A female patient in her forties was diagnosed with a recurrence of leukemia. She was struggling through several issues as a single mother of 4 children, 2 of whom were disabled, before she found out about her cancer returning. The patient and her children lived in an apartment with her parents, but they were unable to provide much assistance as they each had been diagnosed with cancer as well. The patient’s treatment required an evaluation for a stem cell transplant and travel to a larger comprehensive cancer center. The patient had no means of transportation and was physically, emotionally, and mentally exhausted when she received a referral to a nonclinical oncology patient navigator. The navigator assisted the patient with transportation and lodging at the remote cancer center and secured transportation for her local appointments as well. The navigator addressed other extensive financial barriers this patient faced. She enrolled the patient in a program that helped with medication copays and connected her to support programs for both she and her family members. By connecting with a patient navigator, this patient was able to stay on schedule with her complex series of appointments and complete her treatment plan while receiving much-needed psychosocial and emotional support for both herself and her children.
The Harold P. Freeman Patient Navigation Institute aptly describes how a patient navigator acts as the support hub for all aspects of the patient’s movement through the healthcare system and serves to foster smooth and timely continuity of care to the point of resolution.1 Healthcare disparity influencers, similar to those faced by this mother of 4, impacts a patient’s ability to initiate, stay in compliance, and complete their treatment. This disparity creates a burden on individual lives and the healthcare systems poised to support them. In 2003, there were over 200 cancer care programs nationwide identified by the National Cancer Institute providing patient navigation.2 By 2018, the American Cancer Society (ACS) has funded more than 80 patient navigation programs across the United States. Studies are on the rise to help prove how patient navigation directly impacts how cancer patients can overcome critical barriers that cause a delay or desist in treatment, yet patient navigation is a nonbillable service and presents as a costly program to hospitals with limited budgets.
This article reflects observations from programs that have gained financial support for nonclinical lay patient navigation programs. It will address financial considerations both from the perspective of leveraging hospital financial support and securing funding from community partners. The approaches described will assume the efficacy of patient navigation and not attempt to prove it in this article. Three areas of focus will be addressed when presenting patient navigation as a funding opportunity: how to identify financial champions for patient navigation, how to appeal to decision makers and investors, and how to build integrated programs that thrive for both patients and supporters alike.
Identify Champions
When considering successful patient navigation programs, a common essential component is a supportive champion. And while a patient navigation champion is often considered vital to drumming up political support in initiating a program, they are just as important in terms of securing the financial support to sustain it.
One primary source for financial backing is through a private foundation or community partner. Powered by a booming stock market and a strong economy, charitable giving by foundations and corporations increased by 6% and 8%, respectively, in 2017, according to Giving USA 2018: The Annual Report on Philanthropy for the Year 2017.3 And since the recommendation from the President’s Cancer Panel to provide support to community-based programs like patient navigation almost 2 decades ago, there has been robust growth in creating programs and funding opportunities. Leading private funders of patient navigation include ACS, the Avon Foundation, and the Susan B. Komen Breast Cancer Foundation.2 While competition for philanthropy dollars is stiff, patient navigation can be an appealing funding opportunity for those wishing to have a direct impact in their local, underserved communities.
With growing pressure on administrators to lower costs, fiscal support for navigation can just as likely be found behind a desk as it is in the exam room. If grant funding is secured to implement patient navigation, data analysis can be performed to demonstrate navigation value that impacts patient care delivery and outcomes and provides return on investment. A 6-month Accenture-MetroHealth study showed that patient navigation helped reduce no-show and cancellation rates by 3%, and each full-time navigator added $150,000 in additional hospital revenue per year.4 Results like these can be persuasive justification when pushing for budgetary approval for a hospital-funded FTE patient navigator.
If an institution cannot afford or rally its full support behind a navigation program, there’s also potential for a cost-sharing model between the hospital and a nonprofit or community organization partner. The human capital investment associated with staff employment, training, and supervision is typically the largest proportion of patient navigation program costs.5 If another organization is willing to help supplement those costs and perhaps even take ownership of the employment aspect, hospitals may be more likely to embrace patient navigation.
Additional champions can be found both in the hospital and throughout the community in advocates like physicians, nurses, social workers, volunteer board members, hospital philanthropy directors, and community leaders. No matter their title, these champions are key potential relationships who recognize the value of navigation and are willing to leverage their power and influence to drive program advocacy and funding. It’s important to remember, however, that fluctuating factors like political and economic climate can significantly impact opportunities for funding or the extent of funding afforded to support these programs. This reinforces the importance and the need for the oncology community to come together to support funding for patient navigation.6
Appeal to Decision Makers
In response to the 2005 Institute of Medicine report entitled From Cancer Patient to Cancer Survivor: Lost in Transition, which highlighted the need for more patient-centered, coordinated care, the American College of Surgeons Commission on Cancer added a patient navigation standard in 2012.7 The standard requires a patient navigation process that aims to remove barriers to care. As a result, healthcare leaders and community backers have invested in patient navigation due to its collaborative, integrative, and patient-centered approach to care. Essential elements in any proposal make a case for addressing needs, both specific patient barriers and critical gaps in the local healthcare community. Further, how a patient navigation program can leverage multiple sources of support can appeal to a donor and sway budgets over less efficient program requests. In addition, requests for support may require an impressive budget, compelling articles, letters of support, and case studies or patient stories.
