Health Equity in Action: Questions from the Role of Patient Navigation Panel

by | Nov 27, 2024 | WCRC Events, Our Community | 0 comments

Questions From Panel #2: The Role of Patient Navigation in Achieving Health Equity


Answered by Dr. Melissa Mazor of The Tisch Cancer Institute and Icahn School of Medicine at Mt. Sinai

 

Why is navigation for men’s health not given the attention of women’s health? What can be done to better implement navigation strategies for men’s health?

This is a really important question, and I want to take a step back and consider a few factors outlined below.

In the clinical setting, especially at Cancer Center’s where navigation exists, navigation is provided for men and women with cancer. However, most of the research and discussion around navigation is heavily weighted towards cancers that impact the woman majority. The origins of these gender disparities in navigation are complex but to summarize, navigation originated in breast cancer and a lot of the research and philanthropy has also been focused towards navigation for breast cancer. This has changed over the years, and we are seeing a rise in navigation and other types of cancer, especially colorectal and prostate. Additionally, when it comes to navigation for men there are other complex social influences that may impact navigation. The important point is though, and we hope to continue to change the reimbursement policies so that it is available across the continuum for all patients.

I provided a link to an article that reviews research on navigation for prostate cancer: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9195379/

I also included some feedback from one of our community scientists and prostate cancer patient advocates for men’s health and navigation which provides some good insight.

  • “This question of men’s access to ‘health’ and in reverse, how to access men on health issues is, as you know, central to my ongoing reflections and related frustration of finding it so hard to change. The roundtable at the retreat was not designed to come up with solutions but some good ideas came up.”
  • “Interestingly, I had a conversation on Wednesday with Congressman Bowman (16th district) and Yasser Salem whom I first met at RTC. Yasser has founded Hira Health Group and a number of other health related ventures (www.hirahealthgroup.com). Congressman Bowman will not run for reflection this time as he lost the primary but he intends to work with Yasser on access to health in communities. Our conversation focused on ’navigation’ in communities and possible public/private partnerships to facilitate access. On the specific aspect of men and from my own experience, women (spouses, daughters, mothers, granddaughters) are instrumental. We came up with the idea to build a ‘mapping’ of relevant resources to identify gaps and focus on specific communities. The objective would be to create an ‘ecosystem’ integrating and coordinating available resources, a form of ‘community navigation’. There should be an opportunity to optimize resources. This is obviously nothing new and it may sound a bit idealistic, but I strongly believe that the main issue is not so much a shortage of resources but a lack of access for marginalized communities. Women have been a lot more effective but men’s issues with vulnerability and masculinity bring an additional layer to overcome. In this context, navigation is not just ‘patient navigation’ but the broader ‘community navigation’.”
 How can legislation improve or standardize navigation as a mainstream standard of care?

This really comes down to policy and research. Although we have started some initial policies towards reimbursement of navigation, there still is a long way to go. I highly recommend following the recommendations by ACS CAN regarding what we can do at the policy level either as an individual or community organization or clinic. I also recommend supporting researchers who can continue to show that navigation improves patient outcomes and can also be cost effective for hospitals and clinics.

Please see the ACS CAN and ACS links below for their really great webinars and information on navigation policy.

The medical (and health economic) benefits of navigation seems really clear. How far are we from significant federal or institutional funding at scale that is needed to provide navigation capacity that is needed?

It’s important to understand the context of how navigation has been paid for and how we hope to see it will be paid for in the future. Previously navigation has depended on federal and foundation level grants and philanthropy to fund programs. Depending on the funding source the navigation program is either funded temporarily or long term. However, in order to ensure the navigation is integrated as standard of care, what we need is a system that will allow for reimbursement from all insurance to pay for the navigation service period until this happens navigation will not be consistent across organizations and geographic locations.

Fortunately, we have made great strides with the future of reimbursement for navigation. CMS or the Centers for Medicaid and Medicare services recently passed policy providing a system of reimbursement for navigation for patients undergoing active cancer treatment (see link). https://www.cms.gov/newsroom/press-releases/cms-finalizes-physician-payment-rule-advances-health-equity

Although this passed in January 1 of 2024, it will take some time for hospitals to understand how to adequately bill for these services and implement that into their systems. In addition, this only covers a subset of navigation and does not cover navigation for screening or survivorship and also does not require that all insurance companies pay for navigation. It does seem to be that many insurance companies are adopting these reimbursement practices, and we foresee with continued advocacy that this will be integrated into reimbursement for most public and private insurance companies. In addition, there is legislation that was submitted to the secretary of health recommending that navigation reimbursement will also include screening and survivorship navigation along with adjusting aspects about the reimbursement rates and the cost of copays that it currently stipulates.

I highly recommend following the current policies on the ACS CAN website for the most up-to-date information. They also have some great videos that explain the complexities behind the reimbursement and policy action we can take. For now, I also suggest supporting any research or continued funding for navigation services.

 What agency regulates navigation and are there upward mobility opportunities for navigators?

There are several organizations that provide guidance for navigation. It’s important to note that navigator roles vary across professional license, institution, and needs of the patient population and community.

The following organizations are leading bodies in navigation and provide guidance regarding navigator roles.

Submit a Comment

Your email address will not be published. Required fields are marked *