2. The Benefits of Patient Navigators 1
Dr. Harold P. Freeman in Harlem founded Patient Navigation in 1990. Freeman pioneered
this program to reduce barriers for patients of low socioeconomic status, newly diagnosed with
cancer and to provide a seamless patient care experience. A patient navigator is an individual
that is connected with a patient after they are diagnosed with a chronic illness such as cancer.
Patient Navigators help patients have a better understanding of their diagnosis and treatment
plan. Patient navigators also help the patient with any barriers in their continuum of care.
Harlem Hospital in Harlem, New York, conducted two research studies for breast cancer five
year survival rates, the first study that ended in 1986, evaluated 606 patients. Half of the patients
studied were uninsured and living in poverty with many barriers to sufficient health care. The
five-year survival rate of these patients was 39 % (Freeman, 2006). A second study conducted
between 1995-2000 with 324 patients’ half uninsured and living in poverty. The five-year
survival was 70%, compared to 39% in the earlier Harlem Hospital study (Freeman, 2006).
These results represented that Patient Navigators along with low cost cancer screening exams,
dramatically increased patient compliance. Increased patient compliance, ultimately leads to a
healthier community and higher survival rates. Patient navigators are an essential resource for
patients because research has shown utilization of patient navigators can increase patient
compliance, decrease health care costs, decrease mortality rates, and increase patient satisfaction
scores.
The first step in diagnosing someone with
cancer is a diagnostic exam performed in the
radiology department. When patients first
come to the radiology department for their
exam, they do not know they have cancer.
Figure 1:(Freeman 2013)
3. The Benefits of Patient Navigators 2
Usually the doctors are sending the patient for symptoms or findings maybe incidental. After the
exam, the patients referring physician is responsible for explaining to the patient the results of
the diagnostic test. Many times the referring physician is the disconnect in telling the patient of
their imaging results. In a diagnosis, time is critical when having a new malignancy. The
staging and treatment process must begin immediately and patients living in low socioeconomic
communities may not fully understand the importance of the process. Patients living in
underserved areas are historically undereducated and illiterate in their health. A study performed
by the Connecticut VA Health System evaluated the length of time, results were delayed before
the health system had a navigator and after. The results are as follows; in 2003, the average was
136 days from suspicion of cancer to treatment compared to 55 days in 2010, with a trend toward
diagnosis of non-small cell lung cancer at an earlier stage (Hunnibal, 2012). In the radiology
department, when a patient has a new malignancy a Patient Navigator should be contacted to
expedite the treatment process. The Patent Navigator should contact the physician’s office so
they are aware they need to bring the patient in as soon as possible and explain the results. The
Patient Navigator should be present at the appointment to explain to the patient, the process of
treatment and how their position benefits the patient. After the explanation of results, the patient
at some point will come back to the radiology department for additional exams for staging and
treatment. Coming back to the same place cancer was found could arise many emotions for a
patient. Having a Patient Navigator can help calm the patient by reducing fears, anxiety and
making sure the patient goes in for the exam. The patient navigator is beneficial to the patient
while going through a treatment process, while making sure that tests and treatments are met,
leading to faster treatment and reducing mortality rates.
4. The Benefits of Patient Navigators 3
Health care is a second language for most people, especially individuals living in poverty,
which is associated with health illiteracy, due to the lack of education and resources available.
The individuals living in this socioeconomic category, face barriers that patient navigators can
help eliminate. There are many benefits to employing patient navigators; a major benefit is
increased patient compliance. Patient compliance can make or break treatment and save the
health care industry money. Patient Navigators eliminate most barriers a patient may face such
as; explanations about their health, transportation, and child care, and money stresses. After
appointments, patient navigators can better explain what the doctor said in the visit, this helps the
patient understand what the physician had to say as well as answer any questions. Through
explanation to a patient can increase patient compliance. By patient navigators eliminating
barriers and delays, the patient receives care and treatment within a timelier manner. Patient
nonadherence to prescribed medications is associated with poor therapeutic outcomes,
progression of disease, and an estimated burden of billions per year in avoidable direct health
care costs (Igua, 2014).
In addition, to patient navigators helping patients understand their care, PN’s are helping the
healthcare budget. Patient Navigators are eliminating barriers for patients by increasing their
education and compliance. The noncompliant patient is not new to the health care sector
however; with the new Affordable Healthcare Act, quality is now more important than quantity.
Costing the facility more money than ever, for missed appointments. A missed appointment is
just one factor. Another costly factor is when a patient is noncompliant with medications,
leading to more rigorous care because of worsening symptoms and disease progression. The
overall cost to the health care system is thought to be between $100 and $259 billion annually
(Stelmach, 2015). Unnecessary Emergency Room visits also contribute to the overall cost.
5. The Benefits of Patient Navigators 4
Uninsured patients go to Emergency rooms for symptoms and complaints that can be managed in
an outpatient clinic. In 2010, Uninsured patients cost one Texas based hospital over $5 Billion in
uncompensated care. More than half of the ER visits were from uninsured or Medicaid patients
that had primary care related visits. Memorial Hermann Health System in Houston, Texas, who
founded the previous statistics, implemented a test patient navigation system for these ER
patients in an effort to reduce the health systems expenses. The results; these cost savings were
greater than the costs to implement the program, which demonstrates that an ED-based
navigation program led by CHWs is cost -effective for Memorial Hermann (Enard,2013).
