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Pilot Program Introduces Nurse Navigators to Fill Gaps in Care

The pilot program will connect cancer patients with nurse navigators, who will connect the patients with community resources to fill gaps in care.

nurse navigator gaps in care

Source: Thinkstock

By Sara Heath

- Horizon Blue Cross Blue Shield of New Jersey and Regional Cancer Care Associates (RCCA) are launching a joint pilot program connecting cancer patients with nurse navigators to fill gaps in care.

When a patient is undergoing chemotherapy or other intensive cancer treatment, most of the provider focus is directed at that treatment. This leaves the patient liable to care gaps that cause elements of cancer care to fall through the cracks.

Nurse navigators – defined as healthcare professionals who can help patients engage with certain parts of the healthcare industry – have potential to help fill these care gaps.

The nurse navigators in the Horizon BCBSNJ and RCCA program will be in charge of following a patient after completing treatments at RCCA and keeping track of potential interim medical complications.

This is a part of Horizon BCBSNJ’s shift to a more proactive strategy for patient care, according to Allen J. Karp, Senior Vice President of Healthcare Management for Horizon BCBSNJ.

READ MORE: What are Healthcare Navigators, Patient-Centered Care Benefits?

"Instead of reacting to adverse conditions that can arise between cancer treatments, such as dangerously low hemoglobin counts that trigger ER visits and hospital admissions, we're taking a pro-active, coordinated approach to care," Karp explained in a statement. "The nurse navigators' role will be to follow the cancer patients after their treatment, serve as a resource to address their needs and conditions, and remove any barriers to accessing the care they may need."

Nurse navigators will also connect patients to community health programs that can address the social determinants of health. For example, some programs can provide patients with rides to medical appointments when necessary.

Additionally, nurse navigators will be able to direct patients to other healthcare providers who can address other medical needs not necessarily connected to the patient’s cancer care. This will fill in gaps in care and address the lingering needs many patients face between cancer treatments.

Ultimately, this will reduce the likelihood of a medical complication worsening.

"The same patients receiving oncology care have elevated risks for heart failure and other pulmonary diseases,” Karp noted. “So, closely monitoring, following and caring for cancer patients can go a long way toward pre-empting the onset of other dangerous health conditions.”

READ MORE: Education, Clear Healthcare Navigation Next Steps in Patient Care

The pilot, which will include about 2,000 patients who receive care at one of RCCA’s 24 locations, is a part of RCCA’s efforts to build a cancer care medical home, said RCCA President and CEO Terrill Jordan.

"We are excited to participate in this groundbreaking pilot here in New Jersey,” Jordan said.

“This program exemplifies RCCA's comprehensive approach to caring for our patients. It's an extension of our oncology medical home, where we ensure high quality 'total care' for you and your families,” Jordan continued. "By working more collaboratively with Horizon, we are empowering our physicians and their clinical staff to follow the progress of our patients beyond the four walls of our local clinics. It allows us to coordinate your care with your other healthcare providers and community support."

Other medical groups have launched similar programs to offer cancer patients nurse navigator supports during care. In October 2017, the American Cancer Society (ACS) and The Academy of Oncology Nurse & Patient Navigators (AONN+) announced a partnership to create better patient access to nurse navigator services. The pilot specifically allowed ACS members access to educational materials from the AONN+.

“AONN+’s collective resources will help empower ACS’ navigators with the education and skillsets necessary to further their professional competencies,” said AONN+ Co-Founder and Program Director Lillie Shockney, RN, BS, MAS, ONN-CG. “There’s little question that certification for oncology navigators is an issue about which both AONN+ and ACS are passionate.”

READ MORE: Effective Nurse Communication Skills and Strategies

Healthcare navigators are effective in improving patient engagement with care, as well as in reducing healthcare costs. Evidence shows that healthcare navigation is effective, even when conducted by a non-clinical worker.

A 2017 article published in JAMA Oncology found that non-clinician, layperson navigators lowered medical costs by nearly $800 per patient per quarter. That amounted to overall cost savings of $19 million across the provider network.

“This patient-centered, preventive, proactive approach has the potential to lead to increased patient activation and earlier management of symptoms, decreasing the likelihood of unplanned admissions or inefficient care,” the report concluded.

Healthcare and nurse navigators are important for more than just lowering healthcare costs. Navigators can help build patient relationships, empower patients, increase patient education, and reduce the likelihood that patients go without necessary healthcare.

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