Training program aims to standardize high-quality oncology patient navigation
The American Cancer Society launched a national training and credentialing program designed to standardize high-quality, expert patient navigation for individuals with cancer and their caregivers.
The ACS Leadership in Oncology Navigation (ACS LION) program will help oncology organizations train nonclinical patient navigators in core competencies. The program also will provide support to oncology organizations seeking to implement sustainable navigation.
Cancer centers that have signed on as initial partners include Duke Cancer Institute Supportive Care & Survivorship Center, Mount Sinai Tisch Cancer Institute, Penn Medicine’s Abramson Cancer Center, Thyme Care and The US Oncology Network.
“Over the past 30 years, there have been 25 different randomized controlled trials that demonstrate unequivocally that navigation improves patient, caregiver and payer outcomes,” Arif Kamal, MD, MBA, MHS, FACP, FAAHPM, FASCO, the cancer society’s chief patient officer, told Healio. “It’s one of the few win-win-wins across the board within oncology care. Surprisingly, though, there has not been a consistent reimbursement by a payer for these navigation services.”
As a result, navigation programs are only financially feasible for very large cancer centers. This has set the stage for potentially widening disparities in cancer care.
Healio spoke with Kamal about the need for the ACS LION program, what it will offer, and how it will help navigators and cancer centers.
Healio: How has the lack of consistent reimbursement for navigation programs affected their implementation?
Kamal: Very large cancer centers that can take on the costs of running a navigation program have been able to offer these programs, but this comes at the cost of not serving all populations. The large cancer centers are not necessarily in all the communities where patients are. Without a reimbursement mechanism, there has been an overreliance on philanthropy or internal support. We saw the first inkling of this changing in the first draft of the physician fee schedule by CMS last fall. This allows for navigators to be reimbursed for the first time, particularly those we would call professional nonclinical navigators.
Healio: What are professional nonclinical navigators?
Kamal: They are professionalized in the sense that they are employed by health systems, health departments or oncology provider organizations, private practices or clinics. They have access to electronic medical records and the systems within that, but they are nonclinical in the sense that they are not nurses, social workers or physicians, and the services they provide are not clinical in nature. Professional nonclinical navigators have similar backgrounds or lived experiences as the people they’re navigating. In the physician fee schedule update, it requires that this workforce receive training and credentialing, and the American Cancer Society has decided to start helping to build the country’s capacity for navigation.
Healio: What will the program entail?
Kamal: The idea is that any person being hired by an oncology program to be an oncology professional navigator could come to the American Cancer Society and go through rigorous but online and asynchronous training. The training covers issues related to ethics and compliance working within a clinical setting. It addresses how to demonstrate compassion within certain limitations of involvement. It’s a 10-part series, and then they take a credentialing test to become ACS LION credentialed navigators, and that meets the spirit of what the billing update has indicated. That person can then move forward and participate in billable activities within those oncology organizations.
The LION program also offers free webinars and boot camps. We have a bootcamp launching in April that is focused on building a business case for doing navigation. For example, imagine you are an oncology practice and you want to do this but don’t know how to get started. We bring in those organizations for free, and they go through an intensive 1-month curriculum with us to get to a place where they have a business plan to present to their decision-makers about building a navigation program.
Healio: What are the potential implications of the ACS LION program?
Kamal: For 30 years, we’ve been saying, “If only there was reimbursement, we would do this.” That’s not the challenge anymore. Now, the challenge is a business plan. It’s a workforce adequacy and development challenge. Frankly, it’s also a visibility challenge. This change happened in a federal document that went into effect Jan. 1, and my guess is most oncology practices have no idea this is happening. You can imagine that this change will be up for review again every fall when the physician fee schedule is reviewed. Now is the time to take advantage of this opportunity because political winds can shift.
One of my goals is to build momentum early. Medicare and the seven largest commercial insurers have signed on, so the vast majority of patients will have coverage in the active treatment space and in the survivorship space. This sea change has occurred in a very short period, and now our goal is to train thousands within this year to build capacity. Although our training and credentialling program does cost money, we do give out scholarships and preferred access. We estimate that there may be almost 10,000 navigators who are eligible for this. We also believe there will be growth in the navigation capacity since this is now in place.
Healio: Is there anything else you’d like to mention?
Kamal: We’ve been discussing this through an oncology lens, but the navigation coverage is for any serious illness. It starts from the time of an abnormal finding through survivorship and end-of-life care. It’s important that oncology practices recognize that they may have patients who aren’t going to die of their cancer but may have other diseases like heart failure, diabetes or advanced liver disease for which navigation might be very helpful. Because the eligibility starts at abnormal finding, it means that a patient who has a shadow on their mammogram is eligible for navigation services from that moment on. Many oncology practices are interested in how to get people into timely care from the beginning. Navigation can be a facilitator of that. It’s an important opportunity for oncology practices to also work with primary care practices, radiologists, OB/GYN practices and others that are integrated with them.
For more information:
Arif Kamal, MD, MBA, MHS, FACP, FAAHPM, FASCO, can be reached at American Cancer Society, P.O. Box 1685, Atlanta, GA 30301; email: arif.kamal@duke.edu.
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