Navigator Program Lowered Costs, Utilization for Elderly Cancer Patients

A program linking elderly cancer patients to lay navigators was shown to substantially reduce costs and decrease hospitalizations, making it an appealing tool for providing value-based oncology care.

Researchers from the University of Alabama at Birmingham conducted an observational study that tracked Medicare costs and health service use among beneficiaries aged 65 or older with cancer, and compared the outcomes for those within the Patient Care Connect Program (PCCP) and a matched sample of control patients. Their findings were published in JAMA Oncology.

The PCCP used “lay navigators,” who are not medical professionals, to guide patients through the healthcare system and connect them with needed resources. The navigators received training that allowed them to evaluate patients’ distress and assist them with a wide range of concerns, from financial to informational to spiritual.

The 6214 patients in the navigated group were matched with an equal number of control patients, who did not have a navigator, using propensity scores. These scores were calculated based on cancer phase, baseline cost of care and utilization, and other characteristics. Even after matching, the navigated patients were more likely to have received chemotherapy than those in the comparator group, as the program targeted high-risk patients with comorbidities or more advanced cancer.

These navigated patients had higher Medicare costs at the beginning of the study, but their costs decreased much more rapidly than those of the comparison group, as they incurred lower costs after 6 quarters—the costs declined by $781.29 more per quarter per navigated patient. Specifically, the navigated patients had more significant quarterly reductions in inpatient, outpatient, and physician costs, although their hospice costs increased more than those of the comparison group.

Extrapolating from the mean quarterly savings and caseload, a navigator responsible for 152 patients per year could help reduce costs by $475,024 annually. Taking into account annual salary and benefits at $48,448, each navigator was estimated to provide a 1:10 return on investment. Additionally, resource utilization decreased more among the navigated patients than in the control group. The navigated group’s emergency department visits decreased by 6.0% more per quarter, hospitalizations by 7.9% more, and admissions to the intensive care unit by 10.6% more.

The study authors pointed to a number of factors that could help explain the PCCP’s successes in lowering costs and utilization. The navigators take a “patient-centered, preventive, proactive approach” to care, as they engage patients outside of the healthcare setting and direct them to community resources. This method could “lead to increased patient activation and earlier management of symptoms, decreasing the likelihood of unplanned admissions or inefficient care.”

Even the finding of increased spending on hospice care could be an encouraging sign, the authors wrote. The navigators’ role in “facilitating earlier conversations about goals of care and care preferences” could help expand access to palliative care and support for cancer patients and their families.

They acknowledged that patient navigator programs like the PCCP are “not sustainable within the current fee-for-service payment model, which does not reward coordination of care.” However, they held out hope that a value-based payment system would give health systems incentives to implement and expand navigation services.