Patient Navigation: A Program to Enhance the Patient Experience and the Bottom Line

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In the eyes of a patient, especially one with a chronic or complex illness, the healthcare system can feel overwhelming. Compound the inherent complexities of the system with a variety of barriers patients can face – transportation, language, and many others – and patients can have difficulty following the care plan developed by their team of providers.

Founded and pioneered in 1990 by Dr. Harold P. Freeman, patient navigation originally focused on the critical window of opportunity to save lives from cancer by eliminating barriers to timely care between the point of suspicious finding and resolution by diagnosis and treatment. Since its inception as a community-based intervention program, patient navigation has expanded and transformed into a nationally recognized model that extends well beyond cancer care to include the timely movement of an individual across the entire healthcare continuum.

While patients clearly benefit from the guidance of a patient navigator, a growing body of evidence suggests that patient navigation increases both patient satisfaction and hospital revenue. Nationally, patient navigation is becoming well-recognized for being a cost-effective strategy to address several healthcare priorities. An attractive career choice for those looking to make a difference in healthcare, patient navigation also provides economic development opportunities in communities throughout the United States.

About the Speaker:
Carol Santalucia, Vice President, of CHAMPS Patient Experience, LLC is a seasoned healthcare leader with a passion and commitment to enhancing the patient experience. After 28 years in various service excellence and leadership roles at Cleveland Clinic, where she played a pivotal role in the design, creation and implementation of Cleveland Clinic’s service recovery model Respond with H.E.A.R.T., and the development of their patient navigation program and Service Excellence and Patient Advocacy Department, Carol began her own healthcare consulting practice, Santalucia Group, LLC.

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Patient Navigation: A Program to Enhance the Patient Experience and the Bottom Line

