How Patient Navigation Drives Quality and Produces Profit in Health Care

Transcription

1 How Patient Navigation Drives Quality and Produces Profit in Health are Judy. Kneece, N N Eduare Inc., harleston, earning bjectives Define patient navigation Describe the benefits of patient navigation on qualityof-care Financial Disclosure Educare Inc., President alary Nursenav ncology, hareholder

2 Quality: rganization's efficiency, outcomes of care and level of patient satisfaction. - Health esources dministration Quality is NEVE an ccident Quality is W the esult of Intelligent Planning merican ollege of urgeons recognized that Patient Navigation was an essential component of quality health care delivery 2008: NPB included Patient Navigation as an accreditation standard 2012: o added Patient Navigation as an accreditation standard

3 Patient Navigation Definition ommission on ancer; -hange Individualized assistance offered to patients, families and caregivers to help overcome healthcare systems barriers nd facilitate timely access to quality medical and psychosocial care From pre-diagnosis through all phases of the cancer experience. How Patient Navigation reates a ulture of Quality for the Patient The Patient UTIN: round each cancer is wrapped a patient. Handle with care. Dr. Henry P. eis

4 Dedicated Team of Physicians Focus on Quality are for a Patient s ancer Patient Navigator Focuses on a Patient s Quality of are ancer are Delivery 15% of cancer care is delivered in omprehensive ancer enters with all physicians and support staff located on-site Ideal model for patients and physicians 85% of cancer care is delivered in ommunity ancer enters with physicians practicing independently at multiple sites that are separated by distance and time reates barriers for patients in navigating their own care reates problems for physicians in delivering collaborative care

5 ancer are Delivery ommunity ancer enters face a challenge in delivering the same patient-centered cancer care as omprehensive enters hallenge: Finding a cost-effective solution to close gaps in care delivery Making the ase for Patient Navigation The Patient Experience

6 Diagnosis: NE hocked Emotionally verwhelmed Forced to Proceed: No Time for Delay Patient Faces an Unknown Health are ystem Totally Unprepared ilo are Delivery Diagnostic adiology urgery Pathology Medical ncology adiation ncology Plastic urgery D I U E P T H M E D N D N P T I Physicians Practice Independently, eparated by Time and pace

7 Dr. Fitzhugh Mullan ancer Diagnosis 1982: ge 32 Vital igns: oung Doctor s truggle With ancer I was experiencing medicine from the other end of the stethoscope, coming from a very personal perspective. Various specialists were doing diligent work, but kind of smokestack work, each in their own chimney. This was a graphic demonstration of what I think is a major ailment in our system, which causes gross inefficiency. Dr. Mullan s writings created widespread awareness and advocacy for reform 1986: o-founded the National oalition for ancer urvivorship (N) Identifying ross Inefficiencies in ilo are Patient hallenges Health are Provider hallenges

8 Patient: Inefficiencies Experienced Diagnostic Medical adiation Plastic urgery Pathology are adiology Fragmented Hard ncology to Navigate ncology on urgery wn P M P engthy Wait U -Time Between E ppointments D T D D Barriers to Patient are Not ddressed I H Medical anguage E Difficult to Understand T N N I onflicting dvice eceived from Physicians Patient s Emotions are at Highest evel Healthcare Team: Inefficiencies Experienced Diagnostic urgery adiology U D I 0 E Pathology Medical ncology adiation ncology Plastic urgery Time from Diagnosis P to Treatment M Increases P E ommunication Between T Physicians D Dis Difficult H Potential for Duplication of ervices Increases T Transitions of are May Increase N Error N Potential I Uncoordinated are Decreases Patient atisfaction Malpractice Potential Increases Major ause of Inefficiencies in ilo are Delivery Diagnostic adiology D I 0 urgery U E Pathology P T H Medical ncology M E D N adiation ncology D aps of Time reated During Delivery of are N Plastic urgery P T I

