In the eyes of a patient, especially one with a chronic or complex illness, the healthcare system can feel overwhelming. Compound the inherent complexities of the system with a variety of barriers patients can face – transportation, language, and many others – and patients can have difficulty following the care plan developed by their team of providers.
Founded and pioneered in 1990 by Dr. Harold P. Freeman, patient navigation originally focused on the critical window of opportunity to save lives from cancer by eliminating barriers to timely care between the point of suspicious finding and resolution by diagnosis and treatment. Since its inception as a community-based intervention program, patient navigation has expanded and transformed into a nationally recognized model that extends well beyond cancer care to include the timely movement of an individual across the entire healthcare continuum.
While patients clearly benefit from the guidance of a patient navigator, a growing body of evidence suggests that patient navigation increases both patient satisfaction and hospital revenue. Nationally, patient navigation is becoming well-recognized for being a cost-effective strategy to address several healthcare priorities. An attractive career choice for those looking to make a difference in healthcare, patient navigation also provides economic development opportunities in communities throughout the United States.
About the Speaker:
Carol Santalucia, Vice President, of CHAMPS Patient Experience, LLC is a seasoned healthcare leader with a passion and commitment to enhancing the patient experience. After 28 years in various service excellence and leadership roles at Cleveland Clinic, where she played a pivotal role in the design, creation and implementation of Cleveland Clinic’s service recovery model Respond with H.E.A.R.T., and the development of their patient navigation program and Service Excellence and Patient Advocacy Department, Carol began her own healthcare consulting practice, Santalucia Group, LLC.
3. Topics for Discussion
• The Optimal Patient Experience
• Patient Navigation
• Patient Navigation’s Effect on the Bottom Line
• Patient Navigation’s Effect on the Patient
Experience
4. The Optimal Patient Experience
Optimal
Patient
Experience
Building Trust
Reducing
Anxiety
Engaging
Employees
Cultural
Commitment
8. www.champspatientexperience.com
@carolsantalucia
History of Navigation
Pioneered in 1990 by Dr. Harold P.
Freeman; focused on the critical
window of opportunity to save lives
from cancer by eliminating barriers to
timely care between the point of
suspicious finding and resolution by
diagnosis and treatment
Since its inception as a community-
based intervention program, Patient
Navigation has expanded and
transformed into a nationally
recognized model that extends
beyond cancer care
10. www.champspatientexperience.com
@carolsantalucia
Types of NavigatorsClinicalNavigator
•Assist patients with
treatment and
prevention-related
tasks
•Apply their clinical
knowledge to help
patients understand
treatment and care
options, as well as
discharge
instructions
•Provide individual,
family and caregiver
counseling
LayNavigator
•Connect patients to
different resources
and information in
the healthcare
system and the
community
•Coordinate
screenings and
appointments
•Remove barriers to
accessing care in a
timely manner
•Reduce the burden
of overwork for
providers
InsuranceNavigator
•Provide individuals
and families with
the information
necessary to
determine which
health insurance
option best fits their
needs
•Help individuals and
families enroll in
their plan of choice
13. www.champspatientexperience.com
@carolsantalucia
Responsibilities May Include…
• Guiding patients through healthcare system by
assisting with access to healthcare
• Coordinating logistics for plan adherence
• Accompanying patients to appointments
when necessary
• Developing relationships with participating
physicians and service providers
• Provide coaching and support to patients and
families when appropriate
15. www.champspatientexperience.com
@carolsantalucia
Characteristics of a Navigator
• Excellent Communication Skills
• Ability to process large amounts of
information
• Ability to build and maintain trusting
relationships
• Exercises good judgment
• Ability to function well on a team
• Ability to maintain healthy boundaries
16. www.champspatientexperience.com
@carolsantalucia
Cleveland, OH Pilot
Head and Neck Cancer Business
Challenge
• High no-show rates for outpatient radiation
appointments leading to lost revenue at the
medical center
Placement of Navigator
• .5 FTE onsite working with physicians, nurses
and social workers
Breast Cancer Business
Challenge
• High no-show rates and a lack of healthcare
coverage leading to lost revenue at the
medical center
Placement of Navigator
• 1 FTE onsite working with physicians, nurses
and social workers
Emergency Department Challenge
•High number of self-pay readmits
•Goal of decreasing 30-day Medicare
readmits
Placement of Navigator
•1 FTE onsite working with unassigned
patients coming through the ED
17. www.champspatientexperience.com
@carolsantalucia
Pilot Performance Metrics
Focus Area Primary Metrics Secondary Metrics
Head and Neck Cancer 1. Reduce no-show rates for
outpatient radiation appointments
2. Reduce cancellations
a. Increase in patient satisfaction
b. Reduce Ombudsman complaints
c. Improved quality
Breast Cancer 1. Reduce no-show rates for
outpatient radiation treatment
2. Increase in coverage numbers and
revenue for BCCP
a. Track days between key
appointment
b. Increase in patient and physician
satisfaction
c. Improved quality
d. Reduce Ombudsman complaints
Emergency Department 1. Reduce 30-day Medicare Readmits
2. Decrease self-pay revisits
a. Increase patient and employee
satisfaction
b. Decrease LOS in observation
c. Improved quality
d. Reduced Ombudsman complaints
18. www.champspatientexperience.com
@carolsantalucia
Head and Neck Cancer Pilot Results
Pre Post
% Missed Appointments 12.45% 9.68%
% Kept Appointments 87.55% 90.32%
Annual Salary .5FTE: $17,500 ROI: 2.48 Months
0
5
10
15
Dec Jan Feb Mar Apr May
Percent Missed Appointments
2011
2012
19. www.champspatientexperience.com
@carolsantalucia
Breast Cancer Pilot Results
0
5
10
15
20
May June July Aug Sept Oct
Percent Missed Appointments
2011
2012
Pre Post
% Missed Appointments 9.96% 7.81%
% Kept Appointments 90.04% 92.19%
Annual Salary 1 FTE: $35,000 ROI: 5.7 Months
21. www.champspatientexperience.com
@carolsantalucia
Current Navigation Programs
Large Healthcare
Provider
Large Healthcare
Provider
Large Regional
Healthcare Provider
Non-Profit Community
Organization
Action • Operational metrics
and workflow
optimization to better
serve diabetes
patients and other
chronic diseases
• Integrated lay
navigator into ER to
reduce the number
of self-pay admits
and readmits
• Integrated lay
navigators into care
model to better serve
sickle cell, head/neck
cancer and breast
cancer patients
• Employed a
community-based lay
navigator outreaching
to those in need
Outcomes • Increased facility and
resource efficiency
• Reduced no-show
rates for diabetic
education, foot and
eye visits
• Increased revenue
through conversion of
uninsured to
Medicaid
• Lowered ER
admissions /
readmissions for
unassigned patients
• Identified and
resolved system
issues preventing
unassigned patients
from receiving care
• Reduced no-show
rates and
cancellations for
outpatient radiation
treatments
• Lowered cost of care
by redirecting sickle
cell patients from ER
to day clinic
• Improved access to,
quality, pace of care
• Increased patient and
physician satisfaction
• Continuously building
trusting relationships
with community
members that have
consistently resulted
in community
members receiving
timely care
23. www.champspatientexperience.com
@carolsantalucia
• Navigators are experts
who help patients
experience the best of
our healthcare system
by developing key
relationships to
personally help them
navigate the system
successfully
Navigation and the Patient Experience
24. The Optimal Patient Experience
Optimal
Patient
Experience
Building Trust
Reducing
Anxiety
Engaging
Employees
Cultural
Commitment