Patient navigation program cuts cancer care costs : Oncology Times
The total cost of cancer care can be significantly reduced by using patient navigators to guide patients dealing with complex medical systems. A cancer navigation program deployed in conjunction with a statewide Medicare Advantage health plan across a wide range of practice types found that the total cost of care per patient decreased by $429 per months for those who used patient navigation compared to those who did not have a navigation aid.
“Newer, more effective cancer therapies are constantly being introduced,” said Ravi B. Parikh, MD, MPP, FACP, assistant professor in the Department of Medical Ethics and Health and Medicine Policy at the University of Pennsylvania. “Despite many of these advances, coordination of care can often be fragmented, education about the best care options may be lacking, and access to care is not always easy. We are missing some of the fundamentals that support the whole person. Navigation can fill these gaps, and we believe this study helps chart the way forward for expanding cancer navigation to help more people. The researchers presented the findings at the 2022 ASCO Quality Care Symposium (Summary 4).
About the study
Based on a 1989 national study of the limited resources available to low-income people with cancer, the first national patient navigation program was established in 1990 in Harlem, NY, to help patients through complex healthcare systems. In more than 30 years of use and expansion, referral programs for cancer patients have been shown to reduce the total cost of care in multiple settings and create value by improving the patient experience, keeping people out of hospital and improving survival. However, these programs have been very difficult to broadcast widely.
Researchers explored whether an independent cancer patient navigation program deployed in conjunction with a Medicare Advantage plan could demonstrate similar cost savings when deployed in a wide variety of practice settings in the state of New Jersey. . They looked at claims data from more than 4,000 eligible cancer patients at community and hospital practices in New Jersey, a state with a wide variety of practice settings, from small community practices to large academic medical centers.
About 16% of cancer patients received a navigational aid. For statistical analyses, the researchers ultimately matched 222 cancer patients who received patient navigation with 222 who did not receive a navigation aid.
The navigation program was a technology-enabled virtual cancer navigation service staffed by both lay health workers and nurses. The navigation team coordinated care virtually (via video or phone), interacting with each patient an average of 2.6 times per month. They addressed any barriers that were getting in the way of care, helped facilitate discussions about care, and performed proactive and reactive symptom assessments. If there was a problematic response to a patient’s treatment, the patient’s oncology team was notified the same day. The primary outcome of the study was the total cost of care, but excluded Medicare Part D drug expenditures.
For their calculations, the researchers looked at health care and payment records from March 2021 to June 2022, comparing total monthly costs of care per limb for patients with and without navigators.
The average total cost of care decreased by $429 more per month per member for the group that received a navigational aid compared to the group that did not receive a navigational aid. A separate analysis suggested a plausible savings range of $209 to $708 per member per month in the navigation-assisted group. The greatest impact on cost savings was associated with inpatient visits, which was expected based on previous studies. In addition, many of the program’s interventions have focused on reducing acute care utilization.
The researchers concluded, “This is the first study to demonstrate that a cancer navigation program can reduce overall costs when deployed in conjunction with a health plan across a wide geographic area and range of practice types.
The researchers plan to examine exactly how navigation benefits patients since this study looked at many aspects of the app at the same time. The questions that need to be answered are: Was the navigation beneficial due to more frequent communication about symptoms than a doctor typically offers, or were the navigators able to refer patients to community housing or financial assistance? They also hope to better understand how patients and oncologists perceive symptom management performed by a third party outside the clinic.
ASCO Medical Director and Executive Vice President Julie R. Gralow, MD, FACP, FSCT, FASCO, said, “Patient Navigators play a critical role in helping cancer patients overcome a variety of organizational challenges. and others related to their care. We now have evidence on a larger scale than ever before, through the use of a virtual navigation program which, in addition to the wonderful social services offered by navigators, can also help patients save significantly on total cost care.
Mark L. Fuerst is a contributing writer.