  1. 1. www.champspatientexperience.com @carolsantalucia Patient Navigation: A Program to Enhance the Patient Experience and the Bottom Line Carol Santalucia, MBA Vice President CHAMPS Patient Experience
  2. 2. www.champspatientexperience.com @carolsantalucia How I Got Here Education Work Experience Personal Experience
  3. 3. Topics for Discussion • The Optimal Patient Experience • Patient Navigation • Patient Navigation’s Effect on the Bottom Line • Patient Navigation’s Effect on the Patient Experience
  4. 4. The Optimal Patient Experience Optimal Patient Experience Building Trust Reducing Anxiety Engaging Employees Cultural Commitment
  5. 5. www.champspatientexperience.com @carolsantalucia Current Tactics Optimal Patient Experience Process Improvement Amenities Facility Enhancements Our Approach: Leveraging People
  6. 6. www.champspatientexperience.com @carolsantalucia What is Patient Navigation? Process in which an individual… Guides a patient through and around barriers Virtually integrates our fragmented and complex healthcare system
  7. 7. www.champspatientexperience.com @carolsantalucia Pole Questions • Do you use patient navigators in your organization? – Yes – No
  8. 8. www.champspatientexperience.com @carolsantalucia History of Navigation Pioneered in 1990 by Dr. Harold P. Freeman; focused on the critical window of opportunity to save lives from cancer by eliminating barriers to timely care between the point of suspicious finding and resolution by diagnosis and treatment Since its inception as a community- based intervention program, Patient Navigation has expanded and transformed into a nationally recognized model that extends beyond cancer care
  9. 9. www.champspatientexperience.com @carolsantalucia • Breast Cancer 5-year Survival Rate increased from 39% to 70% once navigation was implemented Navigations Impact on Outcomes
  10. 10. www.champspatientexperience.com @carolsantalucia Types of NavigatorsClinicalNavigator •Assist patients with treatment and prevention-related tasks •Apply their clinical knowledge to help patients understand treatment and care options, as well as discharge instructions •Provide individual, family and caregiver counseling LayNavigator •Connect patients to different resources and information in the healthcare system and the community •Coordinate screenings and appointments •Remove barriers to accessing care in a timely manner •Reduce the burden of overwork for providers InsuranceNavigator •Provide individuals and families with the information necessary to determine which health insurance option best fits their needs •Help individuals and families enroll in their plan of choice
  11. 11. www.champspatientexperience.com @carolsantalucia Pole Question • For those of you who have patient navigators in your organization, what type of navigator are you using? – Clinical Navigators – Lay Navigators – Both
  12. 12. www.champspatientexperience.com @carolsantalucia Role of the Lay Navigator Patient Lay Navigator Physician Case Manager Nurse Pharmacist Dietician Mental Health Social Work Clinical Navigator Discharge Nurse
  13. 13. www.champspatientexperience.com @carolsantalucia Responsibilities May Include… • Guiding patients through healthcare system by assisting with access to healthcare • Coordinating logistics for plan adherence • Accompanying patients to appointments when necessary • Developing relationships with participating physicians and service providers • Provide coaching and support to patients and families when appropriate
  14. 14. www.champspatientexperience.com @carolsantalucia Pole Question • What title best resembles what your organization calls its navigators? – Nurse Navigator – Patient Navigator – Case Manager – Social Worker – Community Health Worker – Community Outreach Worker – Other
  15. 15. www.champspatientexperience.com @carolsantalucia Characteristics of a Navigator • Excellent Communication Skills • Ability to process large amounts of information • Ability to build and maintain trusting relationships • Exercises good judgment • Ability to function well on a team • Ability to maintain healthy boundaries
  16. 16. www.champspatientexperience.com @carolsantalucia Cleveland, OH Pilot Head and Neck Cancer Business Challenge • High no-show rates for outpatient radiation appointments leading to lost revenue at the medical center Placement of Navigator • .5 FTE onsite working with physicians, nurses and social workers Breast Cancer Business Challenge • High no-show rates and a lack of healthcare coverage leading to lost revenue at the medical center Placement of Navigator • 1 FTE onsite working with physicians, nurses and social workers Emergency Department Challenge •High number of self-pay readmits •Goal of decreasing 30-day Medicare readmits Placement of Navigator •1 FTE onsite working with unassigned patients coming through the ED
  17. 17. www.champspatientexperience.com @carolsantalucia Pilot Performance Metrics Focus Area Primary Metrics Secondary Metrics Head and Neck Cancer 1. Reduce no-show rates for outpatient radiation appointments 2. Reduce cancellations a. Increase in patient satisfaction b. Reduce Ombudsman complaints c. Improved quality Breast Cancer 1. Reduce no-show rates for outpatient radiation treatment 2. Increase in coverage numbers and revenue for BCCP a. Track days between key appointment b. Increase in patient and physician satisfaction c. Improved quality d. Reduce Ombudsman complaints Emergency Department 1. Reduce 30-day Medicare Readmits 2. Decrease self-pay revisits a. Increase patient and employee satisfaction b. Decrease LOS in observation c. Improved quality d. Reduced Ombudsman complaints
  18. 18. www.champspatientexperience.com @carolsantalucia Head and Neck Cancer Pilot Results Pre Post % Missed Appointments 12.45% 9.68% % Kept Appointments 87.55% 90.32% Annual Salary .5FTE: $17,500 ROI: 2.48 Months 0 5 10 15 Dec Jan Feb Mar Apr May Percent Missed Appointments 2011 2012
  19. 19. www.champspatientexperience.com @carolsantalucia Breast Cancer Pilot Results 0 5 10 15 20 May June July Aug Sept Oct Percent Missed Appointments 2011 2012 Pre Post % Missed Appointments 9.96% 7.81% % Kept Appointments 90.04% 92.19% Annual Salary 1 FTE: $35,000 ROI: 5.7 Months
  20. 20. www.champspatientexperience.com @carolsantalucia 41 36 33 34 35 36 37 38 39 40 41 42 No Navigation Navigation Percent Self-pay Revisits Emergency Department Results 7 3 0 2 4 6 8 No Navigation Navigation Percent of Medicare 30-day Readmits 6-month Savings: $29,702.09 6-month Savings: $127,102.86
  21. 21. www.champspatientexperience.com @carolsantalucia Current Navigation Programs Large Healthcare Provider Large Healthcare Provider Large Regional Healthcare Provider Non-Profit Community Organization Action • Operational metrics and workflow optimization to better serve diabetes patients and other chronic diseases • Integrated lay navigator into ER to reduce the number of self-pay admits and readmits • Integrated lay navigators into care model to better serve sickle cell, head/neck cancer and breast cancer patients • Employed a community-based lay navigator outreaching to those in need Outcomes • Increased facility and resource efficiency • Reduced no-show rates for diabetic education, foot and eye visits • Increased revenue through conversion of uninsured to Medicaid • Lowered ER admissions / readmissions for unassigned patients • Identified and resolved system issues preventing unassigned patients from receiving care • Reduced no-show rates and cancellations for outpatient radiation treatments • Lowered cost of care by redirecting sickle cell patients from ER to day clinic • Improved access to, quality, pace of care • Increased patient and physician satisfaction • Continuously building trusting relationships with community members that have consistently resulted in community members receiving timely care
  22. 22. www.champspatientexperience.com @carolsantalucia Supportive Networks Collaborative Health care leaders committed to advancing Patient Navigation through leadership, expertise and influence Navigator Network Forum for Patient Navigators to network, learn and share resources
  23. 23. www.champspatientexperience.com @carolsantalucia • Navigators are experts who help patients experience the best of our healthcare system by developing key relationships to personally help them navigate the system successfully Navigation and the Patient Experience
  24. 24. The Optimal Patient Experience Optimal Patient Experience Building Trust Reducing Anxiety Engaging Employees Cultural Commitment
  25. 25. www.champspatientexperience.com @carolsantalucia Thank You Carol Santalucia, MBA Vice President CHAMPS Patient Experience www.champspatientexperience.com 216.255.3636 carol.santalucia@chanet.org Follow me on Twitter @carolsantalucia

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