Penn. Hospitals Find Navigators Can Make Care More Efficient

Jan. 27--Overuse of the emergency room, unnecessary hospital readmissions and poor compliance with disease screenings are stubborn problems for the nation's health care system and big contributors to rising medical spending.

Three hospitals in Western Pennsylvania have found a way to blunt these problems by connecting patients with people in their communities. Known as navigators, they help patients schedule doctor appointments, find transportation, pick up medications and make sure they're sticking to discharge instructions after a hospital stay.

Navigators are not medical professionals or social workers. They're more like a trusted neighborhood problem solver trained to help patients overcome obstacles to getting the care they need.

During a nine-month-long pilot program, Jameson Health System in New Castle, Saint Vincent Hospital in Erie and Allegheny Valley Hospital in Natrona Heights found that navigators were effective in getting patients to access medical care more efficiently, according to consulting firm Accenture, which ran the program, and the Highmark Foundation, which funded it.

Jameson Health experienced a 60 percent reduction in unnecessary readmissions during the program. Non-emergency use of the emergency room at Saint Vincent dropped by 43 percent. And Allegheny Valley increased colonoscopy screenings by 13 percent.

"Patient navigation not only creates a one-to-one connection for the patient, it serves as a low-cost investment that delivers significant value to care delivery," said David Balderson, an expert in patient navigation at Accenture.

The aim of the program is similar to one of the goals of the Affordable Care Act, President Obama's health reform law that has made health coverage more widely available. In addition to making it easier and less costly for low-income workers to buy health insurance, the law encourages patients to access more preventive care and pushes doctors and hospitals to better coordinate care and focus on wellness.

The $254,500 pilot program, which ran from July 2013 to March 2014, hired six full-time navigators and trained 30 existing hospital staff in navigation. It targeted a total of 4,000 patients at the three hospitals who had low incomes and were at risk for more than one chronic illness, such as diabetes and heart disease.

Cost savings from the pilot program were not released.

Navigators, who are typically paid about $37,000 to $47,000 a year, do work that is essential to improving health but is not direct medical care, Balderson said. They "help hospitals and patients navigate a number of obstacles within the health system while freeing up time for clinicians to do what they do best -- provide care," he said.

About half of emergency room visits are avoidable, costing the health care system $38 billion a year, according to a 2011 study published in the Annals of Health Law. Preventable hospital readmissions cost the system $41.3 billion in 2011, according to the government's Agency for Healthcare Research and Quality. Early detection of cancer and other diseases can prevent more costly treatments at later stages.

Balderson said five of the six navigators continue to work with the three hospitals.

Yvonne Cook, president of the Highmark Foundation, said the navigator program improves access to health care services while making jobs in communities with low-income populations. The foundation is the charitable, grant-giving arm of Highmark Inc., the largest health insurer in the state.

"We look forward to replicating the successes achieved in that study in other communities in the future," Cook said.

Alex Nixon is a staff writer for Trib Total Media. He can be reached at anixon@tribweb.com.

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