Measuring the Value of Oncology Patient Navigation

Over the past years, oncology patient navigators have become more business savvy and have begun to grasp an enriched understanding about value-based cancer care metrics. This is reflected in their repeated mention as a solution to improve the experience of people and their families living with and surviving cancer.¹ Metrics involve evaluation to demonstrate the impact of navigation on the key areas of quality, coordination, and cost-effectiveness. A recent assessment of the National Cancer Plan continues to highlight the value of navigators.

With the goal to ensure quality insurance coverage for all and the strategy to use nationally recognized, updated clinical practice guidelines to inform coverage decisions for cancer care, navigators are key to either counsel or provide referrals to financial counseling. Their voice was instrumental in the Association of Cancer Care Centers 2023 Financial Advocacy Services Guidelines to assist cancer programs and practices in effectively developing and implementing financial advocacy programs.

In the call to build a sustainable, robust, and diverse workforce with a focus on all types of workers needed to deliver high-quality cancer care, the Academy of Oncology Nurse & Patient Navigators is the home for navigation resources and education for all types of professional navigators. The recently released CMS Payment for Principal Illness Navigation: How Do I Credential My Navigators? ties in foundational knowledge in preparation for using the new billing codes.

The CMS rule that allows Medicare to pay for navigation services to help patients navigate treatment for cancer and other serious illnesses is a significant step in the right direction to promote dynamic and sustainable community engagement. This goal is linked to trust based on mutual respect and bidirectional communication, key characteristics of a navigation practice. Interestingly, the assessment encouraged private payers to follow the lead of CMS in this payment area, and on March 8, the Biden Cancer Moonshot announced new commitments from 7 leading health insurance companies.²

Thank you to each individual and organization that are championing the importance of patient navigation services.

References

1. The White House. Cancer Moonshot. www.whitehouse.gov/cancermoonshot/
2. The White House. FACT SHEET: Biden Cancer Moonshot Announces Commitments from Leading Health Insurers and Oncology Providers to Make Navigation Services Accessible to More than 150 Million Americans. March 8, 2024. www.whitehouse.gov/ostp/news-updates/2024/03/08/fact-sheet-biden-cancer-moonshot-announces-commit ments-from-leading-health-insurers-and-oncology-providers-to-make-navigation-services-accessible-to-more-than-150-mil lion-americans/