The total cost of cancer care can be significantly reduced through the use of patient navigators to guide patients who are dealing with complex medical systems. A cancer navigation program deployed in collaboration with a statewide Medicare Advantage health plan across a wide range of practice types found the total cost of care per patient decreased $429 per month for those who utilized patient navigation compared to those who had no navigation assistance.
"New and more effective therapies for cancer are constantly being introduced," said Ravi B. Parikh, MD, MPP, FACP, Assistant Professor in the Department of Medical Ethics and Health Policy and Medicine at the University of Pennsylvania. "Despite many of these advances, care coordination can often be fragmented, education about the best care options can be lacking, and access to care isn't always easy. We're missing some of the foundational components that enable whole person care. Navigation can fill these gaps, and we believe this study helps to chart a path forward on how to expand cancer navigation to help more people." The researchers presented the results at the 2022 ASCO Quality Care Symposium (Abstract 4).
About the Study
Based on a 1989 national study on limited resources available for lower income people with cancer, the nation's first patient navigation program was put into place in 1990 in Harlem, NY, to assist patients through complex health care systems. In more than 30 years of utilization and expansion, patient navigation programs for cancer patients have shown to reduce the total cost of care in multiple settings and drive value by improving patient experience, keeping people out of the hospital and improving survival. However, these programs have been very difficult to disseminate widely.
The researchers explored whether an independent cancer patient navigation program deployed in collaboration with a Medicare Advantage plan could demonstrate similar cost savings when deployed across a wide variety of practice settings in the state of New Jersey. They looked at claims data from more than 4,000 eligible patients with cancer in community-based and hospital-based practices in New Jersey, a state with a wide variety of practice settings, from small community practices to major academic medical centers.
About 16 percent of the patients with cancer received navigation assistance. For the statistical analyses, researchers ultimately matched 222 patients with cancer who received patient navigation with 222 who did not have navigation assistance.
The navigation program was a technology-enabled virtual cancer navigation service that was staffed by both lay health workers and nurses. The navigation team coordinated health care virtually (by video or telephone), interacting with each patient an average of 2.6 times per month. They addressed any barriers that impeded care, helped facilitate care discussions, and conducted proactive and reactive symptom assessments. If there was a problematic response to a patient's treatment, the patient's oncology team was notified the same day. The primary outcome of the study looked at the total cost of care, but excluded Medicare Part D drug spending.
For their calculations, the researchers looked at health care and payment records from March 2021 until June 2022, comparing monthly per member total costs of care for patients with or without navigators.
Key Findings
The mean total cost of care declined $429 more per month per member for the group that received navigation assistance compared to the group that did not receive navigator assistance. A separate analysis suggested a plausible range of $209-$708 savings per member per month in the navigation-assisted group. The greatest impact in cost savings was associated with inpatient visits, which is what was expected based on prior studies. In addition, many of the program's interventions focused on reducing acute care use.
The researchers concluded: "This is the first study to demonstrate that a cancer navigation program can reduce overall costs when deployed in collaboration with a health plan across a wide geography and range of practice types."
The researchers plan to examine exactly how navigation benefits patients since this study looked at many aspects of the application all at once. Questions to be answered include: Was navigation beneficial because of more frequent communication about symptoms than a physician typically offers, or were navigators able to refer patients to community-based housing or financial assistance? They also hope to better understand how patients and oncologists perceive symptom management conducted by a third party outside the clinic.
ASCO Chief Medical Officer and Executive Vice President Julie R. Gralow, MD, FACP, FSCT, FASCO, commented: "Patient navigators play a vital role in helping patients with cancer move through various organizational and other challenges related to their care. Now we have evidence on a larger scale than has ever been studied before, thanks to the use of a virtual navigation program that, in addition to the tremendous social services navigators offer, they can also help patients save significantly in total costs of care."
Mark L. Fuerst is a contributing writer.