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Proceedings of a Workshop
Pages 1-84

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From page 1...
... Since then, numerous patient navigation programs have been developed with different approaches and goals for various patient populations, and a substantial body of scientific evidence from many studies on the benefits 1 The planning committee's role was limited to planning the workshop, and the Proceed ings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
From page 2...
... Currently, most navigators are nurses or community health workers, but programs may also include case managers, social workers, tumor registrars, or cancer patient peers who serve as volunteers. Many programs emphasize the need to train navigators in cultural and linguistic aspects relevant to the population being served, as race/ethnicity and language concordance between navigator and patient has been linked to improved health care delivery.  Unresolved questions include where patient navigation programs should be deployed and which patients should be prioritized to receive navigation services when resources are limited.
From page 3...
... . This proceedings is a summary of the presentations and discussions at the BOX 1 Suggestions from Individual Workshop Participants to Improve Patient Navigation Programs in Oncology Providing Effective Navigation Services Throughout the Oncology Care Continuum •  stablish navigation strategies for all stages of care (e.g., E prevention and screening, diagnosis, treatment, survi vorship care, and end-of-life care)
From page 4...
... Assessing Needs and Resources for Successful Patient Navigation •  elineate the population(s) a program would serve, conduct D a community health needs assessment, and identify gaps or bottlenecks in the services provided.
From page 5...
... •  evelop standards for structuring navigation programs to maxi D mize outcomes. (Buescher, Shulman, Melissa Simon)
From page 6...
... The webcast and speakers' presentations have been archived online.2 HISTORY OF PATIENT NAVIGATION Freeman noted that when he first came to work as a surgeon at a hospital in Harlem, he "wanted to cut cancer out of Harlem." But in the breast clinic there, he cared for many women who had visible tumors that were sometimes so advanced they were ulcerated at the time of diagnosis. This led him to appreciate the need to facilitate early detection via breast cancer screening, and he made it possible for women to undergo such screening free of charge.
From page 7...
... The overall purpose of the funding was to determine whether patient navigators help to reduce barriers to access to care and improve health care outcomes in underserved patient populations (Urrea, 2009)
From page 8...
... in 2010 required states to use patient navigators to facilitate access to health insurance and renewed the Patient Navigator Outreach and Chronic Disease Prevention Act. By 2012, the American College of Surgeons Commission on Cancer (CoC)
From page 9...
... She said several studies have demonstrated health inequities in cancer care and outcomes. For example, breast cancer mortality among African American women in New York City, Chicago, or the United States in general has been reported to be 27, 62, or 41 percent greater, respectively, than that of white women (Hirschman et al., 2007; Hunt et al., 2014; Whitman et al., 2011)
From page 10...
... Addressing the Impact of Poverty on Cancer Care Freeman stressed that the effects of poverty are extensive, including inadequate physical and social environments, information, knowledge, and diminished access to health care, as well as risk-promoting lifestyles, attitudes, and behaviors, all of which decrease cancer survival (Freeman, 1989)
From page 11...
... He emphasized that "no person should die from cancer because they are poor. Let's navigate our population." Communication and Education Inadequate communication between clinician and patient is a common barrier to cancer care that patient navigators can address, as several speakers pointed out, and can be due to a patient's lack of fluency in English, health literacy, or self-efficacy, or to insensitivity on the part of clinicians.
From page 12...
... '" But Greg Simon, president of the Biden Cancer Initiative, added that communication will not be adequate "if we do not balance the power between the medical system and the patients so that the patients use their voice because they know it will be heard." Darcy Burbage, supportive and palliative care nurse navigator at the Christiana Care Health System, also emphasized the roles of navigators in providing patient education, especially with regard to symptom management, available resources, and clinical trials. Sometimes patient navigators will ask clinicians to explain things better to patients who are having trouble understanding their medical situation and options, she said.
From page 13...
... Paskett agreed and noted that if a cancer patient is trying to make decisions about radiation therapy and surgery, the navigator will explain all of the different treatment options and help the patient assess which treatment decision is most appropriate for his or her personal situation. Freeman added that for patients diagnosed with prostate cancer, nurse navigators at the Ralph Lauren Center for Cancer Care in Harlem explain the meaning of an elevated level of prostate-specific antigen (PSA)
From page 14...
