Today’s Managing Health Care Costs Number is (not) $100,000
Last weekend’s Washington Post had coverage of cancer navigators, and asked the question “do cancer navigators help decrease medical claims cost?”
There are now 5000 members of the National Academy of Oncology Nurse and Patient Navigators, and the National Institutes of Health spent $30 million to study the impact of navigators.
The results? Navigators clearly helped the segment of patients most alienated in the medical system. One studyshowed an increase in filling anti-breast cancer hormone agents, and another showed more mammography and better quality of life. The researchers found that “navigation had its greatest benefits within centers with the greatest delays in follow-up under usual care.” Harvard Link
It’s less clear that navigators add value to the care of those who are not disadvantaged. Those with barriers(non-English speaking, uninsured, employment issues) received less evidence-based care even with navigators.
There is good evidence from South Africa that community health workers helped increase testing for HIV and drug adherence. I highly recommend Sizwe’s Test by Jonny Steinberg, which shows the difference that community health workers made in South Africa not just on those with HIV, but on the entire community. Atul Gawande has reported on “hot spotting” in disadvantaged communities like Camden New Jersey.
On the other hand, navigation represents our tendency to layer on an additional intervention to make up for the fact that our system is complicated and unresponsive to our patients’ needs, and can distract attention from improving the system itself.
Did navigation save money in the NIH study? There’s no “hard’ evidence of this, and even researchers have turned to anecdote. From the WaPost article
For one patient in the National Cancer Institute study who had rectal bleeding, for example, the determined efforts of a navigator finally persuaded him to show up for a colonoscopy, one researcher recalled. Physicians found a large growth that probably would have turned cancerous; its removal saved perhaps $100,000 in cancer care, not to mention the patient’s health, she said.
“We prevented a cancer there,” said Electra Paskett, associate director of population sciences in the Comprehensive Cancer Center at Ohio State University.
We don’t know if a colonoscopy for rectal bleeding prevented a cancer, and we certainly don’t know that it saved $100,000.
We should continue efforts to make our system more responsive to patient needs. Navigators can help disadvantaged patients – and navigation programs can make a difference in a disadvantaged community when the navigators come from the community itself. Some of the benefit is seen by patients, but even the act of creating well-paying jobs with benefit and community respect in some communities can pay large dividends.
Navigation programs can be a huge “perk” for those who are not disadvantaged, but can be overwhelmed by our complicated health care system and its byzantine billing system. But we should not assume from the evidence so far that broad-based navigation programs save medical claims costs.
