1. The Dollars and $ense of Navigation:How to quantify your role Donna Moore Wilson, BSN, RN, CBCN Oncology Nurse Navigator Bon Secours St. Mary’s Hospital Richmond, Virginia Donna_Moore-Wilson@bshsi.org

2. Objectives • Defining the role of the navigator • Choosing appropriate navigation metrics to justify the role • Developing a plan to demonstrate navigation’s value and return on investment

3. Bon Secours St Mary’s Hospital

4. Mission of the Navigator Provide a resource for cancer patients to assist them in navigating through the complex healthcare environment & around any barriers to timely care which might exist… Bon Secours Cancer Institute (2006)

5. Bon Secours Navigation Goal • Improve communication between patients, providers, and caregivers • Connect patients with community resources • Collaborate across the medical team on all aspects of cancer care from diagnosis, treatment and survivorship.

6. Defining Navigator Program • Goal of the program • Key stakeholders • Organization/patient needs

7. Goal of the program • Decide on model that is most compatible for organization and patient population served • Tumor Site • Patient Entry Point • RN, Social Worker, Community Health Worker, Lay person/survivor

8. Key stakeholders • Patient, family members, and community • Physician buy in • Physician Champion • Administration buy in • Return On Investment

9. Organizational/Patient needs • Expectations from providers • Expectations from administration • Patient demographics

10. Navigation Role • Outreach • Education/Prevention • Early Detection/Access to Care • Diagnosis/Treatment • Time of abnormal finding, diagnosis, treatment • Barriers, concerns issues arise • Survivorship • Summary/Care Plan • QOL issues

12. Metric Selection • Meaningful • Reliable • Feasible • Understandable • Evidenced Based

13. Outcome Metrics • Timeliness to care • Referrals to ancillary services • Retained patients • Patient satisfaction Catholic Health Initiatives, 2013

14. Metric Recommendations • Disease site/staging at time of diagnosis • Target is to increase early stage diagnosis • Referral source • Timeliness to care • National benchmarks can be used as reference (breast, lung, colorectal, head & neck) Catholic Health Initiatives, 2013

15. Navigator Productivity Indicators • Patient volumes • Initial, ongoing, and surveillance/survivorship • Number of barriers to care identified • Number of referral needs for barrier migration • Time spent making referrals • Patient acuity level Catholic Health Initiatives, 2013

16. Navigator Productivity Indicators • Patient satisfaction • Retention (decrease outmigration & subsequent revenue = downstream revenue) • Navigator impact on treatment adherence (revenue capture) • Referral to services • Can demonstrate downstream revenue Catholic Health Initiatives, 2013

17. Navigator Productivity Indicators • Provider Satisfaction • Outcome metrics • Timeliness to care • Coordination/continuity of care • Collaboration with addressing patient concerns • Quality of patient education Catholic Health Initiatives, 2013

18. Demonstrating value • Increased volume and revenue • Increased patient & provider satisfaction • Reduced time from abnormal screening to diagnosis • Earlier stage at diagnosis • Reduced outmigration

19. Demonstrating value • Adherence to treatment appointments/ reduced no-show rates • Resolution of patient’s barrier to care • Reduced emergency visits • Shortened hospital readmissions • Improved coordination of care

20. Conclusion • Navigation is an unreimbursed service • Administration faced with pressure to quantify benefits of navigation • Critical to track revenues from new or returned patients who were attracted by the program’s navigation services • Vital to track navigation-specific patient satisfaction. 2011 The Advisory Board Company

21. “Alone we can do so little; together we can do so much.” Helen Keller

22. References Bon Secours Cancer Institute. (2006). Oncology patient navigation program. Retrieved November 5, 2008, from Bon Secours Richmond Health System. Catholic health initiatives. Navigation program resource guide: Best practices for patient navigation programs. (2013). Retrieved August 3, 2013 from http://navigator.vc.ons.org/file_depot/0-10000000/0-10000/1338/folder/8022/CHI+Navigation+Program+Resource+Guide+(Outside+CHI+Version+0413).pdf Oncology roundtable, the advisory board company. Maximizing the value of patient navigation: lessons for optimizing program performance. (2011). Retrieved August 5, 2013 from http://www.advisory.com/~/media/Advisory-com/Research/OR/Research-Study/2011/Maximizing-the-Value-of-Patient-Navigation/Maximizing-the-Value-of-Patient-Navigation.pdf