Navigators assist with non-clinical needs
Executive Summary
Care navigators meet with EmblemHealth members at primary care practices and coordinate all their non-clinical needs.
• Most of the time, navigators get a referral when patients are in the hospital and contact them before discharge.
• They meet with patients when they come into the office and follow up by telephone.
• They work closely with the embedded clinicians that include a nurse case manager, a pharmacy case manager, and a social work case manager.
Team works in primary care practices
For EmblemHealth members who receive point-of-care case management, care navigators are the go-to people when patients have questions or need assistance.
The care navigators are part of a five-person team the New York City-based health plan embeds in offices of Manhattan’s Physician Group and Staten Island Physician Practice, which are now part of AdvantageCare Physicians, one of the largest physician practices in the New York metropolitan area. The five-person team includes a nurse case manager, a pharmacy case manager, a social work case manager and two care navigators who help guide patients through the system.
"If there is a question about a bill, the navigators can get patients to the right people. They can help people access community resources, make sure they are connected to their physicians, and along with the care team, identify any red flags that indicate the patient should contact the physician or go to the emergency department," says Andrew Kolbasovsky, PsyD, MBA, vice president of quality and care coordination at Advantage Care Physicians.
The care navigators are not clinicians, but previously worked in other areas of EmblemHealth where they had direct contact with patients. Some came from the behavioral health department or worked as case manager assistants.
"What we looked for was the ability to communicate. It’s really important for the navigators to be able to connect with people. We felt that we could teach them the information they needed to know, but it would be the hardest to teach them how to be an effective communicator," he says.
The navigators meet with patients and help them with all the non-clinical issues that can keep them from following their treatment plan. They work closely with the case managers, pharmacy case manager, and social worker and call on them when patients have clinical issues.
The navigators get most of their referrals from hospital admissions but physicians, nurses, or other people on the care team can refer patients if they need extra help. Some patients hear about the service from a friend or relative and refer themselves, Kolbasovsky says.
When EmblemHealth members who are patients in one of the participating practices are hospitalized, the health plan alerts the navigator, who contacts them while they are still in the hospital whenever possible, he says. The navigator introduces himself or herself as someone who is working with the patient’s physician and who is available to help when the patient gets home. He or she explains how the program works and makes sure the contact information in the patient record is up to date. The navigator helps patients set up a follow-up visit with their physician, but asks them to check in with him or her before the appointment.
The navigators meet with patients when they come into the office, and follow up by telephone, Kolbasovsky says. The frequency of the interventions depends on the patient’s conditions and risk factors.
When patients transition to home from the hospital, the navigators make sure any needed equipment has been delivered and that the patients understand their conditions and treatment plan, and follow up regularly for several weeks, he says.
When the navigators get a referral, they perform a screening for patient needs and help them access community services such as housing or utility assistance programs, and resources for food and transportation as well as health plan benefits, Kolbasovsky says.
The health plan assigns navigators to physician practices in the community in which they live whenever possible. "They not only know the community resources in the area where patients live, they also know the bus and train system," he says.
The navigators follow protocols that guide them on how and when they connect with other members of the point-of-care case management team. For instance, if a patient has behavioral health issues, the navigator calls the social worker and arranges a meeting. Or if the patient says he can’t afford the co-pay for his medication, the navigator can call in the pharmacist, who may be able to identify another medication or another form of medication, then work with the patient’s physician to make the switch.
"Once they make that connection, the navigators become a real resource for the patients and their family members. They are another person that patients can call on to answer questions or help them get the services they need," Kolbasovsky says.
For instance, a physician may say that if a patient’s pain gets worse, he or she should call the doctor or nurse. The navigator follows up with the patient and monitors the pain.
The navigators are located in the physician offices, which gives them access to the care team. "When an issue comes up, they can walk down the hall and consult the doctor or nurse. If they were in the corporate office, they would have to leave a message, and if the doctor returns calls after office hours, they would have left for the day," he says.
The navigators have the extra time to spend with patients and develop a close relationship. Often, the patients tell the navigators things they don’t tell their physicians or other providers, Kolbasovsky says.
"The patients say the navigators make them feel like people really care about them. The navigators frequently receive cakes, flowers, and other gifts from their patients," he says.
