Building the Case: Oncology Patient Navigation and Payer Engagement

The CDC estimates that the number of men with cancer will increase by 24% from 2010 to 2020; this equals 1 million men. In the same period, there will be a 21% increase in the number of women with cancer; this equals 900,000 women. By 2030, when the last baby boomers turn 65 years of age, the number of older adults is expected to reach 20% of the population.

So, how will hospital systems and payers meet the complex needs of their oncology patients? A key member of the cancer program multidisciplinary team is the oncology patient navigator. There are moments in every cancer patient journey in which a well-informed, well-timed intervention (phone call, personal visit, etc) can effectively engage patients and positively influence their health-related behavior.1 Timely interventions and removal of barriers are the essence of oncology patient navigation. Patient navigation in cancer care refers to specialized assistance for the community, patients, families, and caregivers to assist in overcoming barriers to receiving care and facilitating timely access to clinical services and resources.2 An effective navigator will be able to address the patient needs in a timely manner at the earliest point in the continuum of care. The goal is to introduce the navigator and the navigation services at the earliest point of entry in the continuum, staying 1 step ahead of the patients and their families and preparing them for the next step. Navigators are often one of the strongest connections patients have during their entire cancer journey.

Oncology Navigation Metrics and Value-Based Cancer Care

Although the utility of navigation programs in cancer care is clear to providers and systems, it is necessary to be able to demonstrate its value with metrics and outcome data. Value-based cancer care is our reality; it is our present landscape in healthcare.3 The key drivers of patient navigation are providing highly coordinated patient-centered care and demonstrating success through navigation metrics in the categories of patient experience, clinical outcomes, and return on investment/business performance.

In 2017, the Academy of Oncology Nurse & Patient Navigators (AONN+) published “Academy of Oncology Nurse & Patient Navigators Announces Standardized Navigation Metrics.”4 This article identified 35 evidence-based navigation metrics in the categories of patient experience, clinical outcomes, and return on investment. The navigation metrics can be utilized by any model of navigation (clinical and nonclinical) and in any setting (community cancer center, academic cancer center, Oncology Care Model, etc). In addition, the article “AONN+ Evidence-Based Oncology Navigation Metrics Crosswalk with National Oncology Standards and Indicators,”5 published in June 2018, compared the AONN+ navigation metrics with value-based cancer care metrics and oncology national standards. More than 275 value-based cancer care metrics and oncology national standards support the 35 AONN+ evidence-based navigation metrics.

The US healthcare system is the costliest in the world. It is projected that by 2026, 20% of the gross national product will be spent on healthcare.6 In light of the growing aging populations and chronic health conditions, there is a global challenge to provide cost-effective quality healthcare. The landscape of healthcare has shifted, driven by the Triple Aim to reduce cost per capita in healthcare, improve the patient experience of care, and advance health outcomes.7 Improving standardization of patient navigation metrics would allow clinicians, policymakers, patients, and researchers to better measure the impact of patient navigation across the continuum of cancer care. It is imperative for navigation to continue to build a strong sustainable business case through the collection, measurement, and reporting of the 35 evidence-based national metrics. Harnessing the power of this information to create best practices will elevate navigation and garner industry support for advancing patient-centered care delivery.5 Achieving metric synergy—which is the process of the multidisciplinary team reviewing, identifying, and working collectively to produce successful outcomes in key oncology metrics—will be extremely enticing from the payer perspective.

Value-Based Cancer Care: Payers and Hospital Systems

Value-based cancer care is providing high-quality, evidence-based, cost-effective care for all patients. As a core component of value-based care, cancer care navigation programs can help to reduce healthcare costs while generating additional revenue opportunities for hospitals. Reducing costs is a triple win for the patient, the hospital system, and the payers. Payers and providers have opportunities to capitalize on their investments, tailor experiences to what consumers want, promote adoption of these innovative services, and solicit feedback—and that goes double for the largest part of the population, the older patients. Payers and cancer programs will need to enhance the patient experience to continue to capture and keep their market share.

Summary

The navigator role has been established by the Oncology Nursing Society core competencies and the AONN+ knowledge domains, which support the navigator role in enhancing the delivery of care for the oncology patient and demonstrating success through strong metrics. The payers and hospital systems will benefit tremendously through enhanced patient experience, clinical outcomes, and return on investment. The patients are the ultimate winners by having the navigator exceed their expectation for them during their entire cancer journey by removing barriers and increasing access to medical and psychosocial support…Patients First!

How the Navigator Will Enhance Oncology Patient Outcomes and Payer Engagement

  • Early identification of barriers with timely referrals to the appropriate discipline
  • Oncology metrics that support value-based cancer care in the categories of patient experience, clinical outcomes, and return on investment
  • Concierge member experience and “listening to the patient”
  • Provide enhanced access to services across the entire continuum
  • Provide oncology patient education and decision aids
  • Coordinate financial counseling and assistance for oncology medications and services
  • Incorporate the use of technology (ie, telehealth for appointments and visits)

References

  1. Beaton T. 80% of Payers Investing in Member Engagement, Satisfaction. https://healthpayerintelligence.com/news/80-of-payers-investing-in-member-engagement-satisfaction. 2017.
  2. Health Catalyst. Customer Journey Analytics: Cracking the Patient Engagement Challenge for Payers. www.healthcatalyst.com/insights/data-driven-patient-engagement-solutions-payers. 2019.
  3. Strusowski T. Creating value in cancer care through standardized metrics and partnerships between patient navigators and physicians. J Clin Pathways. 2018;4(3):42-47.
  4. Strusowski T, Johnston D, Sein E. Academy of Oncology Nurse & Patient Navigators Announces Standardized Navigation Metrics. https://aonnonline.org/education/articles/10-aonn-announces-standardized-navigation-metrics. 2017.
  5. Strusowski T, Johnston D. AONN+ evidence-based oncology navigation metrics crosswalk with national oncology standards and indicators. www.jons-online.com/issues/2018/june-2018-vol-9-no-6/1852-aonn-evidence-based-oncology-navigation-metrics-crosswalk-with-national-jons-oncology-standards-and-indicators. 2018.
  6. Centers for Medicare & Medicaid Services. NHE Fact Sheet. www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html. Accessed May 1, 2018.
  7. Jojola CE, Cheng H, Wong LJ, et al. Efficacy of patient navigation in cancer treatment: a systematic review. Journal of Oncology Navigation & Survivorship. 2017;8(3):106-115.

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