... A review of the 2017 CoC survey of accredited cancer centers found that a fragmented medical system ranked highest among system barriers, said Miller. Lathan noted that at numerous points in the cancer care trajectory, patients can be lost to follow-up (Waldman et al., 2013)
From page 15...
... executive director of Cancer Services at Penn Medicine/Lancaster General Health, noted that "every runner in that race has hundreds of batons that are currently going around the track at any given point in time, and the challenging part the navigator needs to figure out is which of those batons is most likely to drop, and if dropped, is going to break." One of the gaps in cancer care can be transportation to a health care facility. According to Amy Bertrand, patient navigator at ACS, transportation was one of the bigger barriers for cancer patients at her health care facility, with many lacking cars or public transportation to take them to their treatment site.
From page 16...
... Oo noted that at her facility, patient navigators help patients access the services they need and help them get to their appointments. Horn emphasized the need for this because "when you are the cancer patient, there are
From page 17...
... "I needed help from people who had been there before. That is you [patient navigators]
From page 18...
... She suggested that patient navigators include a discussion about hospice care with their cancer patients. Valania stressed the need to improve the use of advance directives.
From page 19...
... "The navigator prevented a cancer in this gentleman by not letting him be lost to follow-up and by encouraging him and teaching him how to be his own navigator," Paskett said. Tony Burns and his sister, Doris Burns, who both had cancer and lived in an impoverished neighborhood, stressed the importance of their patient navigators and a navigation system at the facility where they were treated.
From page 20...
... Freeman noted that "anyone with cancer would benefit from some extra help, even if you are a billionaire, but in the real world we probably cannot pay for navigating everybody." He suggested patient navigation be a targeted intervention for patients at high risk for delays in cancer care, because delays are linked to poorer outcomes. Patients at risk would include those with low economic status, those with limited education or health literacy, and those lacking insurance, he said.
From page 21...
... These handouts can provide information on how to contact patient navigators when needed. "So if somebody does not necessarily need me right off, I know that they are likely to pop up because I planted a seed.
From page 22...
... WHO NAVIGATES? Several workshop participants reported on the different types of patient navigators, from lay or peer navigators to professionals, such as nurses and social workers, and debated which types were most appropriate.
From page 23...
... She noted that the most robust navigation programs have a combination of both nurse and lay navigators who work closely together. Oncology social workers can also function as patient navigators.
From page 24...
... She added that there is close communication between the lay and nurse navigators responsible for the same patient. For example, the lay navigator may let the nurse navigator know that the patient is still confused about the diagnosis or treatment and needs a better explanation.
From page 25...
... The study also showed that patient navigation helped patients most in need and at risk for delays in treatment," Paskett stressed. Paskett also reported that her review of 29 studies on patient navigation conducted between 2010 and 2015 (mostly for patients with breast cancer, but also patients with cervical, colorectal, and lung cancer)
From page 26...
... Hospital admission and readmission rates also declined after the program was implemented. Kris Blackley, director of patient navigation at the Levine Cancer Institute, described a study of patients at her facility that showed that the patients who did not receive navigation services were 52 percent more likely to have unplanned hospital readmissions within 30 days, compared with patients who had these services (Kowalkowski et al., 2016a)
From page 27...
... . "We have enough evidence to say that patient navigation works in most of the cancer care continuum, in many populations, and for several outcomes," Paskett said.
From page 28...
... This innovative dissemination and implementation science study aims to improve the delivery of timely, high-quality breast cancer care for vulnerable patients in Boston through a coordinated care delivery model. This model includes a patient navigator network that coordinates the efforts of all patient navigators across health care systems, a registry or tracking system to identify patients most at risk for delays in care that is sharable across health systems, and a platform to both screen for and address barriers related to the social determinants of health in low-income populations.
From page 29...
