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How Non-Clinical Staff Enable Patient Engagement, Care Coordination

Patient navigators, health coaches, and community health workers are key to patient engagement and care coordination. But what is the difference between these non-clinical jobs?

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Whether they are called patient navigators, advocates, coaches, or community health workers, non-clinical health workers are becoming increasingly important for patient engagement and care coordination.

About half of all healthcare workers are non-clinical staff. This includes community health workers, patient navigators, health coaches, and other individuals who interact with patients but do not dispense medical advice or carry out procedures, according to a 2014 report from the Brookings Institute.

“Although many discussions of the healthcare workforce focus on doctors and other occupations requiring advanced degrees, the healthcare system would not function without pre-baccalaureate workers—those with less than a bachelor’s degree,” the report stated.

“These workers perform a variety of clinical, assistive, and administrative tasks, and like all healthcare staff, should be working at their full level of competence in order to achieve the ‘triple aim’ of improving the experience of care, improving health outcomes, and reducing per capita costs.”

Understanding exactly how to best leverage non-clinical workers depends on securing the right member of staff to tackle the right issues of patient care.  But when hiring these patient engagement experts, healthcare organizations often face the challenge of disambiguating overlapping functions, unclear job titles, and tailored skill sets.

What are the differences between patient navigators, health coaches, and community health workers?  How can provider organizations maximize their investment in patient engagement staff by integrating these valuable professionals into the multidisciplinary care team?

Patient navigators, advocates help patients manage their health

Patient navigators, also known as patient advocates, help patients develop the skills necessary to understand the various parts of the healthcare industry.

According to the American Medical Association (AMA), “a patient navigator is someone whose primary responsibility is to provide personalized guidance to patients as they move through the healthcare system.”

“The term patient navigator is often used interchangeably with the term ‘patient advocate,’ and the role may be filled formally or informally by individuals with clinical, legal, financial or administrative experience, or by someone who has personal experience facing healthcare-related challenges,” the group says.

Patient navigators can work in a hospital or clinic setting, be a part of a community group, or work as an independent consultant.

Patient navigators facilitate patient autonomy by empowering patients with the information and tools necessary to become activated in their healthcare.

When patient navigators explain a patient’s health plan benefits, for example, the patient can make informed decisions about the type of care they will receive “with an enhanced sense of confidence about risks, benefits, and responsibilities,” the AMA says.

The role of a patient navigator or patient advocate may include:

  • Advocating for the patient during health plan negotiations
  • Advocating for the patient during patient-provider communications
  • Assisting in caregiver education
  • Managing clinical or administrative paperwork
  • Delivering patient education and improving health literacy
  • Scheduling necessary preventive care screenings
  • Connecting individuals with community services

Navigators can work in the clinical setting or in the payer environment.

The passage of the Affordable Care Act solidified patient navigators’ roles in the insurance industry. The landmark legislation mandated that each state insurance exchange offer patient navigator services to help explain plan benefits and other complex health information to patients.

Per the ACA, patient navigators provide expertise on the enrollment process, offer impartial plan information, facilitate the enrollment process, and provide referrals in the case of enrollee complaints.

Patient navigators in clinical care similarly provide patients the support they need to work effectively within the healthcare industry. These individuals help patients understand the healthcare landscape, coordinate patient care, and connect patients with community resources that will help patients achieve better health. Those community connections can include transportation services, housing, or assistance accessing healthy food.

Patient navigators in the provider environment are a strictly non-clinical role, the AMA emphasizes.

“Patient navigators should refrain from any activity that could be construed as clinical in nature, including interpreting test results or medical symptoms, offering second opinions or making treatment recommendations,” the organization explains.

Instead, patient navigators should lean on education techniques to ensure patients understand their health, diagnoses, treatment options, and administrative terminology.

There is currently no regulated or national certification requirement for patient advocates. However, the Patient Advocate Certification Board is working to establish a set of industry standards.

Patient navigators have been shown to improve care quality and decrease healthcare spending. A 2017 article published in JAMA Oncology showed that a layperson patient navigator program yielded a tenfold return on investment, with average costs for patients receiving layperson navigation declining by $781.29 per patient per quarter. That created a total cost savings of $19 million annually across the network.

Patients receiving patient navigator services utilized care less frequently than those patients without navigators. Emergency department visits declined by 6 percent, hospitalization declined by 7.9 percent, and ICU admissions by 10.6 percent.

A separate 2018 study published in the American Journal of Accountable Care found that layperson navigators are effective in connecting patients with services that address the social determinants of health.

The observational study showed that peer navigators, or navigators who have also lived or are living through a complex health condition, are able to provide emotional support. Additionally, these navigators have first-hand experience with the types of community organizations that reliably assist patients in obtaining food assistance, education, or housing, for example.

Health coaches drive patient motivation

Health coaches focus specifically on patient behavior change. Patient behavior change is essential to chronic disease management and prevention, both of which require patients to adopt healthy lifestyles to improve wellness.

“A health coach partners with individuals through the process of behavior change. This is done through support in setting goals, unearthing values, strengths, and motivations, and encouraging the development of sustainable healthy behaviors and attitudes,” according to the Vanderbilt University School of Nursing, an institution which provides health coach training.

