The Right ‘Dose’ of Navigation: Better Outcomes and Lower Costs for Cancer Patients

By Brian Dorsey, MD, Medical Director, Thyme Care

In the early 1990s, Dr. Harold Freeman launched an innovative program at Harlem Hospital Center in New York City to improve breast cancer treatment among Black women in the local community.

Freeman’s program used care navigators – people who came from the community and understood the economic, cultural, and personal circumstances of each patient – to help eliminate barriers to timely care access and improve care coordination. The approach was remarkably successful, increasing the 5-year survival rate from 39% to 70%.

Since then, numerous academic studies have validated the positive impact of care navigation. Such programs can reduce symptom burden, acute care utilization and total costs while improving quality of life. Given that potential impact, why hasn’t care navigation seen more widespread uptake?

As a physician, l am keen to focus on the limitations that have historically existed within care navigation delivery models themselves. From that perspective, most cancer care navigation programs fall short because they take a “one-size-fits-all” approach to patient support. Inevitably, when these programs fail to deliver on outcomes, the overall value of navigation is discounted.

No doctor would prescribe every patient the same dosage of the same drug, even if they had the same disease. Cancer care navigation is no different. As Dr. Freeman showed, care navigation programs can be successful when those involved recognize the different needs that patients have and adjust their support accordingly. In other words, an effective program administers the right ‘dose’ of care navigation to each patient. 

Administering the Right Dose of Care Navigation

What does it mean to deliver the right ‘dose’ of care navigation? Consider two patients with breast cancer.

Maria has been in good health prior to her diagnosis. She has the economic means to get to her appointments and maintain a healthy lifestyle during treatment. She can also manage the complexities of her care journey (medication adherence, side effect management) independently. 

Another patient, Deborah, has poorly controlled diabetes complicated by frequent hospitalizations for high sugar. She can only afford public transportation to and from appointments, and relies on family members to help make her healthcare decisions.

A traditional care navigation program would treat both Maria and Deborah the same. A navigator would be assigned to meet with each member to review a standard diagnosis education handout, set up follow-up visits and check in at a regular cadence. Under this approach, it’s likely that neither patient gets the level of support she needs.

However, in a program designed to provide the right dose of care navigation, Deborah might be assigned an intervention set that specifically aims to mitigate her risk of hospitalization. The care navigator would:

  • Coordinate with the care team treating her diabetes
  • Arrange transportation when necessary
  • Assign a nurse to provide medication teaching
  • Organize monthly meetings with her caregivers
  • Proactively monitor her symptoms to avoid unnecessary hospitalization

In contrast, Maria’s care navigator might focus on empowerment, including education on how to evaluate different treatment options and connections to support groups.

Scaling the Right Dose of Care Navigation

Logically, navigation programs that adjust to the unique needs of each patient will be more successful than ones that employ a one-size-fits-all approach. But scaling the right dose of care navigation effectively across an entire patient population remains a practical challenge.

At Thyme Care, we’ve developed a cancer navigation model that accommodates individual member differences at scale by pairing people and technology. Our approach relies on:

Data and analytics that enable whole-person care

Our analytics engine, Thyme Frame, analyzes claims and other data to stratify a member population, flag the highest need members and predict risk over time. With access to and intelligent use of data, we can scalably prescribe the right dose of care navigation for each cancer patient across the population.

A technology platform that supports the care team

The data from our analytics engine then feeds into our care delivery platform, Thyme Box, which provides our navigation teams with the tools they need to help deliver smarter, more coordinated care. The platform also enables complex tasks to be shared across the larger care team in a highly efficient and coordinated way, and provides decision support that enhances the impact of key interventions.

Consider Deborah, our earlier breast cancer patient with diabetes. As a Thyme Care member, Deborah would be automatically flagged as a high acuity patient in need of high-touch support. The Thyme Care Nurse, equipped with information on Deborah’s history and recommendations from the care platform, would proactively reach out to Deborah to monitor her symptoms during treatment, quickly escalating any concerns to her provider and potentially avoiding an unnecessary and costly hospitalization. 

Optimizing resources by aligning efforts and impact with each patient’s unique needs enables the care team to serve a larger panel of patients more effectively, without impeding care quality.

A Better Cancer Care Journey for All

Cancer care navigation programs have been proven to have a positive impact on outcomes and costs. Like any treatment or medicine, the dosage of navigation should match the intensity and impact of the need.

Technology alone is insufficient for bringing flexible, effective care navigation to scale; pairing technology with people is critical. At Thyme Care, we leverage data to determine the right dose of care navigation for each patient according to their specific needs, and help navigators and care teams deliver that care in a more coordinated and efficient way.

That kind of support should be an integral part of cancer care for every patient and care team. Importantly, it can be replicated across different health plans, regions and populations. And because the approach is data-based, it enables constant learning and improvement.

At Thyme Care, we continue to work closely with health plans and providers to bring scalable, patient-centered navigation to life, furthering our mission to transform the cancer care journey for all patients.

Learn how Thyme Care is improving outcomes and lowering costs for health plans, providers and members:

The editorial staff had no role in this post's creation.