... Freeman quoted Albert Einstein, who said, "Not everything that counts can be counted, and not everything that can be counted counts." Freeman stressed, "We have to be sure we are counting the things that really count. We might be counting a lot of things that look good scientifically, but maybe they are not the right things that count when doing patient navigation." REAL-WORLD MODELS OF PATIENT NAVIGATION A number of workshop participants also described patient navigation real-world models, including • Christiana Care Health System Navigation Program • Women's Wellness Connection Navigation Program • American Cancer Society Patient Navigation Program • Cancer Patient Navigators of Georgia • LIVESTRONG Cancer Navigation Program • Wayfinder Patient Navigation Program • DuPage Patient Navigation Collaborative • Dana-Farber Cancer Institute Patient Navigation Pilot • Massachusetts General Hospital Patient Navigation Programs • Apoyo con Cariño Palliative Care Program • Patient Care Connect Program • Sutter Health Patient Navigation Program • Blue Distinction® Cancer Care Program • Geisinger Oncology Navigator Program
From page 30...
... Disease-specific oncology nurse navigators staff the program, including in-patient nurse navigators who help improve the discharge planning process. In addition, the program has social workers and lay navigators who work in their community health and outreach program.
From page 31...
... "That's almost 150 women who we likely helped by finding their cancer earlier," McCracken stressed. American Cancer Society Patient Navigation Program Bertrand reported on the ACS Patient Navigation Program, which consists of more than 100 patient navigators who usually work in large cancer centers that are certified by the CoC, or systems that provide care to large populations with a significant percentage of medically underserved individuals.
From page 32...
... Cancer Patient Navigators of Georgia Kerber reported on the Cancer Patient Navigators of Georgia (CPNG) , a statewide virtual organization of patient navigators with the mission of connecting, educating, and sharing best practices among patient navigators in Georgia to reduce barriers to care and increase services related to cancer.
From page 33...
... Wayfinder Patient Navigation Program Paskett reported on the Wayfinder patient navigation program, which is funded by multiple sources, including The Ohio State University, Susan G Komen, a breast clinic, a family practice clinic, a gastroenterology clinic, and a gynecology clinic.
From page 34...
... The program engages community health workers or patient navigators through a freestanding community organization called Access DuPage. These navigators have no allegiance to a particular health care system, hospital, or clinic, and can leverage every community health and human service across the entire county.
From page 35...
... The pilot program also integrates lung cancer screening, tobacco cessation treatment, and genetic testing and counseling. Lathan said that the program was structured to "keep as much in the community health center as possible," with none of the revenue from the oncology consults going to the Dana-Farber Cancer Institute.
From page 36...
... . Massachusetts General Hospital Patient Navigation Programs Oo reported on MGH Chelsea HealthCare Center's programs and strategies designed to assist refugees and immigrants from Africa, Central America, the Middle East, and Nepal.
From page 37...
... "We may think this colonoscopy is what they need to do now, but it is their decision," she noted. Although the Chelsea health workers may have specialties, there is cross-training with clear systems of protocols and detailed manuals, so they each can provide navigation services for cancer care.
From page 38...
... After developing a breast cancer screening program for Latinas, Oo said that MGH wanted to develop one for refugee women, particularly Arabicspeaking women from Africa or the Middle East. Recruiting, retaining, and financially supporting navigators for each group has been a major challenge, Oo said, so MGH also trained medical interpreters to provide navigation services for these populations.
From page 39...
... Patients received five home visits from patient navigators, who focused on advanced care planning, pain and symptom management, and hospice care. In addition, navigators helped patients access community resources, and provided emotional and logistical support for families.
From page 40...
... All patients are covered by Medicare. PCCP encompasses 12 cancer centers in five southern states (Alabama, Florida, Georgia, Mississippi, and Tennessee)
From page 41...
... . An analysis of Medicare claims for more than 6,000 non-navigated control patients and more than 6,000 navigated patients between 2012 and 2015 found that the navigated group of patients had significantly lower Medicare costs and health care utilization, including fewer emergency room Patient Care Connect Program PCCP navigator refers SM addresses unrelieved symptoms (PCCP)
From page 42...
... The number of these patient requests declined over time because "the patients increased their own selfmanagement and ability to navigate the system," Meneses said. "This makes a financial case for the sustainability of navigation programs," she stressed, but also added that "without a transition to a values-based payment system, health care systems cannot necessarily implement or expand or even sustain their navigation programs." Sutter Health Pilot Navigation Program Cantril reported on the Sutter Health pilot navigation program for breast cancer patients.
