UAB has been one of the pioneering organizations, along with Genesis Health System, in the development of the Medical Concierge patient navigation program. Started with help from a 3-year, $15 million grant from the Centers for Medicare and Medicaid Innovation (CMMI), our Patient Care Connect program has trained and deployed teams of non-clinical (“lay”) navigators (non-nurse, non-social worker) in 12 communities in a five state region of the deep south. All of our teams use the Medical Concierge software, which allows us to aggregate data centrally for reporting purposes.
UAB’s Patient Care Connect program was started in July 2012 and is currently serving a patient population of approximately 20,000 Medicare patients. UAB designed and developed all of the care protocols and pathways for the program, including a significantly enhanced distress assessment tool, built into the Medical Concierge software, that forms the basis of the navigator’s patient interview and assessment process. Navigators receive extensive training in the continuum of cancer diagnosis, treatment, and survivorship, as well as in health issues in geriatrics and complicating co-morbid conditions. Medical Concierge has been custom designed to track all patient encounters. The system tracks levels of patient distress, creates work lists as stressors are identified, assists with referrals to other care providers, provides follow up intervention reminders, and serves as a team communication tool. It is very easy to use and provides excellent support to all of our navigation teams. We like the system and highly recommend it.
These navigation teams consist of a nurse leader surrounded by well-trained lay navigators. The lay navigator concept is based on more than 15 years of experience using community health advisors in a variety of community screening, low income resource support, and clinical trial navigation programs at UAB. The Patient Care Connect program pairs a lay navigator (think, “patient advocate”) with a new patient, with the goal of empowering patients’ to overcome barriers to care, make the most appropriate and informed choices for their treatment, avoid the use of the emergency room, reduce the use of ineffective therapies, and maximize the appropriate use of health-care resources. Navigators follow patients through the entire continuum of their cancer journey. Specific program goals include: 1) reducing unnecessary emergency room visits, which lead to high utilization of inpatient resources; 2) encouraging the use of evidence based treatment plans by empowering patients with the knowledge they need to ask the appropriate questions of their care teams; and 3) promoting the earlier adoption of palliative and hospice care by preparing patients in advance about choices available to them should they face advanced stages of their disease.
Medicare provides comprehensive claims data on the entire study population. We observed decreases after implementation from 13.4% to 11% for hospitalizations (18% decrease, p < 0.01), 8.0% to 7.1% for ER visits (12% decrease, p < 0.01), 2.9% to 2.5% for ICU admissions (14% decrease, p = 0.04) and an increase of 3.9% to 4.3% for hospice (9.2% increase p = 0.37). Costs decreased about $158 per quarter per beneficiary over the analysis period. A significant pre-post decrease of $952 per beneficiary (p < 0.01) lead to an estimated total reduction in Medicare costs of $18,406,920 for the 19,335 beneficiaries in the UAB CCN for the five quarters post-implementation. Current savings rate is in excess of $1000 per beneficiary (patient), per quarter.
Warren Smedley, MSHA
Service Line Director, Cancer & GI Services
University of Alabama at Birmingham Comprehensive Cancer Center Birmingham AL
“It’s very frightening,” Whitener said. “You don’t know what you’re going to do, where you’re supposed to go, what all it entails in getting through this. It’s confusing, more than anything.”
That confusion was alleviated once James and his wife, Joyce, met John D. French, III, a patient navigator with the Patient Care Connect Program at the University of Alabama at Birmingham. French’s job is to walk patients like James through the process of cancer treatment, from diagnosis through Survivorship and beyond.
What makes Patient Care Connect so special? It is the first system of its kind. Physicians, nurses and lay navigators developed the program after noticing an influx in cancer patient’s visits to the emergency room. Lay navigators are assigned to newly diagnosed cancer patients to solve issues before they lead to an emergency visit. They administer a Distress Screen to determine if the patient is facing barriers to receiving the best possible care. If barriers are identified, navigators work with a predetermined list of resources to resolve each barrier. Medical Concierge Navigator software is an essential tool in the tracking process.
French is just one of the many navigators in the UAB program helping patients just like Whitener.
Whitener is currently in remission and his wife says they have found a “lifelong friend in French.”
“We will always, always keep in touch with John, and be so grateful for the time he’s spent helping us as a family.”
Patient navigation began in the early 1990s as a way to facilitate better care for underserved populations. During its inception, the navigators were often not nurses but laypeople or social workers. In 2009, The Oncology Nurse Society, the Association of Oncology Social Work and the National Association of Social Workers redefined the field of nurse navigation as the “individualized assistance offered to patients, families and caregivers to help overcome health system barriers and facilitate timely access to quality health and psychosocial care from prediagnosis through all phases of the cancer experience. Navigation has come a long way in a fairly short time but is still difficult to define because navigation is different in every area it is practiced.
There are two different types of navigation. The first is barrier focused navigation, which looks at changes in access to care. By tracking and reporting common barriers to care, the navigator then finds strategies to resolve or reduce the issues keeping patients from getting their best care. The other type of navigation is service focused navigation. Service focused aims at finding and coordinating services to patients and families and making sure they are given the needed education and care. Tracking barriers and arranging care and education for the patients seem to run together into one role for most navigators. ONS recorded some of the major challenges in navigation at this time are accurately measuring and ensuring “desired and optimal outcomes” for all involved in the cancer process, including families and survivors. Research is still being done, including the National Patient Navigation Research Program, to measure the best way to track patients care and ensure them the best quality cancer care they can receive.
All of us at Open Software Solutions value our users and the quality of care they are striving for in their work. The purpose of our newsletter is to get users connected with other navigators to share their ideas and helpful navigation tips. This is a way for OSS and current navigators to discuss topics involving navigation news including changing Accreditation standards, best practices and all pertinent healthcare topics that will involve you. With your response and our research, we can continue to partner with navigators to grow our program to fit your changing needs. Please send us topic ideas or write your own article to be featured in our Navigation Corner! Let us know about upcoming navigation events or webinars that are important to you!