“Health coaches are credentialed members of the healthcare industry who have additional training in the science of health behavior change. Coaches combine their medical expertise with coaching skills to manage a variety of chronic medical conditions.”

A health coach may also be referred to as a clinical health coach, integrative health coach, care coordinator, transitions coach, or disease management nurse, depending upon the individual’s credentials.

Health coaches are usually individuals with some medical background in nutrition, fitness, nursing, or patient motivation.

These individuals receive specific training to use medical knowledge to coach patients along their wellness journeys. However, health coaches do not use their medical background to offer clinical advice, read lab results, or use medical information to make a diagnosis.

Similar to patient navigators, there is no standard certification program for health coaches. Some bodies offer their own certifications, including the Institute of Integrative Nutrition, the National Society of Health Coaches, and the American Council on Exercise.

At the Pennsylvania-based payer Capital Blue Cross, health coach Hilary McMahon, RDN, LDN, CHWC, focuses almost entirely on what lifestyle changes the patient wants to make.

“I start by asking consumers to give me a 35,000-foot view of how they picture their health and wellness through the week and what they see it to be down the road,” McMahon shared with PatientEngagementHIT.com.

“There are all different types of paths for different types of people,” McMahon explained. “The motivator is to really get to the crux of what that person wants to change about their lifestyle.”

For example, McMahon’s experiences show that patients who begin a diet and exercise regiment simply because a doctor advised them to lose weight don’t usually see long-term results, she said. McMahon sees more success with patients who have identified a meaningful motivator, such as getting in better shape to play with their grandchildren.

Community health workers address social needs

Community health workers focus primarily on addressing the social determinants of health that can prevent patients from seeing success with clinical and wellness interventions.  

Community health workers are in charge of connecting patients with resources that support food security, housing, better education, and address other socioeconomic issues that might impact a patient’s ability to live a healthy life.

The new emphasis on social health has led to an increase in community health worker employment, according to the Bureau of Labor Statistics. The job market for this profession should expand 16 percent between 2016 and 2026, a rate that is faster than average industry growth.

Anecdotally, healthcare workforce experts agree with the prediction that community health workers will be in higher demand.

“We're seeing an uptick in organizations using community health workers, and the role itself has been codified by the fact that the Department of Labor now tracks community health workers,” said Kelly Aiken, vice president of programs at the National Fund for Workforce Solutions and its medical workforce initiative CareerSTAT.

“There is some movement on reimbursement for community worker services,” she continued. “Increasingly, we're seeing providers wanting to create more structure and defined competencies for what a community health worker is and does.”

These professionals may be employed by a hospital or a community health organization. Hospitals that hire their own community health workers tend to be larger institutions with extensive resources, Aiken noted.

Community health workers tend to serve as the bridge between a hospital’s community service offerings and the patient. For example, at the University of Illinois Hospital & Health Sciences System (UI Health), community health workers are integral to a system-wide initiative to reduce homelessness.

After UI Health uses its own data analytics systems to identify at-risk patients, its partners at the Center for Housing and Health tap community health workers to connect these patients with housing authorities.

“[Community health workers] have always been strong advocates for housing,” said Stephen Brown, MD, UI Health Director of Preventive Emergency Medicine and one of the initiative leaders. “They do a lot of the quarterbacking after we refer homeless patients to them. They contract with outreach organizations and they have outreach workers.”

These community partners face the challenge of working directly with the homeless patients, Brown explained. Outreach workers will search under bridges if necessary and make themselves available 24 hours each day to be able to find patients to arrange housing assistance.

Community health workers can also offer day-to-day assistance to patients by going to the grocery store with them to purchase healthy foods or connecting patients to transportation services.

Why are these workers important?

Patient wellness and care coordination have become vital components for success under value-based payment models. Organizations now recognize that patients fare better clinically when organizations address the social determinants of health and help patients understand their own health and the medical industry.

Non-clinical healthcare workers can help patients connect with the resources outside of diagnostic care – social support, self-management skills, or advocacy – that will help patients improve wellness.

All of this comes as the nation faces skyrocketing costs associated with chronic disease management. Eighty-six percent of the nation’s $2.7 trillion healthcare spending was dedicated to chronic care management in 2017, according to the CDC. Strong care coordination, patient behavior change, and consideration of the social determinants of health are just three strategies that can help reduce that spending.

Physicians, nurses, and other clinical professionals may need the help of non-clinical workers to keep up with demand. A growing shortage of clinical staff only compounds this need.

A 2018 analysis from the American Academy of Medical Colleges (AAMC) showed that the industry will lack between 42,600 and 121,300 physicians by the end of the next decade.

While nurse practitioners and physician assistants are filling clinical care gaps, non-clinical workers will be essential to fill in other areas where clinicians previously offered social support to patients.

Non-clinical patient care workers are fundamentally responsible for ensuring the patient is able to manage her own health and improve overall wellness. And while that overarching priority does create overlap between patient navigators, health coaches, and community care workers, these career paths also have their own distinctions.

These differences may influence hiring choices for healthcare organizations integrating strategies to meet patient social needs.

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