From page 43...
... Blue Distinction® Centers for Cancer Care Wendy Marinkovich, managing director of the Blue Distinction® Specialty Care Programs at Blue Cross Blue Shield Association, reported on the Blue Distinction® Centers for Cancer Care. This program emphasizes patient-centered coordination of care using an integrated, multidisciplinary delivery model, evidence-based practices, and a commitment to improving the quality and affordability of cancer care (Blue Cross Blue Shield Association, 2017)
From page 44...
... Geisinger's oncology-specific navigation program began in late 2010 when it received an NCI Community Cancer Center Program award that enabled it to hire four nurse navigators whose primary purpose was to bridge the gaps in care for patients with cancer in rural areas. These oncology nurse navigators worked in Geisinger primary care sites and connected patients with suspicious findings to appropriate clinicians.
From page 45...
... Assessing Needs and Resources Pratt-Chapman suggested defining the patient populations and needs that would be addressed by navigation programs to ensure that services match patient needs, and identifying gaps or bottlenecks in the health care services provided. One should also consider how the program will impact
From page 46...
... ' We have to struggle to fit the categories of health care in which we are providers to the needs of the patient and patient navigation." Melissa Simon said it was important to "understand what actually happens on the ground in clinics." When devising her navigation programs, she and her colleagues conducted citywide assessments of imaging sites, Federally Qualified Health Centers, and community clinics, and undertook an "environmental scan," which involved "following a patient from the time she hits the door of the clinic or imaging center until she leaves, documenting every single process of care," Melissa Simon said. She also suggested considering the complexities of health care systems at all levels from everyone's viewpoint, including the impact of policies, because "health inequities do not just happen" but are the result of program design, Simon said.
From page 47...
... or provided by the CoC. Making Services Convenient for Patients Narayan stressed that navigation services must be convenient for patients or they will not take advantage of them, as LIVESTRONG discovered when it piloted an in-person service center that cancer patients could come to for support.
From page 48...
... "Find out what are the barriers we need to help work against and go from there," she said. Fischer suggested tailoring a cancer navigation program to incorporate community views on pain management, palliative care, and end-of-life care.
From page 49...
... Buescher suggested developing standards for staffing navigation programs to maximize return on investment and other outcomes, and developing and disseminating standard tasks and expectations in navigation, so that all staff can function as navigators in meaningful ways, without relying on a single individual. Lawrence Shulman, professor and deputy director of clinical services at the University of Pennsylvania Abramson Cancer Center, asked how administrators determine the number of navigators to hire.
From page 50...
... She said when she asks clinicians who are new to her health care system if they have worked with patient navigators before, they often respond, "Yes, but I don't know if my navigator at the other system does what your navigators do." Patients, too, are often confused about the role of the navigator, Blackley added. Pratt-Chapman also suggested clarifying what is expected from navigators, delineating what they should not do, and how they should work with their team members.
From page 51...
... Blackley stressed, "We need more information available for those evidence-based practices so we are more able to show the value of navigation and what our navigators are able to do for our patients." She added, "When we all are focused on the same metrics, like those AONN+ [Academy of Oncology Nurse & Patient Navigators] put out, you have strength in numbers." Blackley noted that there are a number of digital tools for tracking metrics.
From page 52...
... However, she still gives primary care clinicians the option to deliver the cancer diagnosis themselves to patients, and she added that ideally, the primary care clinician and the patient navigator would both be present when conveying a cancer diagnosis and the next steps to be taken. Valania suggested that patient navigators should "take the time to know your team.
From page 53...
... Oo noted that when vacancies recently occurred on her cancer navigation team at MGH, the clinicians in the adult medicine practice at the hospital advocated for filling those vacancies because they realized their productivity, and consequently their salaries, are tied to those navigation services. "It has become such a symbiotic relationship that some of our other departments are chipping in money to support us," Oo said, noting that her navigation services now include an obstetric navigator who helps underserved patients follow through with pre- and postnatal care, which is paid for by the obstetrics and gynecology department at the hospital, rather than by her program or any outside funder.
