We’ve known for a long time that quality navigation improves outcomes for providers and patients. Yet navigation is still underutilized across many specialties, not to mention among general care providers. And that leads to higher costs – especially when it comes to the emergency department (ED).
Many patients will go to the ED for primary care due to bureaucratic barriers within Medicaid as well as convenience and general lack of understanding of the health care system. But would implementing community health workers as patient navigators change that trend?
In 2013, Project Access-New Haven (PANH) tackled this exact question. The organization began a study to determine whether implementing patient navigation with community health workers could cut down on the cost of emergency department visits for Medicaid beneficiaries with high usage patterns. The 100 patients that participated in the study had each visited EDs between four and 18 times the previous year for a range of ailments including abdominal pain and chest pain.
During the study, navigators coordinated their patients’ care by scheduling appointments, giving reminders and ensuring treatment compliance. The results confirmed what we’ve known to be true – navigators provide indisputable value. The average cost savings per member each month was $153, along with a 22% drop in ED usage. Even more drastic was the 48% drop in hospital treatment for participants who were assigned navigators, when compared with the control group.
So if it’s been proven time and again that navigators benefit patients and providers across the board, why are they so underutilized? According to Darcey Cobbs-Lomax, the executive director of Project Access, it often comes down to funding, as quoted in the article:
“My organization is entirely grant-funded, and grant money is thin-spread. On top of that, we don’t currently have a state budget. So, I no longer have my $200,000 state contract, which was paying for our patient navigators’ salary.”
While some states cover community health workers through Medicaid, the majority do not. That means that organizations such as PANH must rely on grants and, when those run dry, savings to pay their navigators. When the money runs out, the benefits of navigation go with it.
Patients deserve better as well: navigators are the missing link between physicians and their patients, helping overcome financial, logistical and cultural barriers to get their patients the care they need. Lauren Kelly, director of Research and Evaluation at Project Access, was quoted on the importance of fixing more than just medical care:
“Fifty-five percent of our patients live at or below the poverty line. Many have low levels of formal education and health literacy, and experience food insecurity and homelessness.”
Navigators do far more than simply text appointment reminders to their patients. But the current fee-for-service model of health care reimbursement presents a significant hurdle to widespread navigation. Even though the US health care system is currently undergoing a shift toward value-based care, the full transition is still a long way off. But when states such as Connecticut are spending $245 million on ED visits alone, one begins to wonder how those numbers would be affected if more funding were available for navigators.