Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Patient Care Navigation Program Reduces Cancer Care Costs

Helping patients navigate the care experience has the potential to lower costs and reduce resource use, core components of value-based care.

Reducing care costs, resource utilization

Source: Thinkstock

By Jacqueline LaPointe

- Using non-physician and nurse providers as part of a patient navigation program can significantly lower healthcare costs and utilization for cancer patients while generating a return on investment, a recent JAMA Oncology study revealed.

From 2013 to 2015, the University of Alabama at Birmingham (UAB) Health System hired non-licensed staff to help high-cost and high-risk cancer patients navigate the medical system and their treatments at part of the Patient Care Connect Program (PCCP). The patient navigators specifically linked patient with resources, improve care coordinated, anticipated their health needs, and encouraged patients to play a more active role in healthcare decision-making.

Using Medicare claims data from 2012 to 2015, UAB researchers found that the patient navigation program reduced cancer care costs and resource use. The UAB Health System saw mean total healthcare costs decrease by $781.29 more per quarter per navigated cancer patient compared to healthcare costs for non-navigated cancer patients.

In total, UAB Health System saw a $19-million reduction in healthcare costs per year across their Cancer Community Network.

The healthcare cost savings stemmed from inpatient and outpatient cost reductions at $294 and $275 per patient, respectively — although inpatient costs declined more dramatically for navigated cancer patients. The mean quarterly cost decline for navigated cancer patients was $522 per quarter per patient versus just $198 per quarter per non-navigated patient.

READ MORE: Costly Aspects of an Overstretched Revenue Cycle Management

While not as large of a difference, outpatient costs fell by $473 per quarter per navigated patient compared to a $194 per quarter per non-navigated patient outpatient costs reduction.

Physician visit costs also dropped for cancer patients in the navigation program. The navigated patient group saw a $339 quarterly cost reduction while the non-navigated patient group faced a $129 quarterly cost reduction.

Researchers, however, noted that healthcare costs for cancer patients in the navigation program were initially higher than the non-navigated patient group. That being said, healthcare costs fell faster for the navigated patients and their costs became lower than the non-navigated patient group after six quarters.

Despite significant cost savings, the claims data revealed that hospice care costs were actually greater for navigated cancer patients. The navigated patient group incurred a $39 boost in hospice care costs versus a $36 increase in the non-navigated patient group.

In terms of resource use, UAB researchers reported that high-cost healthcare utilization decreased for cancer patients in the navigation program. The study uncovered the following resource use reductions for navigated patients compared to non-navigated patients:

READ MORE: Price, Utilization Increases Upped Healthcare Spending by 4.5%

  • Emergency department visits declined by an additional 6 percent per quarter
  • Hospitalizations dropped by an additional 7.9 percent per quarter
  • ICU admissions went down by an additional 10 percent per quarter

“Costs to Medicare and healthcare use from 2012 through 2015 declined significantly for navigated patients compared with matched comparison patients,” the UAB researchers concluded. “Lay navigation programs should be expanded as health systems transition to value-based healthcare.”

With cancer care costs projected to increase to $173 billion year by 2020 according to a 2014 study, healthcare organizations are searching for cost-effective ways to reduce cancer care spending while still maintaining high-quality care for value-based reimbursement success.

Making cancer care delivery more efficient may also be a top priority for providers participating in Medicare’s Oncology Care model, which qualifies as an Advanced Alternative Payment Model under the Quality Payment Program as part of MACRA implementation.

READ MORE: Value-Based Care Analytics Help Cut Healthcare Costs in Utah

The bundled payment model requires providers to maintain quality care for a chemotherapy episode while keeping costs below a set financial benchmark. Participants in the two-sided financial risk track of the model could lose revenue and have to repay CMS if the cost per episode exceeds the benchmark.

Participants could also risk a 5 percent value-based incentive payment under the Quality Payment Program’s Advanced Alternative Payment track for cost and quality underperformance.

Some healthcare organizations have turned to patient navigation and care coordination programs as a method for making care delivery more efficient. For example, an Ohio-based ACO, Partner for Kids, hired care coordinators at Nationwide Children’s Hospital to help guide families through the medical system and focus on their specific needs.

The care coordinators along with a feeding tube intervention helped the hospital to save over $11.7 million in total inpatient savings and decrease hospital admissions and lengths of stay.

Most patient navigation and care coordination teams, however, are primarily made up of nurses, the UAB researchers stated. Healthcare organizations could realize a greater return on investment if they use non-licensed staff to head the programs.

The UAB Health System paid patient navigators an annual salary between $33,400 and $42,300 to manage a caseload of 152 patients throughout the year.

Since navigated patient costs declined by a mean of $781.29 more per patient per quarter than non-navigated patients, patient navigators helped to saved $475,024 annually with their caseload.

Based on an annual salary of $48,448 (salary plus fringe benefits), UAB researchers determined that a patient navigator generated a 1:10 return on investment.

“The estimated potential 1:10 return on investment of the PCCP helps make a financial case to organizational leadership for sustainability of navigation programs,” wrote UAB researchers. “The observed benefit is likely because of the PCCP approach of targeting high-risk, high-cost patients and patients who have unmet needs, which is reflected in the differences observed between the navigated and non-navigated patients in our study.”

What’s more, the patient navigation program could lead to cost savings for other parts of the care continuum, the UAB researchers noted.

“This patient-centered, preventive, proactive approach has the potential to lead to increased patient activation and earlier management of symptoms, decreasing the likelihood of unplanned admissions or inefficient care,” they claimed. “The PCCP is a model of navigation that supports patients throughout the cancer care continuum and may be a mechanism to extend palliative and supportive care more fully into the community, particularly in rural areas that lack palliative care resources.”


Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...