The role of patient navigation in the changing healthcare landscape

The complexities of the healthcare system make it hard for an average patient to get the care they need. It becomes even tougher when these patients have a chronic condition that requires continuous treatment and multiple resources. That's where patient navigation comes in.

Patient navigation doesn't just help patients get the care they are entitled to. It helps clinics and hospitals increase efficiency, reduce operational costs, improve reputation, and enhance health outcomes.

Let's take a closer look at the concept of patient navigation.

Patient navigation is the process of guiding a person through the complexities of the healthcare system to help them receive the treatment they need. Patient navigators (also called patient advocates) are people who streamline this process.

These professionals help patients:

• Set up appointments

• Arrange follow-ups

• Get through screening, diagnosis, and treatment

• Communicate with healthcare providers

• Obtain information from insurance companies

• Find options for legal and social support

• Become educated so they can make informed decisions

Patient advocates don't just work with healthcare providers to arrange the treatment that patients require. They can also communicate with employers, lawyers, and case managers to facilitate access to treatment.

Different types of patient navigation include:

• Medical care navigation: Communicating with healthcare providers, coordinating appointments, identifying resources, explaining information, and defending patients' rights to ensure appropriate treatment

• Billing navigation: Reviewing patients' medical bills to ensure accuracy, working to resolve billing errors, and negotiating with healthcare providers

• Insurance navigation: Understanding and explaining the nuances of insurance coverage, including co-pays and out-of-network provider options, helping choose an insurance plan, and informing patients about overlooked benefits such as preventive care and telehealth

• Legal navigation: Helping patients understand legal issues related to their treatment, assisting with filing forms for compensation and disability, and coordinating with lawyers to advocate for the patient's rights

Overall, navigation can become an essential part of healthcare for patients without the knowledge and resource to study the complex system on their own. In many cases, these are people with serious conditions, such as cancer or AIDS, who require multiple expensive procedures but don't have the emotional and physical strength to navigate the system.

While patient navigation offers multiple benefits to patients and their families, it also significantly impacts healthcare organizations.

Some of the benefits include:

Reduction in no-show rates

With every missed appointment costing a physician around $200, the overall effect of no-shows on the US healthcare system is astronomical.

Studies demonstrate that 45% of no-shows are a result of patient misunderstandings. A patient navigator doesn't just explain the importance of regular appointments to the patient. They coordinate these appointments, arrange reminders, and even help patients with transportation to the clinic. As a result, the no-show rate decreases.

Better health outcomes

By facilitating access to the necessary care, patient navigation can improve health outcomes.

An experiment conducted at Harlem Hospital Center in New York City demonstrated the drastic effect of patient navigation. Over 22 years, breast cancer patients with low economic status had a five-year survival rate of 39%.  After introducing patient navigation, the five-year survival rate increased to 70%.

The rapidly aging US population requires more and more assistance navigating the healthcare landscape. By implementing patient navigation programs, healthcare organizations can take care of the increasing needs.

Effective prevention

Patient navigation isn't just about getting patients the treatment they need. It also involves educating patients and implementing preventive measures. Patients with low income who live in rural areas rarely have access to sufficient information about preventive tactics. Meanwhile, the elderly population often doesn't know about all the preventive options their insurance plans offer.

By educating patients about preventive measures and insurance options, patient navigators reduce the need for treatment. This, in turn, helps healthcare organizations cut costs and reroute the funding to other channels, including research.

Lower costs

Patient navigation reduces healthcare costs for the patient and for healthcare organizations. By helping patients get the care they need in a timely manner, patient navigators:

• Improve survival rates

• Prevent serious conditions

• Help low-income patients with insurance opportunities

A recent study presented at the 2022 ASCO Quality Care Symposium demonstrated that a cancer patient navigation program can reduce overall costs of healthcare. The study looked at 44 patients enrolled in a Medicare Advantage Plan. Patients who took advantage of patient navigation reduced the cost of care by $429 per month.

Case managers and patient navigators play a major role in improving the patient's experience and health outcomes. However, they have different responsibilities.

Patient navigators

Patient navigators help the patient achieve optimal healthcare. They usually work with patients who have acute or chronic health conditions. Patient advocates accompany patients through their healthcare journey and provide assistance even after the condition in question is cured or in remission.

Case managers

Case managers usually help coordinate healthcare, assist with transitions, arrange discharge planning, and deal with everything related to the person's hospital stay or experience in a doctor's office. Their role usually ends when the patient leaves the facility.

Patient navigators face a variety of challenges daily, including:

• Lack of communication

• Burnout

• Lack of support for navigators

• Time constraints

• Lack of motivation

These challenges can be addressed by streamlining the patient navigation program, seeking additional funding, and hiring more specialists to increase the quality of guidance without causing burnout.

While a fairly young concept, patient navigation is becoming increasingly popular across the healthcare landscape. The obvious benefits of implementing a patient navigation program drive the demand for patient advocacy specialists.

Healthcare organizations can support their navigation programs by implementing high-quality training, providing the right technologies, and educating all healthcare system members about the importance of collaboration with these professionals.