Five keys to generating high ROI with health system patient navigation programs

Health systems that thrive in the long term will move beyond patient engagement to relationship engagement.

They will know who their patients are—from what they prefer to be called to their next likely health event—and they will anticipate and proactively engage with their customers with a personalized approach. They will become the trusted resource for new and current patients, and a go-to source for referring doctors. They will understand the needs and preferences of each patient, and they will send the message: “At our health system, you are known, valued, and heard.”

It’s the only way, in this increasingly competitive market filled with consolidation and new business entrants such as retail clinics, to gain a competitive advantage.

Increasingly, healthcare systems are implementing forms of navigation programs to help their customers traverse the complex healthcare landscape. These initiatives, when designed effectively, activate patients, improve quality and reduce costs, and build brand loyalty and retention.

Navigation services that lead to significant revenue and quality gains possess the following five attributes:
1. Broad navigation services. Traditionally, patient navigators have assisted with complex care management, often with chronic or highly complex patients. However, healthcare systems need to embrace a shift toward general navigation for all patients, including vulnerable and underserved populations, such as Medicaid patients. Each patient has their own unique context of financial security, emotional resiliency, health literacy, and health status. Navigation programs can be applied to every patient, personalizing how we support each individual in engaging with the health system.
As healthcare consumerism increases and as patients take more ownership over their healthcare decisions—including where they receive care—navigation services can be a differentiator, attracting more patients to choose your health system.
2. The right mix of technology and people. The technology in a patient navigation initiative should be a catalyst for achieving scale, consistency, and personalization. It should help team members standardize best practices while highlighting opportunities to personalize experiences. And it should ensure that every patient gets the right information at the right time through their preferred channel of communication in a scalable way.
For example, texting is an easy way for a navigator to connect with a patient personally to ensure he or she is prepared for an upcoming procedure. Patients are highly responsive to text messaging. About 90% of all text messages are read within three minutes of delivery, according to MobileSquared, a research company. A recent study in JAMA found that texting approximately doubles the odds of medication adherence, and another study, in the Annals of Emergency Medicine, found that texting improved patient adherence to follow-up care recommendations.
On the healthcare system side, patient navigation technology should include an EMR-integrated customer relationship management (CRM) platform where customer insights, from their individual preferences to their social determinants of health, is stored and builds over time with every interaction. This information can guide future patient interactions and interventions and help to inform overall operational improvements. Effective programs should also drive interventions, through the use of intelligent workflows and predictive analytics.
3. Integration with other systems. Every interaction with patients should build on the previous interaction so healthcare systems continually learn how to best manage each customers’ experience. This can only occur if information collected by navigators flows into the healthcare system easily and is pushed out to the appropriate clinical staff seamlessly.
This means that the technology used in these programs, particularly the CRM platform, should integrate with other technology used by the health system, such as the existing EMR, practice management, enterprise communication systems, patient survey tools, and consumer apps.
4. Proven ROI and customization. Effective patient navigation leads to measurable improvements. One study by the National Cancer Institute found that patient navigation increased rates of resolution of abnormal cancer screening findings, increased rates of treatment initiation, and increased patient satisfaction. Other studies point to cost savings as a result of navigation programs. For example, a study by the University of Alabama at Birmingham (UAB) Comprehensive Cancer Center found that cost declined a mean of $781.29 more per patient per quarter when navigators were used, for a total savings of $19 million annually.
Effective patient navigation programs should deliver:
• Improved quality and patient satisfaction (through patients who are more engaged, better prepared for services, and know who to call when complications occur post-discharge);
• Reduced costs (including directing patients to lower cost-settings when appropriate, reduced length of stay, and reduced readmissions); and
• Growth (through more retention and patient acquisition).
All navigation programs should provide the above benefits, but every healthcare delivery system has unique technology, market, workflow, and staffing. Navigation programs need to be tailored to meet the needs of a particular healthcare system.
For example, in one article appearing in the Journal of Clinical Oncology, Stanford Cancer Institute relates how it attempted to implement a navigation program similar to the highly successful program at UAB (referenced earlier). Stanford found that, while its navigation program could retain elements of the UAB program, it needed to adapt its service parameters to meet the needs of its own system.
5. Smart staffing. Health systems are dealing with the physician and nursing shortage, and rising rates of clinician burnout. Approximately 70 percent of nurses are burned out, according to a recent Harris Poll, and about 54 percent of physicians have at least one symptom of burnout, according to a Mayo Clinic study.
Navigation programs can help, particularly when nonclinical navigators are used. This more cost-effective approach ensures clinical staff can work to their highest level of license. It also means that the hiring of navigators can be based more on “soft skills,” such as strong communication and customer service, a knack for hospitality, the ability to display empathy, cultural competency, and when applicable, fluency in the first language spoken by patients.
Smart staffing also means that escalation protocols should be in place so that navigators can alert clinical staff members when patient care issues and questions arise that are outside their realm of expertise.

Patient navigation services are moving from a nice-to-have option to a must-have resource for all patients. It’s time for health systems to step up and expand their offerings—their long-term viability depends on it.

Paul Roscoe is a more than 25-year healthcare industry veteran who is CEO and cofounder of Docent Health, a healthcare experience company helping health systems adopt consumer-centric delivery models. Over his career, Paul has served as the CEO of VisionWare Inc and the CEO of Crimson (an operating unit of The Advisory Board Company), amongst other leadership positions.

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