From page 54...
... Oo noted that at her facility, a team that includes social workers manages patient navigators and community health workers. These managers provide three types of supervision: (1)
From page 55...
... NAVIGATION RESOURCES Several workshop speakers also noted resources and tools that they found helpful for designing patient navigation programs, tracking patients and time spent navigating, conducting distress assessments, deploying telehealth digital tools, and identifying standards for patient navigation. Program Design Pratt-Chapman reported that the George Washington University Cancer Center has a free online toolkit for cancer control professionals to advance the field of patient navigation.15 This toolkit can be used to educate and train patient navigators, provide technical assistance, build navigation coalitions at the state level, and identify policy approaches to sustain patient navigation.
From page 56...
... "We have to be available for our patients at the time that works for them, so we need to make it work," she said. Patient navigators in her facility's supportive and palliative care 17 See https://smhs.gwu.edu/gwci/BarriersTool (accessed February 27, 2018)
From page 57...
... ; • George Washington University Cancer Center's Implementing the Commission on Cancer Standard 3.1 Patient Navigation Process: A Road Map for Comprehensive Cancer Control Professionals and Can cer Program Administrators (George Washington University Cancer Center, 2017) ; and • CoC National Accreditation Program for Breast Centers Standards Manual.19 PATIENT NAVIGATION COMPETENCIES AND STANDARDS Navigators have a variety of backgrounds, so establishing competencies for patient navigators creates professional standards and a framework for training, Pratt-Chapman noted.
From page 58...
... Blackley stressed that "Standardization of navigation is difficult, but now that we have tools available for this through ONS, AONN+, and other organizations, it is important that we build on them and not try to recreate the wheel because that causes confusion in the community." Burbage noted that many cancer centers are accredited by the CoC and rely on the core competencies specified by the CoC for their patient navigation programs. Most clinical and social worker navigators at cancer centers are required to be certified in oncology, or at least to acquire that 20 See https://www.colorado.gov/pacific/cdphe/health-navigator/credentialing-and registry (accessed March 12, 2018)
From page 59...
... Commission on Cancer Standards Miller reported on the American College of Surgeons' CoC standards for cancer navigation services. She noted that the CoC is a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients primarily through setting standards.
From page 60...
... The staff can be patient navigators, social workers, nurses, or other clinicians. "The CoC does not require a patient navigator, but rather, a patient navigation process," Miller said.
From page 61...
... They then conducted focus groups with patient navigators across the country and received input from 22 navigation experts, as well as input from a survey of more than 500 navigators. The final competency list included competencies in eight domains: patient care, knowledge for practice, practice-based learning and improvement, interpersonal and communication skills, systems-based practice, professionalism, interprofessional collaboration, and personal and professional development (Pratt-Chapman et al., 2015)
From page 62...
... More than 1,300 patient navigators have enrolled in the training in the first year of its release. The training has also become a core piece of the curriculum of the University of Houston's bachelor-prepared social work program, Pratt-Chapman reported.
From page 63...
... Kerber added that the Georgia CORE also has a lay navigator training program, as well as a train-the-trainer program. The Georgia CORE and the Georgia Society of Clinical Oncology also provide education and other forms of support to cancer patient navigators on a regular basis, she said.
From page 64...
... 64 EFFECTIVE PATIENT NAVIGATION PROGRAMS IN ONCOLOGY TABLE 1  Professional Certificate Programs Program Website Target Audience Cost Cancer Navigator cancernavigatorprogram.org Social workers, $550 Program counselors, chaplains, and other staff supporting patients, including navigators Cancer Navigator cancernavigatorprogram.org Registered nurses $550 Program George Washington bit.ly/GWCCOnlineAcademy Any navigator No cost University Cancer Center -- Oncology Patient Navigator Training: The Fundamentals George Washington bit.ly/GWCCOnlineAcademy Supervisors of No cost University Cancer navigators, program Center -- Executive leaders Training on Navigation and Survivorship Harold P Freeman www.hpfreemanpni.org Patient navigators $995 Patient Navigation Institute Patient Navigation Program
From page 65...