9 Examining the aps in ilo are Delivery Diagnostic adiology D I 0 urgery U E Pathology P T H Medical ncology M E D adiation ncology D Plastic urgery P T I White pace: Transition Period Between N ervice N ines Where There is No Patient wnership or ccountability White pace in an rganization Harvard Business eview The large, but mostly unoccupied territory, in every organization where rules are vague, authority is fuzzy, budgets are nonexistent and strategy is unclear and where, as a consequence, errors occur. During Transitions of are, the Patient is eft to Find Her wn Way Potential Hazards: Patient ut-migration or Malpractice How an ommunity ancer enters lose aps in are Delivery? Diagnostic adiology D I 0 urgery U E Pathology P T H Medical ncology M E D N adiation ncology D????? N Plastic urgery P T I

10 The nswer Diagnostic adiology D I 0 urgery U E Pathology P T H Medical ncology M E D N adiation ncology Patient Navigation D Full ontinuum of are N Plastic urgery P T I Multidisciplinary are onferences Physicians eview ll Patient ases Weekly Weekly Multidisciplinary onference loses White pace aps in Physician ommunication Facilitates ollaborative Decision Making Navigator erves as a Patient s Personal P Navigator Provides Emotional upport, Education, ssessment, Triage, and dvocacy Throughout the ontinuum of are

11 D I 0 U E P T H Navigation loses White pace aps During Transitions of are With Patient urveillance and ommunication M E D N D N P T I Patient Navigation Full ontinuum of are ombined With Multidisciplinary are onferences Physicians eview ll Patient ases Weekly reate a VITU ancer enter How Patient Navigation Impacts Patient and Facility Quality utcomes

12 Patient Benefits Diagnostic adiology urgery urgery Pathology Pathology Medical ncology adiation ncology Plastic urgery Navigates Patient Through ll ervice ines P M P ddresses U and emoves E Barriers to are D T D D upports Patient and Family Emotionally I H Educates E Patient and Family T N N I Monitors Phycological and Physical tatus Teaches elf-are kills erves as Patient dvocate to are Team Facility Benefits Diagnostic urgery adiology U D I 0 E Pathology P T H Medical ncology N adiation ncology N Plastic urgery Decreases Time from Diagnosis M to Treatment Facilitates ommunication E Between Physicians D D Decreases Duplication of ervices P T I Decreases Inappropriate ccess to are Decreases Hospital eadmissions Manages Patient Transitions of are Patient Navigation Has ucceeded In losing The aps in ommunity ancer are Delivery

13 How Patient Navigation Translates into reating Facility Profit Presenting the Evidence of How Patient Navigation Increases Financial Profitability How Navigation Increases Facility Financial Profitability ase tudy # 1 ase tudy # 2 ase tudy # 3 Increases Patient atisfaction Froedtert & The Medical ollege of Wisconsin ancer enter educes Patient ut-migration Henrico Doctors Hospital, ichmond, Virginia educes No-how ppointments ccenture-metrohealth, leveland, hio

14 Patient Navigation Impact on Patient atisfaction ase tudy # 1 Froedtert & The Medical ollege of Wisconsin ancer enter Patient atisfaction tudy 3 ear tudy Patient Navigation Impact on atisfaction Froedtert & The Medical ollege of Wisconsin ancer enter Patient Evaluations: Quality of are % 97% 57% % Increase Froedtert & The Medical ollege of Wisconsin ancer enter

15 verall core: Patient atisfaction ow 30s Froedtert & The Medical ollege of Wisconsin ancer enter High 50s 93% % Increase Press aney: esearch confirms a definite link between a patient s perceptions of quality to the profit margins for healthcare facilities. Patient atisfaction Translates into Financial Profit eturn on Investment: Increasing Profitability by Improving Patient atisfaction 2013 Patient Navigator: uardian of Patient atisfaction Throughout Full ontinuum of Patient are

16 How Patient Navigation educed ut-migration ase tudy # 2 Henrico Doctors Hospital ichmond, Virginia Understanding the High ost of Patient ut-migration For ancer Programs Patient ut-migration It is Not Just NE Patient eaving ut-migration is a oss of Downstream evenue for a ancer Program and ll Practicing Physicians

