As navigation services continue to grow and expand, so does the need to show return on investment (ROI) to key administrative and C-suite leaders. For those within the world of oncology, and especially those working in navigation, the impact navigators have on patients and their caregivers is unsurprisingly evident and clear. Their impact on the patient experience is on full display through patient satisfaction, removal of barriers to care, and improved care coordination.
According to a literature review by Gorin et al, cancer care coordination led to improvements in 81% of outcome measures, including screening, patient experience with care, and quality of end-of-life care, with patient navigation as the most frequent care coordination intervention.1 However, for the key stakeholders who sit in the C-suite, this development, although beneficial to patients, needs more quantitative data to further tell the story of patient navigation and its benefits.
The navigation profession as a whole would benefit from further research and increased awareness of navigation to not only the psychosocial and economical element of the cancer journey but also the clinical outcomes throughout the entire cancer continuum. This information would likely facilitate moving the needle for enhanced reimbursement and ROI expenditures for navigation services going forward.
With the new ruling from the Centers for Medicare & Medicaid Services that took effect January 1, 2024, patient navigation services were finally recognized as a path toward reimbursement.2 Although this is a monumental step forward toward reimbursement efforts for navigation services across the country, there is still work to be done. Equipping navigators with the tools they need to tell this story is step 1.
Acknowledging the gap in awareness and quantitative data highlighting the valuable contributions of navigation services to patients and the healthcare system, AONN+ developed the CATCH (Catching & Addressing Threats to Care & Health) initiative. This reporting system tracks navigators’ interventions with positive outcomes to further highlight navigation value and efficiency.
A “Catch” is considered a navigation win where the navigator caught an issue (near miss event) and intervened to correct it, benefiting the patient while providing the best practice outcome. Navigators utilize these skills in everyday practice handling many aspects of care touchpoints (clinical, psychosocial,) which will now be recognized on a national level through the AONN+ platform.
The CATCH initiative aims to align navigator interventions to the AONN+ standardized metrics as well as the Professional Oncology Navigation Standards of Professional Practice.
“The evidence supporting the impact of oncology patient navigation is extensive in the literature. Putting this evidence in practice can be daunting to take it from paper to implementation. CATCH is a dissemination strategy of successful interventions. An added beauty is the alignment with a standardized metric—a foundation of navigation sustainability! The difference made counts for the patient and the institution of care.” — Sharon Gentry, MSN, RN, HON-ONN-CG, AOCN, CBCN
Professional Oncology Navigation Task Force (PONT) Standards: PONT created this document to provide professional oncology clinical navigators and patient navigators with clear information regarding the standards of professional practice. This includes the knowledge and skills all professional navigators should possess to deliver high-quality, competent, and ethical services to people impacted by cancer. These standards also provide benchmarks for use by healthcare employers and information for policy and decision makers, as well as other health professionals and the public to understand the role of professional oncology navigators (Table).3
Understanding the need for standardized navigation metrics to build the case for navigation and evaluate programs, AONN+ developed 35 standardized navigation metrics divided into 3 categories: patient experience, clinical outcomes, and business performance/ROI.4
This metric alignment is essential to begin to understand the data on the actual impact and contributions of navigation services on the patient, treatment journey, healthcare system, and financial landscape of cancer care. By connecting the navigator’s intervention directly with a positive outcome, we can then begin to not only examine the correlation between positive patient outcomes and navigator intervention to discover best practices but also enhance awareness of these services and the need to fund more navigation roles across the continuum.
A 42-year-old female was receiving chemotherapy for triple-negative breast cancer. The patient’s chemotherapy regimen was incorrectly scheduled out of sequence.
Analysis: The US healthcare infrastructure can be a very complicated and fragmented system that is exacerbated by the complexity of oncology care. The navigator’s role is intended to alleviate some of that fragmentation in oncology care by assisting with coordination of care among the many multidisciplinary team members within the cancer care continuum. In this Catch instance, this patient’s chemotherapy regimen was closely monitored by the navigator who had the specialized clinical knowledge to recognize a near- miss event in real time.
While many healthcare providers affect a patients healthcare journey at specific touchpoints, navigators are specially trained and positioned to act as the patient’s advocate and essentially prevent patients from falling through the cracks. The navigation role is also unique in oncology care as they have the opportunity to assist the patient throughout the entire continuum of care.
Upon chart review, the navigator noted that the patient was scheduled to start part 2 of her chemotherapy (dose-dense doxorubicin and cyclophosphamide) at the next infusion visit. However, the patient had not yet completed part 1 of chemotherapy, as she still needed 3 more cycles of paclitaxel/carboplatin.
Analysis: As Tracy Wyant, DNP, RN-BC, AOCN, CHPN, CPPS, reported in the ONS Voice, “Sequencing of cancer treatment regimens is based on multiple factors, including the pharmacokinetic properties of the agents in the regimen and their effectiveness based on cell-cycle specificity. Because of potential interactions and effects, some regimens have critically important administration sequencing.”5
This navigator understood the possible consequences of administering chemotherapy out of sequence, including:
Promptly determining that the patient was incorrectly scheduled for the wrong portion of her chemotherapy treatment, the navigator notified the infusion nurse, oncologist, and pharmacist about the finding. This CATCH and intervention prevented the patient from receiving the wrong drug at the wrong time.
Analysis: While administering the wrong drug at the wrong time would affect the patient negatively, the financial implications of the pharmacy preparing the wrong drug that would then not be administered is also of importance. The navigator was also able to prevent unnecessary anxiety and healthcare mistrust for the patient by preventing a medication error. Utilizing a multidisciplinary approach, the navigator was able to coordinate care among the entire medical team.
The patient was able to continue the recommended treatment per the National Comprehensive Cancer Network guidelines for triple-negative breast cancer. Further, the medical team subsequently conducted a safety assessment and corrected procedures within the electronic record system to prevent future discrepancies.
Analysis: The navigator’s intervention had financial, emotional, and clinical outcomes of significance in this case, and it also influenced the healthcare institution to explore and identify gaps in care and subsequently develop more efficient protocols to prevent future issues. By preventing future discrepancies and near-miss events, this intervention can contribute to costs savings by the healthcare institution.
Documenting the metrics that correlate with the navigator interventions can assist the navigator in building a case for navigation services to key stakeholders while also illustrating the real-world scenarios that take place in daily practice. Utilization of these tools combined with real patient experiences and positive outcomes further confirms the need and benefit of navigation services.
AONN+ launched the CATCH initiative in July 2022 and have published 18 CATCH submissions as well as presented the CATCH of the Year award to both a nurse navigator and patient navigator, respectively, at the AONN+ annual conference. Each CATCH is featured in the Journal of Oncology Navigation & Survivorship (JONS) publication in the CATCH of the Month series. A core overview of some of the themes represented include:
Since the launch of the CATCH initiative, AONN+ has highlighted 18 different healthcare and advocacy organizations, including academic, community, rural, urban, and specialty advocacy institutions across the country. Each of these institutions represent diverse populations, geographical locations, mission statements, and many types of oncology specialties. With each CATCH submission, a navigator is able to display their impact on patient care and align the interventions with metrics, which can help tell the story of navigation through the C-suite’s lens.
While progress has been made in the navigation reimbursement landscape, more work and research are needed to further examine the navigator’s role and impact on patient care and build a case for navigation programs. AONN+ remains committed to shining a light on navigation services and its impact on ROI through many initiatives, including CATCH, on a national platform.
Navigators are encouraged to ultimately act as their own best advocate and actively engage in telling their story through research, metrics, and business case development to key stakeholders and administrative leaders. Only then will the profession of navigation catch the attention of the C-suite.
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