... PROCEEDINGS OF A WORKSHOP 65 Course Format Curriculum Online -- 21 lessons • Cancer biology • Prevention and screening methods • Treatment options • Palliative/end-of-life care • Financial resources • Patient education • Advocacy • Resource utilization and support • Spiritual, psychosocial, and emotional support needs • Home health and hospice care • Medicare, Medicaid, and other payers Online -- 24 lessons •  ll content from general navigator program plus A symptom management Online -- 20 lessons, •  verview of patient navigation and core competencies O interactive, evidence- • Basics of health care based with case studies, • Basics of patient navigation comes with free online • Enhancing communication guide • Professionalism • Enhancing practice Online, interactive, Nuts and bolts of navigation and survivorship program evidence-based with development, including case studies and • Identifying need supplemental written • Planning your program: models content and activities, • Components, tools, goal setting, and more comes with free online • Funding and sustaining your program workbook • Evaluating your program • Creating a business plan 2 days, in-person -- 10 • Curriculum not publicly available modules, including •  ocus on increased retention, diagnostic, and treatment F patient interaction and resolution rates case studies continued
From page 66...
... p=1814 students wishing tuition to to become complete navigators required credits Native Patient www.NatAmCancer.org Any navigator $1,100 Navigator's Training working with indigenous peoples Otero Junior www.ojc.edu/academics/ Patient navigators Based on College academicprograms/ tuition to ctehealthnav.aspx complete required credits
From page 67...
... PROCEEDINGS OF A WORKSHOP 67 Course Format Curriculum Bachelor of Helps new navigators guide patients, caregivers, and health science, family members through a treatment plan with the goal of patient navigation improving patient outcomes: specialization, patient •  alues of justice and hospitality V navigation certificate •  hysical, emotional, and social support to patients P following a treatment plan •  ommunication and interviewing to assess barriers to C care •  urrent health care trends and issues that impact the C patient navigators' ability to provide care/assistance •  dentify and explain health resources, including I publicly funded health insurance programs and health delivery systems 5 days, in-person, •  merican Indian and Alaskan Native history and A learning reinforcement impact on community member perceptions and health sessions post-training care •  ultural competency, goal setting and culture, C navigator safety •  avigating the Health Care Systems and the Indian N Health Service Purchased Referred Care •  utreach and education strategies O •  ommunication C •  ealth care team collaboration H •  esources R •  ancer continuum and tumor-specific education C •  linical trials, confidentiality, Health Insurance C Portability and Accountability Act of 1996, data collection and protocols for dissemination •  ribal institutional review boards and approval T processes In-person •  inking patients with services L •  roviding information and resources P •  elping providers interact with patients H •  ealth education and behavior change promotion H continued
From page 68...
... , administrators (level 3) Shenandoah www.su.edu/nursing/ Registered nurses $3,000 University/Inova certificate-programs/ Health System care-navigator-certificate Smith Center smithcenter.org/institute-for- Navigators $995 Patient Navigation integrativeoncology-navigation interested in Training in integrative care Integrative Cancer Care
From page 69...
... Includes identifying evidence-based clinical guidelines, utilizing registries for identifying patients, developing standard work flows, navigator training, navigator supervision needs, and evaluation of services •  -Learning: Preventive health care 101, introduction E to the health care system, introduction to chronic disease, clinical trials and patient navigation, HIV related cancer research studies •  ebinars: Poverty and self-sufficiency, 2013 W National Culturally and Linguistically Appropriate Services Standards for patient navigators, basic crisis management skills for patient navigators, managing difficult patient encounters 5 days in-person/ •  ssist patients in navigating complex health care A blended learning, 56 services across the continuum of care contact hours, and a •  uild skills in delivering care coordination services B preceptorship within new health care models and patient settings 2 pre-training •  orning yoga at patient navigation training M teleconferences, 5 days •  lient assessment C in-person •  ifficult conversations D •  urvivorship issues S •  e art of healing Th •  piritual support S •  utrition N •  pplication of complementary modalities A •  uilding trust B •  lanning your integrative practice P continued
From page 70...
