Navigating a fragmented and confusing health care system from a personal perspective

Thursday, July 5, 2018 | Jacob Turmell

In the past few months, I have had the opportunity to be a consumer of health care due to the illness of a family member. This has been quite a change for me as I am used to being the one who is a provider! With this change in perspective, I was able to experience both the flaws and pockets of excellence in the health care system that we accessed. My process improvement focused brain was constantly observing areas of waste, inefficiency, and duplication. As someone who is very customer-focused with my own patients, I noticed those who went above and beyond to help and explain things and those who were simply there to collect a paycheck—from the front office staff all the way to providers. I saw how fragmented our system still is and how confusing it was for me – someone with quite a bit of health care experience. I could write an entire blog post on areas of opportunities for the health care system, but I would rather focus on the one pocket of excellence we experienced.

As we were facing choices of a possible redo back surgery for my family member, I reached out to a colleague of mine to get her opinion. After all, my area of expertise is cardiology and hers is neurospine. My colleague is a Clinical Nurse Specialist and currently works in a very interesting role. A few years ago, she was approached to start a patient navigator program for one of the local hospitals. But the navigator was not for the patients – it was for the employees! She developed a program that allowed the employees to reach out to her and her team to assist with where to go for procedures, how to select a primary care doctor, what questions to ask when seeing a specialist, and many other things. She partnered with the hospital’s employee insurance company to look at ways to reduce costs for the employees. She has saved the hospital and insurance company a tremendous amount of money and has had a major impact on the quality of life and satisfaction of the employees she serves.

As she and I were discussing the options for my family member, she quickly went from a friend and colleague to the patient navigator role. She facilitated a same-day appointment for second opinion from a physiatry standpoint, rather than a surgical standpoint. She made an appointment for physical therapy after the second opinion to determine if physical therapy would be beneficial. She made me a list of all the paperwork and records that would be needed, and she and I began to pull those together. But the most impactful was that, at the time of the appointment, she met us at the door of the facility and walked us to registration to make sure we knew where we needed to be. Now, some of this was likely due to the fact that she and I are friends, but I realized that this was what she did in her everyday work. She coordinated care and helped patients who are scared, confused, or overwhelmed navigate a very complex world. She, in this role as a patient navigator, epitomizes the transformation in health care that needs to occur.

As I sat through the appointments and physical therapy with my family member, I thought about how this role of a patient navigator could be utilized in cardiology. This role has been used in other areas, such as oncology. An oncology patient navigator is paired with the patient at time of diagnosis. They work with the patient to set up appointments with the oncologist, surgeon, and radiation oncologist. They identify locations for chemotherapy and help with insurance coverages and prior authorizations. Would this be the level of a patient navigator needed in cardiology? I don’t think that would make sense for all of our patient types. However, this might be fitting for some, such as heart failure. And heart failure clinics typically will have RNs who help the patients navigate the complexities of their diagnosis. But what about the rest of cardiology? Do your patients have one contact person in your office they can call who knows them on a personal level? Someone who is familiar with the plan of care and can help guide them with questions? Someone who can help navigate procedures, explain what to expect, and help with insurance verifications?

I think this role can easily be filled by your office RNs who support the providers. If so, do these RNs have the capacity to work with patients in this way? Are they accessible to the patients? Are they bogged down with other work that does not allow them to interact in a meaningful way with your patients?

There are examples of where the role of a patient navigator has been used in the cardiovascular space. In fact, one company, Remedy Partners, offers this as part of a solution to achieve lower costs and higher quality. This is especially important for those groups that are looking at bundled payments (think BPCI Advanced). And what about those who aren’t in a bundled payment program? The patient navigator costs could certainly be reconciled to the improvement in referrals from other physicians and gain of market share.

Health care is destined to become more complex and baffling to patients. Patients and families can easily become overwhelmed and confused as to what the right next step is in the plan of care. The role of a patient navigator can be a huge asset and ally for your patients, especially those with complex diagnoses. I know for me, having my friend as a patient navigator was truly excellence in action during a time of stress and critical decision making.



Illustration: Lee Sauer

About the Author
Jacob Turmell

Jacob Turmell, DNP, RN, NP-C, ACNS-BC, CCRN-CMC, Vice President, MedAxiom Consulting, is a certified Nurse Practitioner with a strong clinical background combined with years of medical industry experience. While earning his Doctor of Nursing Practice degree, Jacob?s focus on systems leadership gave him expertise in organizational assessment, outcome-driven change management, population health, and public policy. At MedAxiom Consulting, Jacob is focused on care processes redesign and provider team optimization.

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