Patient Navigators Skills they bring, what they do, where they work and the value they add for practices and patients

Transcription

1 Patient Navigators Skills they bring, what they do, where they work and the value they add for practices and patients Wanda Ali-Matlock, RN, BS, MBA, FAACM, PCMH CCE Senior Consultant Aleece Caron,PhD Senior Consultant Rita Horwitz, RN BSN Director Business Development & Operations XVII Learning Collaborative Summit Corporate College East, Warrensville Hts., Ohio October 9, 2015

2 Better Health Partnership has no financial or non-financial potential conflicts of interest relevant to this presentation.

3 Patient Navigation Session Objectives 1. Describe how patient navigation has evolved from its inception to the present. 2. Describe the value added by patient navigators in the healthcare industry and the skills and competencies identified as most important to be effective in various roles. 3. Discuss challenges that healthcare and education industries must address for future direction of the patient navigator role.

4 Market Research References Balderson, David. "Simple Solutions to Complex Problems: How Patient Navigation Brings the Human Touch to Health Care." February 18, Center for Disease Control and Prevention. "State Law Fact Sheet: A Summary of State Community Health Worker Laws." 25 May Center for Disease Control and Prevention. < Center for Health Affairs. "The Emerging Field of Patient Navigation: A Golden Opportunity to Improve Healthcare." Issue Brief (December 2012). Freeman, Harold P., and Rian L. Rodriguez. "History & Principals of Patient Navigation." (August 1, 2011). Mary McLaughlin-Davis, DNP, MSN, APRN, ACNS-BC, CCM and Sarah Fay,. Patient Navigator in the Community Care Acute Hospital. Poster Presentation. Cleveland Clinic and The Center for Health Affairs. Lakewood, Ohio: Accenture, Ohio Board of Nursing. n.d. < accessed 6/4/2015>. United States Department of Labor. Bureau of Labor Statistics. n.d. 3 June

5 Patient Navigation Definition Patient navigation is a healthcare service delivery model built around the patient to reduce barriers to care. They: Support individual patients throughout the care continuum relevant to their condition to resolve barriers to care. Work in a variety of settings, including hospital, tertiary care, primary care, home, and the community. Have formal clinical training. 5

6 Patient Navigation: How Did We Get Here? American Cancer Society National Hearing on Cancer in the Poor in 1989 Harold P. Freeman, MD, of Harlem Hospital developed the first patient navigation program in 1990 Navigators focused on timely diagnosis, follow-up and treatment Dr. Harold P. Freeman Program increased five-year cancer survival rate from 39% to 70%.

7 ROI: Value to Healthcare Systems MetroHealth Radiation Specialty Clinic ( ) Reduced no show rates by 3%. Program paid for itself in 3 ½ months. Showed potential to generate $2.1 million in revenue if implemented in other priority areas. Cleveland Clinic: Lakewood Hospital (2012) Reduced hospital re-admissions by 4%. Reduce ED re-visits by 5%. Program paid for itself in two months, saving $156,804.

8 Growing Demand for Navigators United States Bureau of Labor Statistics projects a market growth of 25% by the year More people with access to insurance. Changing healthcare payment models. Studies show navigators are effective in improving healthcare quality, cost and the patients experience. 8

9 Skills & Competencies: Which are most important? Strong organizational skills Effective communication skills Computer proficiency Ability to work in a team environment Excellent interpersonal skills Knowledge of healthcare and community resources Basic medical terminology Comfortable working with medically underserved populations 9

10 Three Domains of Patient Navigation CLINICAL COMMUNITY COMBINATION 10

11 Clinical Navigator Role Coordinate care post-hospitalization; ED discharge Utilize EHR for health maintenance; outreach for disease management Track referrals for completion; flag and follow-up on abnormal report Review medical records for pre-visit planning Make pre-appointment call reminders; arrange transportation Develop reports, charts and graphs to facilitate performance and quality improvement 11

12 Community Navigator Role Register individuals for Medicaid; other governmental insurance Connect clients* to FQHC for medical, dental, and vision care. Connect clients with community resources for food, housing, and medication discounts Participate in community health fairs Has mobile office * People served by the navigator in the community are called clients. 12

13 Combination Navigator Role Performs roles of both clinical and community navigators, plus: Addresses non-clinical needs of walk-in patients and sees patients by referral Develops programs in the community to benefit the populations they serve 13

14 Implementation challenges No sustainable funding mechanism. Inconsistent scope of practice, training and qualification. Inadequate support for role implementation. Lines of responsibilities blurred, with a lot of crossover. No standard volume-to-navigator ratio or correlation between number of providers and navigators on staff. No best practices identified. 14

15 Recommendations Navigator groups and associations must collaborate to develop a standardized scope of practice, training and qualification. Education for navigators must encompass classroom and field experience. Organizational resources must be allocated to support and optimize the role for future sustainability. Must find ways to measure effectiveness of the role in order to identify and disseminate best practices. 15

16 From the Heart: Navigators Value for Patients TWO STORIES Narrated by Kimberly Mihalik, HealthSpan Idalia Lorely Rosa, LPN Care Navigator, MetroHealth Andrew Bisbee, BLS Intermediate Care Technician, Louis Stokes VAMC 16

17 Patient Navigator Panel Discussion Brook Watts, MD Louis Stokes Cleveland VA Medical Center