A Collaborative Effort to Identify and Capture Return on Investment Metrics in Patient Navigation

Contact Name: 
Karli Bergheer, Sherri Costa, Marcia Horn, Karen Masino, Elizabeth Pineda, Gabrielle Ruiz-Tudo
Name of Institution, Organization or Community Where the Project Was Implemented: 
Ascension Wheaton Franciscan Cancer Care, Wauwatosa WI; Cancer Care Navigation Program funded by the Women’s Health Clinical Research Unit, UCLA Health to serve Olive View-UCLA Medical Center, Los Angeles CA; Ingalls Memorial Hospital, Harvey IL; OHSU Knight Cancer Institute, Portland OR; and other institutions that chose to remain anonymous.
Description of Project Setting: 

Group members met remotely via phone conference and represent a variety of cancer health settings which included Commission on Cancer (CoC) accredited programs, National Accreditation Program for Breast Centers (NAPBC), National Cancer Institute (NCI) designated National Comprehensive Cancer Center (NCCC) and Centers for Disease Control and Prevention (CDC) funded.

Patient Navigation
Target Population: 
Cancer Site: 
Project Description: 

The Patient Navigation Special Interest Group is part of a larger project called the Generation and Translation of Evidence (GATE) Cancer Community of Practice. The goal of the Special Interest Groups is to convene health care professionals, researchers, and patients/caregivers to discuss and potentially collaborate on patient-centered outcomes research in the areas of survivorship and patient navigation.

A group interested in the topic of return on investment (ROI) related to patient navigation convened. The group consisted of oncology navigators, a financial counselor, nurses, and managers working in cancer centers across the United States and met on a regular basis via conference calls.

Initially, the group conducted a literature review to identify metrics and/or tools that could be used to measure and capture ROI in patient navigation.  The Patient Navigation Barriers Outcome Tool™ (PN-BOT) developed by the George Washington Cancer Center was one tool identified and was evaluated by several members of the team.

Problem or Issue the Project Was Designed to Address or Improve: 

Research indicates evidence of navigation services resulting in positive outcomes by way of improved coordination and timeliness of care; increased access to clinical trials, reduction and/ or elimination of barriers to care; and the delivery of ongoing support throughout the cancer trajectory.  These services may demonstrate financial return only through downstream revenue sources since navigation services are not currently being reimbursed.  Lack of reimbursement and revenue may lead to difficulty sustaining navigation services. Therefore it is imperative that research focuses on ways to demonstrate the value of patient navigation and its contribution to the organization’s return on investment.

Difficulties Encountered in Planning, Implementing, Evaluating or Sustaining the Project: 
Variations in the navigator role between institutions and settings made it difficult to develop consensus on metrics that could document ROI for navigation services. As an example, the ROI metrics for lay navigators involved in outreach for screening programs would not be the same as metrics for a nurse navigator providing services to oncology patients undergoing treatment because the activities and focus of these two types of navigators are very different. The various tasks performed by navigators are also difficult to itemize and quantify as the activities from patient to patient are varied and are individualized to the patient. The PN-BOT™ was piloted by several project members and consensus was that the tool was very comprehensive and user-friendly in being able to capture metrics. However, issues encountered during the trial included: accessing entered data and exporting data, saving data due to incompatibility issues with programs and access limited to one user at a time. This tool, however, would be very useful for gathering metrics if compatible with your particular facility’s IT functionality and if it aligns with your navigator workflow.
Project Successes: 
It provided a forum for collaboration with other navigators to share knowledge, ideas, perspectives and resources. This project provided an opportunity to bring awareness to the contribution of navigators in various roles in improving the care of patients. Also, engaging in activities to develop this project added to the body of knowledge of the navigation role for all members through finding new tools and new sources of information to support roles across the patient navigation spectrum.
Helpful Information Before the Project Started: 
Initially the project direction was very flexible to allow for everyone’s input, but this also made it difficult to focus on specific activities. Also, the diversity of navigation roles made it difficult to identify consensus ROI metrics and provide a definite direction from meeting to meeting. In February 2017, the Academy of Oncology Nurse Navigators (AONN+) published an article titled Academy of Oncology Nurse and Patient Navigators Announces Standardized Navigation Metrics which identified a number of metrics. Having that article at the outset may have been helpful in determining a clearer path to evaluating ROI metrics.
Project Significance: 
The GATE Cancer Community of Practice provided a platform for this Patient Navigation Special Interest Group to convene and identify an area of interest that was most meaningful to their practice and field.
Lessons Learned for Patients, Caregivers and/or Communities: 
ROI metrics for patients and caregivers is not necessarily a priority, but the absence of navigation services would certainly impact their overall cancer care experience. One group member conducted a cross-sectional survey of patients that confirmed the importance of ROI metrics in patient navigation related to patient education surrounding disease process and care continuity. This type of survey may be something that other cancer centers could implement.
Lessons Learned for Clinicians or Health Care Professionals: 
It may be helpful to consider that quality metrics are as important as ROI metrics in supporting the role of navigation in the care of patients with cancer. Although not easily quantified in financial terms, patient navigation data is important to the evaluation of the quality of a program.
Lessons Learned for Researchers or Additional Research Needed: 
It would be helpful for a multi-disciplinary cohort of researchers to broaden the body of evidence truly connecting how the role of the navigator provides direct financial benefit to the cancer organization. This would involve including non-clinical personnel such as individuals with backgrounds in economics, finance and business analysis.
Additional Information: