Abstract IA35: Sustainabity of patient navigation programs: Lessons learned from a Medicare innovation project
Authors: Rocque Gabrielle B. , Partridge Edward E. 
Published: October 2015

In 2012, the University of Alabama at Birmingham (UAB) received $15 million dollar Center for Medicare and Medicaid (CMS) Innovation grant to establish a lay (non-clinical) navigation program within the UAB Health System Cancer Community Network, called the Patient Care Connect Program. This network is comprised of 12 sites, including both academic and community medical centers of varying sizes and practice structures. The navigators provide an extra layer of support to Medicare patients who are ≥65 with cancer, from the time of diagnosis through survivorship or end of lie. We currently have enrolled &gt;6000 patients. The goal of this program is to empower patients to be active participants in their healthcare and to increase the value of the care delivered within the network. We define value as high quality care with high patient satisfaction, delivered at a lower cost. Cost savings can be attained through proactive management of patient concerns and improving communications between patients and the healthcare delivery system, which has the potential to reduce the number of unnecessary ER visits, hospitalizations, and ICU days while increasing hospice use.

Since the program inception, we have been focused on integrating navigation as a sustainable component of the healthcare system. We have identified three key elements to establishing a sustainable navigation program: 1) early stakeholder engagement, 2) robust communication, and 3) data collection for self-monitoring and demonstration of outcomes. We recognize that it is critical to truly incorporate the navigators into the healthcare team, which requires buy-in from administrators, physicians, nurses, and other members of the healthcare team. Lay navigation programs, as the Patient Care Connect Program, must also integrate with existing nurse navigation programs, social workers, chaplains, and other staff to ensure that patients are supported maximally and services are not duplicated. This focus on the team helps to meet the needs of the healthcare system and to demonstrate the navigator's value such that other team members become advocates of system-based approaches to fund navigators. The second component is a robust communication infrastructure, which is important both at the site level and between sites within a network. We conduct peer-to-peer communications between a UAB lead and the site lead. For example, the UAB medical director communicates directly with the site medical director monthly and the UAB administrator has monthly meetings with the administrators from all sites. This personal, frequent communication allows not only for the UAB team to communicate updates and results to the sites, but also allows for bidirectional information about challenges and success encountered with implementation and maintenance of the program. We also have regular site visits to bring larger groups of physicians, nurses, navigators, and administrators together to discuss the program and review results. These site visits allow for greater participation and the ability to create a learning health system that adjusts to programmatic feedback. We also conduct an annual meeting, which includes members from all sites, so that there is an opportunity for everyone to share experiences and best practices. The final and perhaps most essential component of developing a sustainable program is the ability to collect data on program impact. We have a navigation software system that allows for standardized data collection across all 12 cancer centers. Navigators use this system to record patient information, navigators contacts and interventions, and patient-reported outcomes. Through this grant, we also have a partnership with CMS, who provide claims data for monitoring the impact on resource utilization and cost. In addition, sites are developing infrastructure to use their financial records and tumor registries to collect this data on a real-time basis. Inclusion of these key aspects aids in demonstrating value, which frames conversations with future partners about sustainability.

Our approach to sustainability is to work with multiple stakeholders in parallel. We are engaged in discussion with CMS about potential for future funding when our grant ends. Several options exist for funding including both fee-for-service or bundled payments. CMS is also considering an Innovative Oncology Payment Model, which would include shared savings expectations. Navigation services and the ability to use data for quality improvement are considered integral components of this model. We are currently discussing the possibility of expanding the patient population beyond Medicare patients with several insurance companies. We have also begun to engage large employers who are interested in our network as a preferred provider due to the presence of the navigation program and rapid-learning environment that promotes quality. Patients and caregivers can also play a role in program sustainability, both through philanthropy and community engagement. They can choose to receive health care in a system that includes navigators and they can talk with friends, family and their legislators to serve as advocates of navigation services.

The ability to develop data collection infrastructure also positions a network well to obtain additional grant funding to answer specific, patient-centered questions. This data also can be used to demonstrate value, making navigator programs increasingly attractive to the health system itself. Early engagement with the administrators also ensures that the navigation is in line with the strategic vision of the hospital. Given the current, undeniable shift toward value-based care, navigation programs can become a key approach to improve both improve quality and lower cost, supported by the health system that has incentive to fund these programs. These diverse approaches can be used within any health system with the goal of sustaining navigation services.

Citation Format: Gabrielle B. Rocque, Edward E. Partridge. Sustainabity of patient navigation programs: Lessons learned from a Medicare innovation project. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA35.