ASCO Perspective
“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,” said ASCO Chief Medical Officer and Executive Vice President Julie R. Gralow, MD, FACP, FASCO.

ALEXANDRIA, Va. — A cancer navigation program can reduce overall costs when deployed in collaboration with a statewide Medicare Advantage health plan across a wide range of practice types, according to findings to be presented as part of the 2022 ASCO Quality Care Symposium. 

Study at a Glance  

A reduction of $429 per health plan member per month was seen when patient navigation services were made available compared to no navigation services.

“New and more effective therapies for cancer are constantly being introduced. 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,” said Ravi B. Parikh, MD, MPP, FACP, Assistant Professor of Medicine and Medical Ethics and Health Policy at the University of Pennsylvania.

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, New York, to assist patients through complex healthcare systems¹. In over 30 years of utilization and expansion, patient navigation programs for people with cancer have been shown to reduce 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. This study looked at an independent patient navigation program for people with cancer deployed in partnership with a large, state-wide Medicare Advantage plan in New Jersey.

The study started by looking at claims data from over 4,000 eligible patients with cancer in community and hospital-based practices in New Jersey. The state has a wide variety of practice settings, from small community practices to major academic medical centers. About 16% 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 to $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 and the fact that many of the program’s interventions focused on reducing acute care use.

Next steps
The researchers now want to home in on how exactly navigation benefits patients as this study looked at many aspects of the application all at once. They hope to determine if navigation was beneficial because of more frequent communication about symptoms than a physician typically offers or was it more about the fact that navigators were able to refer patients to community-based housing or financial assistance? The researchers also hope to better understand how patients and oncologists perceive symptom management being done by a third party outside the clinic. 

Funding
This study received no external funding.

View the abstract

For your readers:

• Understanding the Costs Related to Cancer Care 
• Lost in the Cancer Care System? Nurse Navigators Can Help 
• Health Insurance

View the disclosures for the 2022 ASCO Quality Care Symposium News Planning Team: https://www.asco.org/sites/new-www.asco.org/files/content-files/about-asco/pdf/2022-QCS-NPT-Disclosures.pdf   

View the disclosures for Dr. Gralow: https://coi.asco.org/share/CKD-HYVM/Julie%20Gralow

ATTRIBUTION TO THE 2022 ASCO QUALITY CARE SYMPOSIUM IS REQUESTED IN ALL COVERAGE.

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