Newest member of the care team guides patients through the maze
Navigators are bridge between MDs, patients
Today’s complex healthcare system can be daunting for anyone. But when patients are stressed by being in the hospital, overwhelmed by what they need to do to follow their treatment plan, confused by a complicated medication regimen, and facing psychosocial and financial obstacles as well, you’re almost setting them up for failure.
That’s where a new member of the healthcare team comes in. Hospitals, physician practices, and health plans are turning to patient navigators to guide patients through the healthcare maze and help them access everything they need to manage their health.
Navigators remove the obstacles patients face in getting access to healthcare and following their treatment plan. They meet face to face with patients and many times develop a close relationship. While clinicians are often rushed, patient navigators have the time to get to know the patients, find out what their living environments and support systems are like, and answer their questions and concerns, forwarding concerns to their providers when needed.
"Patient navigators act as a bridge between patients and healthcare providers. They are someone who can accompany the patient to see the physician after discharge, help them understand their healthcare benefits, or assist with accessing community resources," says BK Kizziar, RN-BC, CCM, owner of BK & Associates, a Southlake, TX-based case management consulting firm.
Many different roles are included under the title of "navigator," and depending on the individual program, navigators may have different educational levels and training, Kizziar points out. "Some navigators are hospital employees who follow patients from admission to discharge to make sure the transition from acute care to home goes smoothly, but navigators aren’t necessarily a nurse. They can be savvy lay people with training on the clinical and business side of healthcare," she adds.
"Navigators can be a tremendous asset in the post-acute setting, such as physician offices and outpatient clinics, keeping patients informed of their medical options and helping them understand their conditions and what they need to do to optimize their health," says Patricia Pittman, RN, CCM, MHA, independent case management consultant and PRN case manager.
Adding a patient navigator to the inpatient healthcare team allows the inpatient case managers to coordinate the care and the post-discharge services while the navigator steps in as the patient transitions. "We are finding that patients need a lot of hand-holding after discharge. The inpatient hospital case managers simply do not have the time or resources, but navigators are in the perfect position to work with patients after they leave the hospital," Pittman says.
"The new healthcare laws make health systems accountable for patient outcomes like primary care access, quality, and hospital readmissions. To improve these outcomes, it is vital that health systems implement programs that reach beyond their walls and address the root causes of poor health," says Shreya Kangovi, MD, MS, assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania and director of the Penn Center for Community Health Workers.
After interviewing more than 100 at-risk patients, the University of Pennsylvania Health System developed a model of care that uses community health workers who live in the communities they serve and help patients overcome their challenges in receiving healthcare.
The patients told researchers that they felt disconnected from the healthcare system because providers often didn’t understand their living situation. The patients feel comfortable with the community health workers because they share race, culture, and life experiences, says Casey Chanton, MSW, project manager for the Penn Center for Community Health Workers.
The team developed a model for community health workers in the hospital setting and in physician offices. (For details, see related article on page 76.)
Allina Health, a nonprofit health system of 12 hospitals and 90 clinics in Minnesota and Wisconsin, developed a navigator role — called care guides — as a way to help patients with chronic illnesses meet their clinical goals. Care guides are not clinicians; they are lay healthcare workers with at least two years of college who undergo two weeks of training. They work in cubicles in physician offices and help at-risk patients access the community resources they need and support them in meeting their healthcare goals. (For details on the program, see related article below.)
"Our vision was to find if there is a place in the healthcare system for a variety of healthcare roles. Patients don’t always remember everything their doctor told them. The care guides have time to spend with patients to make sure they understand what they should be doing and to support them in meeting their clinical goals," says Kim Radel, MHA, director of Allina Health’s Care COPILOT Institute.