17 Understanding Downstream evenue Breast ancer Downstream evenue: Breast ancer ancer urveillance $ adiology harges $ adiologist Fee creening Mammogram pin-ff evenue ancer Treatment $ Medical ncologist Fee $ ab Fees $ Infusion enter $ Pharmacy Fees $ adiation ncologist $ adiation Therapy $ Physical Therapy $ ccupational Therapy $ Psychological ervices $ enetic Evaluation Fees $ omplementary Therapies $ adiology harges $ adiologist Fee Diagnostic Mammogram Minimally Invasive Biopsy urgical Biopsy ancer urgery $ ab/ek $ perating oom $ entral upply $ Pharmacy $ Pathology ab $ Pathologist Fee $ urgeon Fee $ Hospital tay $ adiology (specimen ) $ Nuclear Medicine $ Plastic urgeon (numerous surgical charges) $ adiology harges $ adiologist Fee $ Pathology ab $ Pathologist Fee $ ab/ek $ perating oom $ entral upply $ Pharmacy $ Pathology ab $ Pathologist Fee $ urgeon Fee $ adiology (specimen) Breast ancer urvivor ears of urveillance 5 ears 10 ears 15 ears 20 ears 89% urvive 83% urvive 78% urvive 63% urvive merican ancer ociety 2016

18 63% emain in ong-term urveillance ontinued ource of Downstream evenue 20 ears $ Medical ncologist Fee $ ab Fees $ adiology/adiologist Fees $ Interventional Biopsy? $ Nuclear Medicine? $ urgeon? $ perating oom? $ ab Fees? $ Hospital harges? ecurrence $ Pathology? $ Pathologist Fees? $ Infusion enter? $ Pharmacy Fees? $ adiation ncologist? $ adiation Therapy? $ Physical Therapy? $ Home Health? $ Hospice? pin-ff evenue ancer urveillance $ Medical ncologist Fee $ ab Fees $ adiology Imaging $ adiologist Fees $ Nuclear Medicine $ Numerous Miscellaneous $ Medical ncologist Fee $ ab Fees $ adiology/adiologist Fees $ Interventional Biopsy? $ Nuclear Medicine? $ urgeon? $ perating oom? $ ab Fees? $ Hospital harges? ecurrence $ Pathology? $ Pathologist Fees? $ Infusion enter? $ Pharmacy Fees? $ adiation ncologist? $ adiation Therapy? $ Physical Therapy? $ Home Health? $ Hospice? ancer urveillance $ Medical ncologist Fee $ ab Fees $ adiology Imaging $ adiologist Fees $ Nuclear Medicine $ Numerous Miscellaneous $ adiology harges $ adiologist Fee creening Mammogram pin-ff evenue ancer Treatment $ Medical ncologist Fee $ ab Fees $ Infusion enter $ Pharmacy Fees $ adiation ncologist $ adiation Therapy $ Physical Therapy $ ccupational Therapy $ Psychological ervices $ enetic Evaluation Fees $ omplementary Therapies $ adiology harges $ adiologist Fee Diagnostic Mammogram Minimally Invasive Biopsy urgical Biopsy ancer urgery $ ab/ek $ perating oom $ entral upply $ Pharmacy $ Pathology ab $ Pathologist Fee $ urgeon Fee $ Hospital tay $ adiology (specimen ) $ Nuclear Medicine $ Plastic urgeon (numerous surgical charges) $ adiology harges $ adiologist Fee $ Pathology ab $ Pathologist Fee $ ab/ek $ perating oom $ entral upply $ Pharmacy $ Pathology ab $ Pathologist Fee $ urgeon Fee $ adiology (specimen)

19 Henrico Doctors Hospital ut-migration tudy esults ncology Issues: Making The ase For the Nurse Navigator, 2011 onducted 4-ear tudy Downstream evenue nalyzed Patient ut-migration fter Mammography creening allbacks 240 Patients Exited are Previous ear

