Patient navigation is a growing trend, but Presbyterian Healthcare Services in Albuquerque, NM, is putting its own spin on the service, supplementing in-person consultations with two-way video chat.
And while healthcare organizations are increasingly using patient navigators to shepherd patients through the care continuum, Presbyterian is using it to divert non-emergent patients from the ED, help them find a primary care physician if they do not have one, make primary care appointments for patients, and educate them about ED utilization.
The goal is not only to reduce ED costs—the organization forecasts a savings of as much as $15 million over five years—but to change patient behavior, educating them on when, where, and how to obtain appropriate healthcare services.
Navigation improves access to care and overall quality of care, John D. Johnson, enterprise director of the customer service center at Presbyterian, said during a session at the College of Healthcare Informatics Executives CIO forum in San Antonio last week.
Under the program, patients presenting at the ED get a medical screening by a mid-level provider. Non-emergent patients are referred to the navigator, who helps them with insurance questions and can either refer them to an urgent care center or get them an appointment with a primary care physician within 12-24 hours. Navigators also follow up to ensure the patient has kept the appointment.
Marketing and communications was part of the strategy—in addition to local media efforts, Presbyterian reached out to physicians, leaders, past ED patients, and other healthcare organizations in the region.
There were barriers, especially when it came to physicians, Pete Shelkin, Presbyterian's vice president and CTO, said. Many were concerned that patients would fall through the cracks and didn't trust that patients would get an appointment with a PCP in a timely manner. There is a perception of EDs as a safety net, he added, and providers do not want to turn anyone away.
"It's one thing to get everybody to agree [to] change culture, it's another to get everybody to agree how to do it," he said.
The organization responded with a guarantee that patients would get an appointment in 12 to 24 hours or would be diverted to urgent care if that was not possible. It also spent lots of time and effort on risk analysis and scenario planning. Physicians contributed to establishing the criteria for which patients would be served by the navigation program.
Now "providers love this program," Johnson says. That's because they want to help their patients navigate the system, understand their insurance benefits and get access to and feel comfortable with visiting primary care physicians.
In the first 47 weeks of the program, 10% of overall ED visits were navigated; an average of 23 patients per day across the two EDs that were live at the time.
More than 10,000 patients have received navigation services to date. Presbyterian reduced its left-without-being-seen rate from 15% to 4.5%. And just 4.4% of patients who went through the navigation process have returned to the ED for non-emergent care.
The number who were admitted as inpatients within 72 hours of navigation was 0.3% compared to 6% for overall ED patients; 2.7% of navigated patients compared to 3.6% for overall ED returned to the ED within 72 hours.
The organization also monitors whether patients are seen in the referred location; 79% of patients are seen by a primary care or urgent care provider.
Although the organization knew patient navigation was a good program for their large, urban hospitals, leaders also knew they could not afford to do it in all of their locations. Teleconferencing technology helped to overcome that challenge.
Two-way video chats between patient and navigator were more effective than a phone call because speaking face-to-face—even on a video screen—helps build a connection. It allows tele-navigators to read subtle body language and facial expressions, for example. And, Johnson added, patients actually like the novelty of the technology.