Navigators reduce no-shows

Chronic care patients need reminder calls to remain adherent to treatment and show up for appointments

As more people become eligible for healthcare under the Patient Protection and Affordable Care Act (PPACA), the question of access will become paramount. Missed appointments can have a three-fold negative effect, hitting provider revenue, impacting the health of patients who miss appointments and limiting access for other patients who could have filled missed slots.
“We’re a self-serve society, but it doesn’t translate to healthcare,” says Lynne McCabe, director of the community care coordination program at Mercy Health in Cincinnati. “Patients need someone to help them navigate.”
Fortunately, a handful of studies and pilots show promise employing for the personal touch to not only help patients make appointments but to raise awareness of the importance of managing chronic conditions to improve overall health. The latter is a critical consideration as providers and payers assume more financial risk in accountable care organizations, patient-centered medical homes and other emerging care models.

Reminder calls work
A study published in the American Journal of Medicine in 2010 showed a correlation between reminder calls and fewer missed appointments. Nearly one in four patients at an outpatient multispecialty clinic who did not receive a reminder call missed their appointment. That number was reduced to 17.3% through the use of automated calling and 13.6% when a real person made the call.
The job titles and descriptions vary widely, but many health systems, payers, large practice groups and others are looking to embed patient navigators or care coordinators at the point of care. These people help guide patients through the care delivery process, resulting in fewer missed appointments, more effective utilization of healthcare services and lower overall claims.
For example, a recent year-long pilot at MetroHealth Cancer Care Center in Cleveland resulted in a dramatic improvement in the patient no-show rate through the use of two full-time navigators. In just three months, the reduction in no-shows for those receiving radiation therapy equaled a navigator’s yearly salary.
Accenture, the global management consulting firm, helped fund the Cleveland pilot and recently signed on to provide pro-bono support for a program from the Highmark Foundation to implement patient navigator programs at three rural western Pennsylvania hospitals. Goals of the program include increasing access to care, improving outcomes, saving money and workforce development, says Yvonne Cook, president of the Highmark Foundation.
“We’re looking for significant ROI,” explains Cook, citing the Cleveland pilot. “Patients will not be the only ones who benefit. Hospitals will, too, because of lower costs. But the benefit has to be at the individual level.”
The foundation has committed $254,500 to fund two patient navigators each at Allegheny Valley Hospital, St. Vincent Health System and Jameson Health System beginning this month.
Mercy Health is expanding its navigator program after a pilot program brought a return of $5 for every $1 spent, says McCabe. The system’s one-year pilot, which ended in May, brought hospital admissions among the high-risk pool down by one-half. Readmissions were cut by one-third, with a similar reduction in emergency visits.
The system is in the midst of certifying its 35 primary care offices as patient-centered medical homes, and the 30 case managers either on the payroll or part of the expansion will become part of the staff at each facility. Some case managers worked at multiple practices with an ideal maximum patient load of 150.

Minimize patient effort
McCabe says the pilot showed that a personal touch with high-risk patients means that patients are more connected to their care. Each patient is contacted at least once a month, with the most at-risk patients being contacted as often as three times a week. Having a single point of contact means that medication reviews, referrals and other healthcare needs can be met with a minimum of effort on the patient’s part.
And that’s the ultimate goal, finding the shortest path to the best care for the neediest patients.
Nurses and social workers who play a navigator-type role will be critical in the near future as more people gain coverage through Medicaid expansion and insurance exchanges. A vast majority of the new enrollees will be previously uninsured people who could be unfamiliar with the healthcare delivery system.
In addition, certain areas of the country could experience physician shortages, longer patient wait times and delays in securing appointments. Reducing no-shows could help avoid unnecessary waste.

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