20 Breast enter Navigator Hired Interventions: ontacted call-back patients within 24 hours Explained why additional studies were needed nswered patient questions ffered expedited appointment for additional views/tests ut-migration 1 ear ater 88% eduction in ut-migration 240 Patients 212 Patients etained 28 Patients 1 ear Before Navigator 240 all-back Patients Exited are 1 ear fter Navigator Hired 28 all-back Patients Exited are Henrico Doctors Hospital evenue* ained: 212 aved Patients 1 ear 212 Patients $125, Imaging Procedures Diagnostic Imaging Procedures *Quantified by data analysis of billable services of cancer and non-cancer patient

21 212 aved ut-migration Patients 29* Positive Breast ancers Diagnosed * 13.7 Percent ncology Issues: Making The ase For the Nurse Navigator, 2011 evenue ained: 212 Patients 1 ear 29 Diagnosed Positive Breast ancers $225, Positive Breast ancers ancer and Non-ancer Downstream evenue Total evenue ained 1 ear Imaging evenue ancer evenue Total evenue $125, $225, $350,000.00

22 4 ears ater: ur Migration 10 Patients or ess Exited creening Mammography all-backs 4 ears ater ut-migration eduction fter Nurse Navigator 240 early 95.8% eduction 240 Mammography all-back Patients eft 1 ear Before Navigator < Patients or ess Exited early fter Navigator dded Value of ne Nurse Navigator 4 ear Estimated evenue* ancer Treatment $225, X 4 ears = $ 900, Imaging evenue $125, X 4 ears = $ 600, ears $1,500,000.00

23 No-how ppointments: Navigator Impact ase tudy # 3 ccenture-metrohealth leveland, hio ccenture-metrohealth; leveland, hio ost of No-how ppointments ancer Treatment $1,500 Per ppointment Navigators Implementation: 6 Month tudy Navigators reduced no-show and cancellation rates by 3% eduction generated enough revenue in 3.5 months to pay annual salaries of 2 full-time Navigators ccenture-metrohealth; leveland, hio

24 No-how ppointment eductions: Financial Impact End of 1st ear Each full-time Navigator position generated $150,000 revenue ccenture-metrohealth; leveland, hio Harvard Business eview: David Balderson, Kaveh afavi, MD Extrapolating these results, two FT navigators across 7 high-cost priority areas in cancer care delivery could yield $2.1 million dollars a year. ccenture-metrohealth; leveland, hio Three Essential Keys For uccessful Patient Navigation Program

25 Navigation Program #1 Written linical Navigation uidelines Navigation Process Written navigation guidelines are essential enter needs to develop own guidelines which incorporate the needs of their stakeholders for every navigation process throughout the continuum of care What needs to be done When it needs to be done Who needs to the perform task linical ncology dvisor: June 2017 linical pathways are a critical structural element in the effort to reduce variability in healthcare and to make costs and outcomes more measurable, predictable and accountable. s value-based reimbursement models become more common, reliable care coordination and clinical pathways are essential to reducing cost and variability of oncology care and improving outcomes.

26 Patient Navigation uidelines creening Diagnostic Period Diagnosis Treatment ample of Navigation Process Needed for Breast Navigator Patient Navigation uidelines urvivorship urveillance ample of Navigation Process Needed Navigation linical Pathway Development linical navigation guideline development can start with examples provided by: NIE (NIH Health and are Excellence) NN (National omprehensive aner Network) Blue ross/blue hield Michigan (shown to improve clinical outcomes while increasing profit)

27 Navigation linical Pathway Development Necessary to customize your clinical pathways with your stakeholder s input and expressed needs Builds consensus and compliance Written clinical pathways should be shared with all stakeholders after development learly outlines and defines expectations for providers Ensures quality standards are understood Navigation Program #2 Evaluation of Every Navigation Process for Effectiveness and Efficiency Navigation Process Evaluation Essential to evaluate every process for: ight Job Done at the ight Time Performed using the most costeffective and outcome-efficient method

