Business Case for Providing Patient Navigation Services in Cancer Care

Navigation services for cancer patients generates financial benefits under both fee-for-service and value-based payment models.

A recent research article found that there is a strong business case for providing patient navigation services in cancer care.

Cancer is among the deadliest illnesses in the United States, according to the American Cancer Society. In 2017, ACS estimated there were 600,000 cancer deaths. Cancer also is among the costliest illnesses to treat. The Agency for Healthcare Research and Quality estimated total cancer treatment costs in 2015 were $80.2 billion.

The recent research article, which was published in Journal of Oncology Practice, found that patient navigation (PN) in cancer treatment drives significant clinical and financial benefits.

"PN has resulted in improved patient outcomes and patient satisfaction and has important financial benefits for cancer programs in the fee-for-service and the alternative payment model worlds, lending support for more robust staffing of PN programs," the article's co-authors wrote.

In a fee-for-service payment models, patient loyalty is the primary financial benefit for healthcare providers, the article's co-authors wrote. "PN can generate financial benefits by significantly decreasing the outmigration of patients to other health facilities for their oncology care."

In value-based payment models, healthcare providers can generate more clear-cut financial benefits from PN programs, they wrote. "In evolving bundled payment systems that financially incentivize high-value care and value over volume, the business case for cancer PN is stronger and more direct. In these payment models, practices can recoup avoided costs through performance-based payments rather than relying exclusively on payments made for billable services."

The article features five examples of patient navigation programs that have demonstrated direct and indirect financial gains for healthcare providers.

1. Patient Care Connect

In 2012, the University of Alabama at Birmingham used a federal grant to develop and launch Patient Care Connect, a navigation program at 12 cancer centers. Patient Care Connect featured nonclinical staff in navigation roles, which included routine distress screening to identify barriers to care among patients.

When compared to a control group on a per quarter basis, cancer patients in the Patient Care Connect program experienced higher decreases in emergency department visits (6.0%), hospitalizations (7.9%), and intensive care unit admissions (10.6%). On a quarterly basis, the lower utilization rates helped reduce cost of care per patient in the PN program by nearly $800, which generated a return on investment estimated at 10:1.

2. Levine Cancer Institute

Charlotte, North Carolina-based Atrium Health's Levine Cancer Institute developed a patient navigation program that featured 25 nurse navigators spread across seven locations.

With the exception of melanoma care, an analysis of 970 cancer patients found patients in the navigation program utilized treatment in an acute care setting less often (18% of the time) than patients who did not participate in the program (30% of the time). Another analysis found that patients who did not participate in the PN program were 52% more likely to experience a 30-day all-cause hospital readmission.

3. University of Pennsylvania Health System

At three University of Pennsylvania hospitals, an internal study showed that a PN program staffed with nurse navigators generated fee-for-service financial benefits for the health system.

Compared to cancer patients who did not participate in the PN program, cancer patients in the program were 10% more likely to stay in the University of Pennsylvania network for treatment. Cancer patients in the program also were more likely to receive related treatments in the health system's network, with 27% higher utilization of infusion services and a 17% higher utilization of radiation oncology services.

4. Sarah Cannon Cancer Institute

At Nashville, Tennessee based HCA Healthcare's Sarah Cannon Cancer Institute, a PN program with nurse navigators supports 65 hospitals in seven states. In 2018, the nurse navigators worked with more than 15,000 cancer patients. The PN program includes PatientID, an internal artificial intelligence capability that helps refer patients to nurse navigators.

The cancer institute's PN program has posted patient loyalty gains for the health system:

• Between 2017 and 2018, a 59% increase in patients participating in the PN program was associated with increased patient volumes.
   
• When cancer patients participate in the PN program starting early in their treatment, 90% of them stay in network for care. This observation has been particularly strong in breast cancer care, where patients had historically only stayed in network about 50% of the time.

5. Sutter Health

At Sacramento, California-based Sutter Health, internal surveys in 2016 and 2017 found significant variability in the health system's PN services for cancer patients, particularly in how and when clinicians referred patients to nurse navigators.

The health system launched a pilot program to determine the impact of when a referral to a nurse navigator was made, with some patients referred when there was a suspicious oncology finding and others referred 5 to 12 days after notification of a cancer diagnosis. In a significant patient loyalty gain, 35% fewer patients sought care at other health systems if they worked with nurse navigators at the time of a suspicious finding.

Sutter found that retaining cancer patients for treatment generated financial gains for the health system—an analysis found the retention of two patients could cover the cost of one nurse navigator.