Patient Navigators: Worth Their Weight in Gold

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For those of us that work in health care, the ins and outs of how the process works, referrals, follow-ups, prescription instructions, insurance – it’s part of our everyday language. But for the average American, dropping them in the health care system can feel as foreign as plopping them down on another planet.

The rules are different, the language is different, the path is unfamiliar and winding, and there is money as well as their health on the line. It can be downright scary and intimidating. The stress of these challenges can make getting well hard to do. Enter the patient navigator.

What is a patient navigator?
Today, Patient Navigators are on the leading edge of the changing tide of health care. They function differently depending on the situation -- sometimes they provide patient education, other times they operate as a coach and a patient advocate.  

Not investing in hiring nurse navigators for your emergency department may wind up costing you. Why? The beauty of patient navigators is they can help on multiple fronts:

1) They reinforce the patient's discharge instructions and help schedule follow up appointments which helps deliver better patient outcomes. They hook patients up with the right services which helps deliver better patient outcomes.

2) Patients are more likely to follow their instructions, get well, and report higher satisfaction scores. Not only is this what we all wish for our patients but thanks to patient satisfaction surveys and outcome measurement systems, these are crucial areas hospitals are measured on and funding is tied to performance.

3) Because patients are receiving better care, it cuts down on repeat visits and re-admissions – which adds to costs and can be even more expensive in the face of funding penalties

How exactly do they do this?
Patient navigators help patients connect the dots to get the care they need. They are a single point of contact for a patient. They can connect patients with different doctors, primary care specialists and therapy providers. They can track down answers to medication or insurance questions. They make calls to remind patients about appointments and arrange for transportation. It’s their job to follow-up with the patient early and often. For a patient navigator that works with emergency department patients, an initial part of their job would be to contact the patient and make sure they understand and are following their self-care instructions at home. They also work to get them to primary care physicians.

They are especially helpful in working with underserved populations. One study published in the Journal of Healthcare Management defined these as people who are low income, uninsured, publicly insured, or recent U.S. immigrants.

The study examined one Texas hospital’s use of navigators. It found some interesting results. Among folks who less frequently used the emergency department for primary care services, navigators helped decreased their odds of returning to the emergency department. Among patients who returned to the emergency department for primary care, the pre/post mean visits declined significantly over a 12-month pre/post-observation period. The authors also found that by lowering primary care emergency department visits it saved enough money to cover the cost of hiring and training the navigators.

So where do patient navigators come from?
Patient navigation is a relatively new field. Sometimes you may have heard them called nurse navigator, patient advocate, healthcare advocate or consultant, or medical advocate. Patient navigators aren’t providing patient care. They are enabling it to happen.

The story goes that in the ‘80s and early ‘90s Dr. Harold Freeman developed the concept in Harlem after survival rates for women with breast cancer at his hospital were low --  39 percent 5-year survival rate. The expected rate: about percent.

He recognized that it is challenging to get well. A lot of different things have to come together. Additionally, the challenges can be greater if you’re poorer. Time away from work, transportation, and childcare all have a cost. After implementing patient navigators, he was able to raise survival rates to 70%.

The field really began growing in recent years in part because of changes brewing ahead of the Affordable Care Act and the move towards accountable health care and Medicaid penalties.

You should know that because it is a relatively new occupation there is no accrediting body or licensing process. But the industry is moving towards that over the long term. Earlier this month, the National Association of Healthcare Advocacy Consultants just posted best practices.

Right now, if someone wants to become a patient navigator there are training programs, certifications, and even master's degrees that produce some of these practitioners. Some hospitals have had success using peer training programs.

How much does it cost to hire patient navigators?
Accenture and a hospital foundation spent $254,500 to fund six patient navigators for a year-long pilot program. The Bureau of Labor and Statistics classifies navigators as Health Educators and Community Health Workers. They list the median income for 2012 as $41,830 a year. With a nursing degree or other medical training they command more.

If you are interested in hiring, there may be some grants available from government agencies. Big Pharma and other Foundations are also pitching in at some hospitals.

What’s the ROI?
According to Managed Healthcare Executive, the returns on investment are considerable. They reported that the year-long Accenture pilot project in Pennsylvania resulted in a 43 percent reduction in excessive emergency department visits. This was across three hospitals. They helped about 4,000 patients.

It also netted other benefits. “… one system had a 60 percent reduction in 30-day readmissions, as part of a broad set of activities…” according to Managed Healthcare Executive.

That project used non-medical navigators that they trained from the community. This kept costs low.

Another hospital Managed Healthcare Executive reported on, Mercy Health in Cincinnati, Ohio, is expanding its navigator program after its pilot program brought a return of $5 for every $1 spent. The system’s one-year pilot decreased emergency visits by about one third. They brought hospital admissions among the high-risk pool down by one-half. Readmissions were cut by one-third.

Who’s hiring patient navigators?
Even though it is a relatively new field, hospitals are starting to catch on to the real benefits that patient navigators can hire.

While they were first utilized mainly to work with cancer patients and chronic disease like diabetes, hospitals are finding ways to leverage their help in more acute situations.

The American College of Cardiology announced in the fall of 2014 that they were launching a patient navigator program at 35 hospitals across the country. Their goal: reduce unnecessary patient readmissions.

The announcement of the program cited “the stresses of the initial hospitalization, to patient fragility at time of discharge, a lack of understanding of discharge instructions, and the inability to carry out discharge instructions” as reasons that drive patient back for readmission. Patient navigators can help in all these areas.

More Details Please
If you have specific questions about how patient navigators can help your hospital, contact me. I’m happy to talk with you about how your emergency department can work more efficiently and get better results.

Patient Navigator Training Collaborative
Patient Navigator: “Patient Navigators – Who We Are and What We Do,” “Ethical Standards and Best Practices – Final Version Published,” “Training Programs for Patient Navigators.”
National Association of Healthcare Advocacy Consultants – Present at the Creation
Agency for Healthcare Research and Quality: “Connecting Underserved Patients to Primary Care After Emergency Department Visits.”
Accenture: “Jameson Health System Launches Patient Navigation Program with Highmark Foundation and Accenture.”
Mena Report: “Pittsburgh Hospitals Reduce Emergency Healthcare Executive: “Navigators reduce no-shows.”
American College of Cardiology: “American College of Cardiology Patient Navigator Program Completes Hospital Selection.”
Journal of Healthcare Management: “Reducing preventable emergency department utilization and costs by using community health workers as patient navigators.”
CNN: “Helping Patients Navigate the Healthcare System.”