Emergency department visits, hospitalizations, and intensive care unit admissions decreased by 6%, 7.9%, and 10.6%, respectively in cancer patients paired with trained nonmedical navigators.
When older cancer patients were paired with trained nonmedical professional "lay navigators," the cost of their care dropped significantly, according to a University of Alabama at Birmingham study published in JAMA Oncology.
The observational study compared records of 12,428 Medicare beneficiaries age 65 and older who were enrolled in the Patient Care Connect Program through the UAB Health System Cancer Community Network, which includes 12 community cancer centers in Alabama, Georgia, Florida, Mississippi and Tennessee.
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The researchers compared changes in quarterly Medicare costs and healthcare utilization for 6,214 navigated and 6,214 non-navigated patients over a three-year period, from 2012 to 2015. The lay navigators were hired from within the community and were required to have a bachelor's degree but were not licensed clinicians.
Total costs declined by $781.29 per quarter per navigated patient for an estimated $19 million savings per year across the network, the study found. Inpatient and outpatient costs had the largest decline with $294 and $275, respectively, per patient per quarter.
In addition, emergency department visits, hospitalizations, and intensive care unit admissions decreased per quarter by 6%, 7.9% and 10.6%, respectively.
The ROI of Lay Navigation
"Using lay navigation is a low-cost strategy to meet the demand for navigation services," Gabrielle Rocque, MD, medical director of the Patient Care Connect Program and lead author on the study, said in a statement.
Based on the cost of a navigator with an annual salary of $48,448 (salary and benefits), researchers estimated a return on investment of 1:10.
The lay navigators in UAB's Patient Care Connect Program provide patients with information about the process of cancer treatment, and help them make informed choices about their care.
The navigators also provide emotional support and problem-solving, "assist with overcoming common barriers to cancer treatment, and encourage patients to make wise use of healthcare resources," the program's website states.
Focus on the Continuum
The program focuses on the continuum of care—from diagnosis through survivorship to end of life—in an age group with high symptom burdens. Navigators managed an average caseload of 152 patients per quarter and targeted high-risk, high-cost patients and patient care, according to the research.
"This study provides hard-core evidence that we can reduce inefficiency and duplication of services, and at the same time make it easier for people to get the cancer care they need," Edward Partridge, MD, director of the UAB Comprehensive Cancer Center and principal investigator on the study, said in a statement.
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"The lay navigation program is a value-based approach that puts patients at the center, employing evidence-based medicine that takes into account each patient's wishes and preferences," Partridge said.
Although use of navigators led to declines across all use sources, the study noted that costs increased for hospice use, "which may be secondary to navigators facilitating earlier conversations about goals of care and care preferences."
Despite the observed benefits of using lay navigators, the study noted that the Patient Care Connect Program "is not sustainable within the current fee-for-service payment model, which does not reward coordination of care."
Alexandra Wilson Pecci is an editor for HealthLeaders.