Obviously, this is a very costly issue that needs a resolution; the research performed by Hermann
Health System concludes that patient navigators will alleviate some of the finical burden by
increasing patient compliance not only in the Emergency Rooms but also in all aspects of health
care.
Noncompliance is a major health problem, It accounts for 10% of all hospital stays and
causes approximately 125,000 deaths a year (Stelmach,2015). As Dr.Freemans’ research
concluded, mortality rates decrease significantly when patients had this resource available.
Decreasing mortality rates among underserved populations was Mr. Freeman’s main goal. While
his research and statistics have proven the value of patient navigators, there is lacking research
from others that patient navigators do or do not improve mortality rates. However, other patient
navigation research has proven many benefits that do affect lower mortality rates. Again, a
major benefit is increased patient compliance. Having a patient navigator to break down barriers
for patients allowing patients to receive the right care at the right time no matter the
discrepancies allows the patient no excuses for delay in care, medications, treatment, or testing.
Having the patient receive care accuracy will improve the outcome of the disease. A patient that
6. The Benefits of Patient Navigators 5
does not have a navigator can feel burdened, which can lead to depression, denial, frustration,
and lack of trust in health care providers. When a patient feels this way, they give up hope,
delaying treatment, leading to progression of the disease. Progression of the disease because of
delay of care can affect the survival rate adding to health care costs for more rigorous treatment
and eventually leading to a higher mortality rate. Having a patient navigator can eliminate these
stresses and make the patient feel as if they have someone they can lean on during a life threating
illness.
Patient navigators have strong interpersonal relationships with patients they are assigned to,
giving navigators the ability to raise significantly raise satisfaction scores. We all know that
patient satisfaction ratings are driving health care. Since President Obama's health care reform
Act, The Center for Medicaid and Medicare Services are reimbursing hospitals and clinics based
on patient satisfaction and likelihood to recommend scores. The Affordable Healthcare Act as
well as medical facilities is putting a strong emphasis on patient satisfaction rates. In 2013, a
group of doctors published a study titled, “Do Better-Rated Navigators Improve Patient
Satisfaction released a study with Cancer-Related Care?” The Patient Navigation Research
Program (PNRP) studied 1,593 adults with a cancer diagnosis; the study evaluated two groups of
patients that receive cancer related care. One group did not have patient navigators and the other
group of patients where appointed a navigator. The Patient Satisfaction with Cancer-Related
Care (PSCC) scale measured the results. The findings confirm our hypothesis that patients who
receive PN from better-rated navigators would report better satisfaction with their cancer-related
care (Jean-Pierre, 2013). Patient Navigators have the ability to increase satisfaction scores by
ensuring quality care for patients and giving the patient a better understanding of their health and
continuum of care. Educating the patient instills trust in the medical providers leading to higher
7. The Benefits of Patient Navigators 6
patient satisfaction, leading to higher reimbursement and better finical stability for the medical
facility. These benefits provide for a healthier community and better quality of life for all
patients receiving treatment for a devastating illness.
Patient navigators have many
benefits as described in the previous
paragraphs. However, all programs
must have pros and cons. The pros
to having Patient Navigators have
many proven benefits for patients, as
well as the medical facilities serving
the patients. Patient Navigation is a
resource that is needed mostly in
underserved communities, One of the
cons to having a patient navigator is the initial cost of a patient navigation program start. Cost
associated with the startup of a program are training and hiring costs. Hiring costs may differ
based on if the patient navigator is paid or volunteer and depending on their level of
professionalism. Training costs may differ based on how far and how long employees need to
travel for training. Another con to patient navigators is the profession is not regulated and there
are currently no set requirements, qualifications, or certification to be a patient navigator. This
could pose a red flag when dealing with patients and their information, as patient information is
regulated by HIPAA. Patient navigators are a newly growing occupation with research backing
their benefits, once the occupation is better understood the cons of the occupation might be
obsolete.
Figure 2: (Meredith,2013)
8. The Benefits of Patient Navigators 7
The Health Care system in America is failing many people because of the lack of
understanding among individuals that have barriers such as economic status, low education,
disabilities, racial, and language barriers. Patient navigators are a great asset to any health
system and the community. A Patient navigator should be integrated into the system to help
patients that are diagnosed with chronic illnesses and that may face barriers. Some might argue
that starting a Patient Navigation program will be too costly and dig too deep into the budget.
Initially, it will cost to develop a program for hiring and training purposes. However, long-term
patient navigators can save a health system money by increasing patient compliance with
appointments and decreasing time a doctor spends with a patient. The pros significantly
outweigh the cons in this situation and Mr. Freeman has displayed what patient navigators can
accomplish by the statistics of reducing morality rates. Every health system should employ
patient navigators for seamless treatment and care.
9. The Benefits of Patient Navigators 8
References
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11. The Benefits of Patient Navigators 10
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