For many people, getting proper medical care can feel like maneuvering through a maze. Even businesses that provide health insurance for their employees are not well-versed in the process.
Think of healthcare navigation as the map to guide a patient’s healthcare journey. Patients can’t be expected to know all the terminology and procedure descriptions that their clinicians provide. A convenient, easy-to-follow process should not be too much to expect. Furthermore, if patients don’t understand their options, they’re less likely to comply with their own health plan.
The terms “healthcare navigation” and “patient navigation” can also be used in direct clinical settings. As such, medical professionals can also be referred to as healthcare navigators. Here are a few tips to help you improve patient care and patient experience at your facility by ensuring both patients and clinicians have what they need.
What is a patient navigator?
Healthcare navigators are unbiased specialists or organizations that help insurance consumers and small businesses find appropriate coverage through the Affordable Care Act (ACA) Marketplace, then complete eligibility and enrollment forms required to secure that coverage. Their services are typically complimentary.
Healthcare navigation ensures that healthcare processes are explained in plain terms to employers and consumer purchasers of insurance, so they have just enough knowledge to feel in control of their journey.
If a treatment protocol is confusing, patients will not be likely to follow it—especially in the healthcare space, where a negative experience at one touchpoint can send your patient to your competitor or tempt them to neglect their health altogether.
Healthcare navigators most commonly work in the health payer space. The navigator role became more recognized in the industry after the Affordable Care Act’s coverage expansion came into play. As more patients found they were able to afford health insurance, it quickly became apparent how many needed help navigating the complexities of applications and procedures. Many have never had health insurance prior to the Affordable Care Act.
Navigators help people understand which available insurance packages will best suit their needs. They also guide beneficiaries through the Marketplace enrollment process and provide patient education. Navigators within the ACA Marketplaces are funded by the federal government, and some organizations are even awarded extra funds by CMS for providing invaluable healthcare navigation to their patients.
Healthcare navigators on the clinical side are often nurses or other healthcare workers who are well-suited for healthcare navigation, as they’re familiar with the ins and outs of treatments, diagnoses, and other care plan details. They’re also experienced enough to streamline the discharge process so it is more educational and efficient for patients.
They ensure patients are able to locate and access the right treatments, generally understand their illnesses, and fully comprehend their care plans. Successful healthcare navigation not only addresses patients’ financial needs, but also alleviates their emotional, spiritual, familial, and physical struggles.
Organizations may also consider hiring non-clinician navigators to reduce healthcare costs. Non-clinician navigators have the ability to engage patients both during healthcare provider visits and in between appointments. This enhanced patient-centric approach can help avoid unplanned, high-cost emergency interventions.
5 reasons to implement healthcare navigation
Here are a few reasons your organization should offer healthcare navigation to your patients.
1. Speedier diagnosis and treatment
Without prompt diagnosis and treatment, serious illnesses—like cancer, diabetes, or HIV— can become fatal.
Patient navigators help their clients get a diagnosis and treatment plan sooner. In fact, one study found that healthcare navigation increased the diagnosis of early-stage cancer from 33 percent before navigation to 53 percent after it was introduced. Early diagnosis increases the likelihood of positive health outcomes for all conditions.
2. Reduced disparities in care
The social determinants of health (SDoH) can create barriers to fair health services.
- Transportation: Not everyone has a car or lives close to a city that has larger, higher-performing care centers. Many patients have to find practical public transportation routes, take off work, and/or find childcare in order to visit a clinician. Travel can be challenging for low-income, rural, or chronically ill patients. Healthcare navigators ensure patients in any circumstance are taken care of.
- Language and cultural differences: English may not be a patient’s first language. It’s crucial that patients understand their treatment plan and communicate their concerns to their clinician. Healthcare navigation provides multilingual healthcare professionals that communicate in patients’ native languages.
- Lack of insurance: Healthcare is a right, and yet, not everyone can afford insurance. Navigators can help find a plan that works best for patients and their families, so they never have to make the difficult decision of foregoing treatments to pay for other necessities.
3. Improved quality of life
According to a study, cancer survivors who had a dedicated navigator that regularly called to offer support and suggest or provide customized reading material reported having a better quality of life than those with a passive navigator.
Patients felt they could reach out to their standard care navigator when they needed help with paperwork, scheduling appointments, transportation, and travel assistance. Next-level navigators also provided community service connections, regular check-ins, and culturally relevant education.
Patient satisfaction is vital to improving health outcomes. Enhanced healthcare navigation has been shown to improve quality of life for colon cancer survivors. Survivors who were not as satisfied with their navigator’s services were less confident when interacting with their clinician, carrying out daily activities, and handling stress. Healthcare navigation has been proven to get patients to adhere to cancer care follow-up treatments and attend pivotal care events.
4. Increased revenue
In the value-based care reimbursement model, healthcare providers face reduced pay from Medicaid and Medicare if they fail to address patient experience and patient satisfaction. To avoid losing revenue, hospitals must juggle efficiency goals with patient-centered care demands.
Missed appointments are a very significant source of revenue loss for hospitals. A set of studies outlined by The Center for Health Affairs revealed that missed appointments cost the wider healthcare system more than $150 billion in 2006 alone. Navigators can make a serious impact on reducing these missed appointments—according to the same set of studies, the no-show rate fell from a staggering 67 percent to just 10 percent at one hospital after navigators were introduced.
5. Improved patient-provider communication
Communication is vital to operations and patient experience. One study, published by Supportive Care in Cancer, investigated how healthcare navigation could address barriers to proper healthcare and found that post-intervention psychosocial support showed a decrease in cancer patients’ distress and depression and a boost in feelings of social support.
In the same study, participants relayed that participation in a program with healthcare navigation helped them overcome communication barriers with healthcare staff by as much as 73 percent. Excellent communication between patient and provider helps prevent errors, improve treatment plan compliance, enable understanding, reduce anxiety, and forge a trusting bond between patients and providers. Patient navigators ensure patients truly feel heard by their clinicians.
Why you should develop a healthcare navigation system
Healthcare navigation will not only improve patient experience and increase patient satisfaction, but can also save your healthcare organization money, time, and other resources while improving your reputation.
If you’re looking to streamline your processes and make your workplace more efficient, we encourage you to learn all you can about improving the patient experience. Discover everything you need to know to take your organization to the next level and keep patients returning to your practice.