Yolanda Curiel has been battling diabetes for 10 years. Her job as a waitress hasn’t helped, since she’s constantly tempted by calorie-laden food. Managing her weight and her medications was a losing battle until her physician referred her to Mary Lou Garcia, who over 10 months guided her to a 17-pound weight loss and to blood sugar readings in a safe range. “Now I take much better care of myself,” says Curiel, 50. “I’m so happy I met Mary Lou.”
Garcia, a “patient health navigator” at River Valley Family Health Clinic in Olathe, Colorado, belongs to an emerging field created by pressures on care providers to actually make people healthier. The navigator’s job is to steer patients to the care they need, removing any barriers — logistical or psychological.
The call for this sort of help is growing louder as insurers shift away from paying a fee for each test, office visit and hospital stay to a “value” system in which hospitals and doctors lose money if patients don’t get and stay stable or well. Navigators make sure people know how to take their medications, for example, and that they’re able to show up for appointments.
“If you don’t get your scheduled radiation treatments, your tumor will grow back,” says David Balderson, who leads patient navigation initiatives for consulting firm Accenture. Though a National Cancer Institute study has raised questions about the cost-effectiveness of these programs, an Accenture analysis in Pennsylvania showed a 43 percent drop in trips to the ER for nonemergencies by patients assigned to a navigator, a 60 percent reduction in people readmitted to the hospital within 30 days of discharge and a 13 percent increase in patients receiving colonoscopies. According to Accenture research, job postings for navigators tripled between 2010 and 2013.
The title of patient navigator doesn’t yet have a universal definition or standardized certification requirements, though many navigators have received specialized training through workshops or online courses leading to a certificate. Their duties vary based on their level of medical training and patient requirements. A cancer patient facing a daunting lineup of surgery, chemotherapy and radiation treatment might get help arranging appointments in the correct sequence. Navigators might schedule rides or child care or set up a home visit from a dietitian, say, or help anxious or depressed patients find counseling.
“She made appointments with every doctor you can think of, and when I was scared or crying, she’d send me to the right people,” says Mary London, 46, whose nurse navigator at Dana-Farber Cancer Institute in Boston, Ludmila Svoboda, has been helping her battle kidney cancer since 2012. Svoboda has coordinated London’s care, including surgery removing part of her right kidney and attention to secondary problems involving her back and stomach. Svoboda provides emotional support as well — in person, on the phone and via email.
“The first question is, what does the patient need to get through the complex health care continuum in a timely way with good quality of care?” says Harold Freeman, the former director of surgery at Harlem Hospital in New York who pioneered the navigator concept in 1990 after watching too many cancer patients die because they didn’t know their way around the system. The Harold P. Freeman Patient Navigation Institute, which he launched in 2007, so far has trained 3,000 navigators.
Early programs focused on cancer care, but navigators are increasingly being deployed to help people with other complex conditions, such as diabetes, cardiovascular disease, congestive heart failure and chronic obstructive pulmonary disease. “It’s been amazing how things have shifted,” says Patricia Valverde, director of the Patient Navigator Training Collaborative at the University of Colorado–Denver, which has taught several hundred navigators, including Mary Lou Garcia. Besides cancer care and chronic illnesses, the training program’s focus now extends to promoting preventive services as well.
Hospitals generally offer navigator services at no cost to patients they believe will benefit: usually those who have complex health problems and a lack of adequate support at home or in their communities. (Valverde says it’s worth inquiring whether your provider offers such services if you think you need them.) While providers don’t typically receive any insurance reimbursement for the services, they sometimes cover them through grant or research funding. They also expect that the navigators will pay for themselves by lowering the overall cost of care in the long run and improving their patients’ health.
Navigators come with a wide range of backgrounds; some are laypeople with an interest in health care, and many are advanced specialty nurses. Lay navigators can often do the most effective job of persuading people to get routine screenings, Freeman notes. And they are also apt to be most familiar with local services such as household help or transportation. An oncology nurse’s expertise can be invaluable for guiding someone facing a terrifying disease. Svoboda meets her patients at the appointment where they get their diagnosis. “Their sigh of relief is obvious and immediate,” she says.
Mary Lou Garcia is not a nurse, but she has worked in doctors’ offices in other capacities, and her extended family has been ravaged by diabetes. She knows how difficult it is for some patients to understand what they need to do to stay healthy, and then do it. “People can relate to me because I know what they’re going through,” she says. In the year that she’s been at her Colorado clinic, the physicians have sent her dozens of patients with chronic health problems that can be managed by diet, exercise, adherence to medication and regular monitoring. She sees three or four a day, on average, and is on the phone with many more. Training programs for navigators are set to spread. The League for Innovation in the Community College, an alliance of more than 800 community colleges, has developed prototype associate degree and certificate programs in health navigation in cooperation with the Centers for Disease Control and Prevention. Some of the league’s members plan to start pilot programs in the near future.
If your doctor assigns you a navigator, Valverde recommends launching the partnership with an in-depth conversation about what the navigator can and can’t do, how long you’ll be working together and what your responsibilities will be. Clear expectations, she says, are key to getting good results.
Excerpted from U.S. News’ “Best Hospitals 2016,” the definitive consumer guidebook to U.S. hospitals. Order your copy now.
More from U.S. News
Got Diabetes? Why You Must Protect Your Feet
Which Practitioner Do I See, and When?
14 Things You Didn’t Know About Nurses
A Personal Compass: What Patient Navigation Can Do for You originally appeared on usnews.com