Describing the need for patient navigation should include a high-level view of the environment and its impact on the patients served. What are the local incidence and mortality rates of cancer? Is the community a hub for cancer treatment for the state or the nation? Including this perspective will resonate with decision makers who have demonstrated a commitment to the development of their local community. Is the navigation site a destination for the state’s underserved? This will be important in an appeal to supporters who have a strong philanthropic commitment to vulnerable populations. Last, what does the state’s scorecard look like in providing healthcare coverage to the uninsured, including Medicaid expansion? Show in presentations to supporters how the patient navigation program can address your state’s healthcare disparity.
Identifying specific barriers that impact cancer patients is the core of any proposal; however, including how a patient navigation program will address local community gaps that impact these barriers will speak to an investor’s concern about their community resources. If a city is compromised in its resources of transportation and lodging for those with limited funds, then how, if funded, will the patient navigation program help patients overcome that barrier?
Leveraging multiple funding resources, even in-kind, can help investors stretch hospital budgets and give foundations confidence that their initial donations will contribute toward sustained efforts. When making the pitch to decision makers, consider a list of multiple supporters and how they intertwine to ensure the program serves patients over many years. Include historical background, especially for later investors, to validate how your patient navigation program has proved to be effective and supported by respected early investors. In-kind support should be well accounted for in budget descriptions as they minimize cost and show how every dollar will go directly to the critical need.
There are many respected articles on the effectiveness of patient navigation that can be included for reference in any proposals made to hospitals and donors. A detailed budget that includes specific in-kind resources such as patient navigation training, tech support, and educational materials all demonstrate a strong collaborative effort that maximizes the investor’s gift. In addition, case studies and/or patient stories are critical in any proposal as patient navigation is patient-centered, thus every point of service is unique, and that is the importance of its presence in any oncology program.
Build Thriving Programs
Many patient support programs have great appeal at the outset, but advocates fail to build in processes that ensure growth and sustainability over multiple years. Funders would likely expect that a patient navigation program included key components such as training, performance measures, and evaluations to gauge both patient and partner satisfaction, yet a patient navigation program can continue to present to funders and healthcare decision makers as a plausible program if it remains strategic in its approach, integrated at its health site, and exploratory in finding new resources in the midst of a changing healthcare environment.
Let’s consider our single mother facing a recurrence of cancer. How was the navigator positioned to help this patient find her? By identifying specific referral channels within the healthcare system, the navigator increases their access to patients and can meet specific needs identified in funding requests. A new patient navigator program may initially be directed toward one type of cancer diagnosis, but even as the types of cancer cases evolve, if the program remains strategic, strong outcomes can continue to be achieved and shared with supporters.
Patient navigation is a unique position within the oncology clinic. Navigators identify with case management, refer regularly to financial counselors, and work closely with oncology nurses and providers. Hospitals that may at least partially fund a patient navigator’s salary will look for key ways the navigator is integrated as a member of the oncology team. Community foundations regularly support hospital initiatives, so funding patient navigation, whether managed by the hospital or a community partner, aligns with their giving portfolio. Having physician, nurse, and administrative champions ensure a navigator is a full member of the oncology team and impacts how this program is viewed by its supporters as truly collaborative.
A patient navigation program will continue to thrive when it continues to seek alliances and resources for its patients. A patient navigator who makes it their aim to stay connected to resources within their own evolving healthcare system and keep apprised of local and national resources will overcome more barriers to care and be able to present a strong and evolving case for their program.
Conclusion
Patient navigation is still a relatively new field in the healthcare arena, but the creation of the Academy of Oncology Nurse & Patient Navigators in 2009 assembled a community that is actively building an infrastructure and path forward for this specialty. With the establishment of professional certifications to distinguish knowledge and skill and the development of key metric measures that show the efficacy of the role, patient navigation is becoming more standardized and gaining validity.
Looking ahead, there’s a need to build on that validity and continue reporting metrics and outcomes that provide quality evidence of the impact of navigation that clearly demonstrates a connection between financial benefit and the role of the navigator. Increased accountability and data will help justify the intention to obtain reimbursement for navigation services, so this field can be self-sustaining without the threat of budgetary cuts or loss of grant funding.5
As conveyed at the beginning of this article, navigation is still commonly viewed through the personal lens of the patient’s cancer journey. While these compelling testimonials illustrate the unique navigator-patient relationship and its life-changing impact, they don’t easily translate to an ultimate bottom line. To move forward in the future, the subjective value of patient navigation needs to be effectively converted into dollars and cents.
References
- Freeman HP, Rodriguez RL. History and principles of patient navigation. Cancer. 2011;117(15 suppl):3539-3542.
- Wells KJ, Battaglia TA, Dudley DJ, et al. Patient navigation: state of the art or is it science? Cancer. 2008;113:1999-2010.
- Giving USA. Giving USA 2018: The Annual Report on Philanthropy for the Year 2017. https://givingusa.org/giving-usa-2018-americans-gave-410-02-billion-to-charity-in-2017-crossing-the-400-billion-mark-for-the-first-time. June 13, 2018.
- Balderson D, Safavi K. How Patient Navigation Can Cut Costs and Save Lives. Harvard Business Review. https://hbr.org/2013/03/how-patient- navigation-brings. March 19, 2013.
- Whitley E, Valverde P, Wells K, et al. Establishing common cost measures to evaluate the economic value of patient navigation programs. Cancer. 2011;117(15 suppl):3618-3625.
- Moy B, Chabner BA. Patient navigator programs, cancer disparities, and the patient protection and Affordable Care Act. Oncologist. 2011;16:926-929.
- Institute of Medicine and National Research Council. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: National Academies Press; 2006.
