement on a large scale.
To help address this challenge, researchers investigated a scalable, independent program in collaboration with a large, statewide Medicare Advantage plan in New Jersey.
“There is a great deal of data out there showing that cancer navigation improves patient experience, lowers the cost of care and improves outcomes,” Bobby Green, MD, co-founder and president of Thyme Care, the developer of the navigation program, told Healio. “That was the reason for starting this company — we knew we needed to build a scalable navigation program.”
The technology-facilitated virtual cancer navigation service involved both lay health workers and nurses. These staff members coordinated health care by video, text or telephone, using these platforms to communicate with each patient an average of 2.6 times per month. These conversations addressed barriers to care, symptom management and adverse reactions to treatment.
In their study of the program, presented during ASCO Quality Care Symposium, researchers compared the monthly per-member total costs of care for patients with navigators vs. those without navigators.
Total cost of care served as the study’s primary outcome, excluding Medicare Part D drug spending.
Green and co-author Scott Worland, PhD, data scientist at Thyme Care, discussed their intervention, its performance in the study and the potential implications for patients with cancer.
Healio: What prompted you to conduct this study?
Worland: A handful of peer-reviewed papers looked at the effect of cancer navigation on costs. Thyme Care had been offering navigation for over a year and we felt that our care model and outcomes data were mature enough to ask the same questions of our own data that had been asked by these other cancer centers. We used our population and the methodology described in a paper written by Gabrielle Rocque, MD, of The University of Alabama at Birmingham, to estimate the changes in costs related to Thyme Care’s intervention.
Green: The primary measure in this analysis was the impact on the cost of care. Our interventions are specifically focused on reducing cost of care and, among other things, reducing it by keeping people from being hospitalized for preventable reasons. We found that compared with the group that did not receive navigation, the mean total cost of care for patients who received navigation decreased $429 more per month per member.
We then found that the bulk of that reduction was due to inpatient spend, or the spend associated with being in the hospital. So, 58%, or $248 of that $429, was due to inpatient spend. We also wanted to see whether this would mean a reduction in the number of times people got admitted to the hospital in the navigated group compared with the control group. We saw that average cumulative inpatient visits were 7% lower in the navigated group.
Healio: Why do you think inpatient spend and hospitalization were reduced in the navigation group?
Worland: Our intervention is designed to prevent a patient from being admitted for an otherwise avoidable acute inpatient visit. With our navigation program, we are proactively checking in with our members, staying ahead of their symptoms and escalating their concerns to their oncologist, if needed. So, we’re taking care of these things before they get to the point that they require hospital admission. It’s a much better situation from the members’ perspective because they are getting care earlier and better care than they would if they had been admitted to the hospital through an acute inpatient admission. We’re trying to engage with these members earlier, before symptoms escalate, in the hope that this will affect outcomes. We want feedback between the outcomes and the care model. So, we’re tweaking the care model based on the outcomes to continually improve the care the members are getting.
Healio: What are the implications of your findings?
Green: I have been practicing oncology for 25 years, and in my career, I have never worried whether a newly approved drug was going to be available for me to give to patients in a fairly short period of time. I would contrast that to cancer navigation. Despite all of these great navigation interventions, many of them never become available to practices because it’s so hard to scale and deploy them. This is the first signal that what we’re able to do at scale here at Thyme Care is starting to have some benefit.
Healio: What is next for your research in this area?
Worland: We would like to continue with a similar line of research, but at a more granular level. We talked about total cost of care vs. inpatient, but also we can look at it while stratifying the population by something like cancer acuity, and look at how we’re driving outcomes for these different layers of the population. We want to continue to strengthen and expand our relationships with health plans, oncology practices and other cancer centers. Having research like this is helpful for going into those conversations, so we can show how we believe this is affecting outcomes.
For more information :
Bobby Green, MD, can be reached at email: bobby@thymecare.com.
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Worland SC, et al. Abstract 4. Presented at: ASCO Quality Care Symposium; Sept. 30-Oct. 1, 2022; Chicago.
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