... EXAMPLES OF POLICY CHALLENGES AND OPPORTUNITIES Several presenters discussed examples of policy initiatives that could help address key challenges in patient navigation, including making navigation services more affordable, making navigation more of a national priority, and creating a national clearinghouse for patient navigation resources. Increasing Affordability of Patient Navigation Direct reimbursement for patient navigation services is not currently available, so it is often financially supported by philanthropic or research grants, volunteer efforts, or institutional resources in large cancer centers.
From page 71...
... Evans asked what more is required by payers for navigation to be reimbursed, given all of the evidence gathered on the value and return on investment of navigation services to date. Marinkovich responded that while provider payment is determined independently by each local Blue Plan, many Blue Cross Blue Shield Plans are considering providing payment for care coordination to practices and provider groups, but they are focusing on patient-centered care that is well coordinated, not necessarily on the role of a patient navigator.
From page 72...
... Melissa Simon said that in 2015, Illinois passed the Breast Cancer Excellence in Survival and Treatment Act,23 which provided funding for three patient navigation pilot programs in Illinois. This bill was passed partly based on data she and others in the Metropolitan Chicago Breast Cancer Task Force had collected on the benefits of patient navigation programs, according to Simon.
From page 73...
... Battaglia said the Massachusetts Department of Public Health has an Office of Community Health Workers with the focus of increasing the capacity of both the community and the health systems to do patient navigation in the field. This office offers trainings24 and "sets the tone" for competency training in the state, according to Battaglia, and also has a technical assistance arm that enables health systems to integrate and implement evidence-based navigation programs.
From page 74...
... Blackley commented that she was surprised to hear there was not much uptake, and Pratt-Chapman responded, "People don't realize that they have valuable information that other people could benefit from." RECENT POLICY INITIATIVES IN PATIENT NAVIGATION A number of workshop speakers reported on several recent patient navigation policy initiatives, including OCM, the Cancer Moonshot and Biden Cancer Initiative, and the NNRT. Oncology Care Model Buescher described OCM, a CMS demonstration program involving approximately 190 practices aimed at improving the quality of cancer care outcomes, the patient experience, and the overall cost of care.
From page 75...
... The OCM navigation requirements were mostly met by assigning these responsibilities to existing staff, including patient navigators, schedulers, and a clinical trials nurse. Additional patient navigators and schedulers were hired to coordinate appointments with clinicians, and the OCM standards were made clear to all nine cancer disease teams.
From page 76...
... These plans are not only documented in their EHR system, but are also printed out and shared with everyone on the care team, including other referring specialists and primary care clinicians. These templates were written to be easily understood by patients, and clinicians were trained in how to use them.
From page 77...
... Buescher attributed his cancer institute's OCM success to a number of factors, including high levels of staff and clinician engagement, process improvement training, protected time for clinicians and staff to work on performance improvement projects, and focused leadership attention. Buescher concluded that OCM "helps recalibrate everybody toward shared goals that are good for both the providers and patients." Robert Green, senior vice president of clinical oncology at Flatiron Health, noted that Flatiron Health, which provides software for oncology clinicians, tailored their software so it conveniently shows in one place all of the quality measures required from participants of OCM.
From page 78...
... That is why we all have to band together to change," Simon said. He suggested that the Biden Cancer Initiative could help on a policy level to further cancer patient navigation, "whether it is federal reimbursement or convincing hospitals and cancer centers that your mission is to help patients, not to make money, and that if you help patients, you will make money." Simon added that as part of the Biden Cancer Initiative, it would be worthwhile to bring together clinicians and experts versed in technology to devise apps and other digital technologies to aid patient navigation.
From page 79...
... "The programs look a bit different because the needs are different and they should be created around the needs and not necessarily around the notion that everybody should have exactly the same model," he said. However, that should not preclude providing standard definitions, training, and certification for patient navigators, which need to be explored more, he said.
From page 80...
... 2013. The effect of nurse navigation on timeliness of breast cancer care at an academic comprehensive cancer center.
From page 81...
... 2012. Using nurse navigation to improve timeliness of lung cancer care at a veterans hospital.
From page 82...
... 2013. Decreasing disparities in breast cancer screening in refugee women using culturally tailored patient navigation.
From page 83...
... 2015. Core competencies for oncology patient navigators.


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