28 Evaluate Every Process For Efficiency Is this task necessary? Is it a required standard-of-care or law? ook at every piece of paper an it be eliminated or can the process computerized? Is an education process repeated? es: equires written instructions or patient teaching materials Evaluate Every Process Is the right skill-level employee performing the task? Navigator: ommon Financial Drain Nurse Navigator becomes high-paid clerical employee pends large amount of time entering data and performing non-nursing tasks For program to be profitable, Nurse Navigators must spend time facilitating nursing tasks

29 an a Navigator Task Be Delegated? $ $ $$ $$$ lerical Med Tech ocial Worker Nurse Effective Navigation Program To be financially profitable, care needs to be delivered by a team of professionals, not just a Nurse Navigator lerical Med Tech ocial Work Nurse Navigation Program #3 Provide Navigator Tools Needed for Efficiency

30 Most ommon Navigator hallenge How an I et It ll Done? Barriers to are Patient Navigation Distress ssessment urvivorship are Plan Finding everage Navigators Need Tools to everage Efficiency Key: Electronic Medical ecords ancer Navigation oftware 2006

31 ancer Navigation oftware Decreases time constraints required for data entry and data retrieval Provides work-flow and navigation processes erves as a tutor for successful implementation of facility clinical paths ancer Navigation oftware alendar linked to patient s record creates reminders and task lists Decreases potential for patient task to be overlooked ancer Navigation oftware Patient portal allows secure communication between patient and navigator

32 ancer Navigation oftware ecords data from all interventions: Barriers ssessment Distress ssessment eferrals and outcomes for identified barriers/distress Educational materials provided to patient ncillary/community support referrals ancer Navigation oftware utomatically builds Treatment ummary for urvivorship are Plan required at end of treatment educes hours of time manually compiling treatment summary and history into a task of only minutes Decreases errors from manual extraction of data from patient record to compile urvivorship Treatment ummary dministration Benefits Provides complete administrative overview of all navigation processes aptures key data elements for benchmarking aptures downstream revenue aptures patient demographics

33 dministration Benefits Tracks referrals in and out of a program Tracks designated quality measures enerates patient progress reports for physicians Navigation oftware election elect software that navigates all cancers and is not cancer-specific Web-based software preferred ccess from anywhere, allows Navigators to be more productive utomatic software updates bility to compile urvivorship Treatment ummary Patient Navigation: The New Pathway to Deliver Quality are and Ensure Financial Profitability

34 merican ancer ociety Economic evaluation of the patient navigator program suggests that such programs can be a cost-effective use of limited resources and yield a net financial benefit for providers. ancer: 2012 Navigation Financial Benefits JM ncology: June 2017 osts among the navigated patients declined a mean of $ more per patient per quarter than among the non-navigated patients, which could be estimated as a $475,024 reduction in cost annually for a navigator managing 152 patients throughout the year. For a navigator with an annual salary investment of $48,448 (salary and fringe benefits), we estimated a return on investment of 1:10. esource Use and Medicare osts During ay Navigation for eriatric Patients With ancer: JM ncology Medicare ecognizes Value of Navigation pril 2017: enters for Medicare and Medicaid ervices (M.gov) announced oncology providers financial incentives ncology are Model (M) offers oncology providers reimbursement according to performance and outcomes ncology providers must commit to: ffer patients enhanced services including care coordination and patient navigation M pril 2017: Press elease Follow national treatment guidelines

35 Medicare ecognizes: Financial Value of Patient Navigation that Follows linical Pathways on Increasing Patient utcomes While Decreasing ost reating a ulture of Patient Quality Patient Navigation has proven value directly linked to closing inefficiency gaps in healthcare delivery while: Increasing Patient atisfaction reating and Maintaining Quality utcomes Producing Financial Profits Truth tages ll truth passes through three stages: First, it is ridiculed econd, it is violently opposed Third, it is accepted as being self-evident Patient Navigation Now Has a History of elf-evidence rthur chopenhauer

36 Patient Navigation Has Proven to Benefit Both: Patients and Health care Facilities reating a ulture of Quality While Ensuring Financial Benefits EQUIE Patient Navigation Thank ou! Judy Kneece