The Patient Care Connect Program was created in 2012 with the support of a three-year $15 million Health Care Innovation Challenge Grant Award from the Centers for Medicare and Medicaid (CMS) with the goal of achieving better health care at a lower cost.
The UAB Comprehensive Cancer Center has a long history using lay navigators in a variety of settings. Lay navigators have participated in cancer health disparities research conducted in the Alabama Black Belt and the Mississippi Delta. They have also participated in programs to educate women about the importance of mammograms in early breast cancer detection.
“When CMS requested proposals that would provide better health care at a lower cost, we proposed to recruit and train lay navigators to work with Medicare patients and help steer them through the system. We planned to install those navigators at UAB and the 11 other institutions that are part of the UAB Cancer Community Health Network,” says Edward Partridge, MD, director of the UAB Comprehensive Cancer Center. “We believed that use of lay navigators would provide better health care at a lower cost, and we estimated that we would reduce emergency room visits, hospitalizations, intensive care unit (ICU) visits, and improve care at end of life by having more hospice admissions. We submitted that grant proposal and we got the funding.”
Early data indicates that the Patient Care Connect Program attained the goals of that proposal by reducing hospitalization rates by almost 20 percent over the three-year grant period. Emergency room visits decreased almost 10 percent, and ICU admissions saw a dramatic six percent reduction.
In terms of Medicare claims, the initial UAB study indicates there was a considerable reduction of overall cost in the navigated patient population from $15,091 to $8,269 per patient quarter, a savings of $6,822 per navigated patient. Cost in the last six months of life decreased from $23,735 to $16,764 per navigated patient while the same costs in the non-navigated group increased from $13,418 to $15,544.
While these financial savings are substantial, Gabrielle Rocque, MD, medical director of the Patient Care Connect Program, says the most important result may be realized from the perspective of the patient experience. “There are countless stories of patients who say they couldn’t have made it through their treatments without their navigator,” she says. “Early results of another survey show a high level of patient satisfaction with the navigation program as a whole.”
Myeisha Hutchinson is one of the lay navigators who has played a role in the success of this program. She and other navigators empower patients to make decisions about their care by providing information, identifying resources, and coordinating care between multiple providers. “We are part of the health care team and work as liaisons and advocates for the patients. We make care more personal for them,” she says. “Ultimately, we want patients to know that we are listening and will help them overcome barriers. We want to make treatment at a big institution like UAB feel like one-on-one care.”
Navigators are proactive in their contact with patients and quickly identify resources to help them manage their care. “I usually get a big thank you for things I think are minimal,” she says. “That’s how I know I am helping the patient.”
Rocque says these navigators offer several advantages. “These individuals are more approachable, and patients are willing to ask them things they may not want to ask nurses or physicians,” she says. “The program also helps us make sure we are focusing on a holistic approach to medicine and are moving beyond the patient’s symptoms to address social issues like transportation problems or family difficulties. We want to make sure we are meeting all of their needs.”
Another key feature of the program is the concept of navigating patients across the continuum of care. “Most navigator programs focus on either screening and early detection or the early phases of treatment,” Rocque says. “Our program focuses on patients who are in the early detection stage as well as those on survivorship or end of life. That allows us the unique opportunity to target our services to those who are most likely to need them.”
The Patient Care Connect Program has had more than 80,000 contacts with patients. “That’s outside of usual health care delivery, so what the navigators are really doing is connecting the dots – connecting various parts of the health system so the patient at home does not worsen and end up in the emergency room,” Partridge says..
UAB’s navigator program has been implemented in the 12 hospitals in its Cancer Community Health Network allowing for evaluation at different types of hospitals. “We have UAB’s top-level cancer center with numerous physicians, a small hospital in Alexander City with one medical oncologist, and everything in between,” Partridge says. “Because of this network, we are able to test this program in multiple sites and it appears to be working well in all of them.”
The Comprehensive Cancer Center plans to continue the program and to expand it to other carriers. They also have applied to CMS to be a demonstration program for a new oncology payment model that is scheduled for roll out in the spring of 2016. Right now, the cost of the program is being covered by the grant, Rocque says, but moving forward there are several different ways the program can be sustained.
“In the short term, most hospitals are choosing to absorb the cost of the navigators because they recognize the benefits. However, that is a short-term sustainability solution as we move toward a valued-based health system,” she says. “Medicare and other systems highlight the importance of providing high quality care at lower cost. The navigators become an integral part of that if we can demonstrate cost reduction, higher satisfaction, and higher quality. Then it makes sense for everybody to support the navigators within their structure of this new value-based delivery system.”
Rocque says an ultimate goal for the lay patient navigation program is to employ the concept across the entire UAB system. “Patients feel that they have a personal advocate throughout their cancer journey,” she says. “Wouldn’t we love to have that for every disease category? If we can do it for cancer, we believe we can do it in other areas.”
