Setting the Course for Comprehensive Care Navigation in Oncology
October 11, 2024This article, authored by several Evolent experts, was published in the October 2024 issue of American Journal of Managed Care’s Evidence-Based Oncology.
Specialty oncology care remains one of the largest drivers of health care expenditures in the US, totaling approximately $209 billion in 2020 with nearly $16 billion in out-of-pocket costs. In recent years, we have seen tremendous growth in the number of new therapies and interventions that have shifted patients from previously poor survival outcomes to a more “chronic disease” state. Coupled with our aging population, this has placed tremendous strain on our ability to deliver cohesive oncology care. This rapid growth in oncology care, combined with an entrenched fragmentation of care delivery in our fee-for-service system, has left patients to navigate a disjointed and confusing cancer journey.
Patient navigation is an evidence-based intervention that, as defined by the Professional Oncology Navigation Task Force, seeks to offer “individualized assistance to patients, families, and caregivers to help overcome barriers and facilitate timely access to quality health and psychosocial care from prediagnosis through all phases of the cancer experience.” An oncology navigation program provides a foundation to help transform the patient’s cancer journey and in doing so addresses significant gaps in quality that include reducing disparities in care, driving down avoidable inpatient and emergency care utilization, and improving the patient experience with goal-concordant care. In helping address these gaps in care and improve the delivery of patient-centered cancer care, navigation programs have achieved meaningful financial outcomes, driving down total cost of care for these patients.
In this article, we lay out the challenges faced in oncology care delivery, including health care policy and regulatory headwinds and tailwinds impacting their success. We then describe the design elements critical to the creation of a successful oncology navigation program.