NaviCareAssociates
PATIENT NAVIGATOR INSTITUTE
WELCOME
http://patient-centered-institute.org/wordpress/
270.883.2775
NaviCareAssociates
Patient Navigator Institute
Our mission is to develop knowledgeable and certified patient
navigators throughout the United States.
NaviCareAssociates
Patient Navigator Institute
What is the Problem? Why do we need a Patient Navigator?
The problem:
As medical care becomes more complex, sophisticated, and costly, the question many
face is “how does the patient diagnosed with a serious and complicated illness or a
long term chronic condition overcome barriers to diagnosis, treatment, and services?
How does one increase access and quality in an efficient and cost-effective manner?
How can I understand what the doctor is saying?”
NaviCareAssociates
Patient Navigator Institute
What is the Solution??
The solution:
As health care changes
from “business centric procedure focused” to “patient-centered and valued based” –
the answer is a patient navigator!
The patient navigator is a member of the healthcare team, working with physicians,
physician assistants, nurse practitioners, nurses, social workers, and medical assistants
as they guide the patient and family through a complex health care continuum.
The patient navigator program is designed to improve patient care and health
compliance behavior. It increases efficiencies, reduces healthcare costs, and improves
patient outcomes while facilitating relationships between healthcare organizations,
physicians, insurance companies, social services, and patients.
NaviCareAssociates
Patient Navigator Institute
The Rationale: Affordable Care Act
Where are the savings?
Patient-Centered Medical Home and Accountable Care Organizations
Physician-led primary care practices: Urban Medical Group, Leon
Medical Centers, CareMore Medical Group, and Redlands Family
Practice:
• Hospitalization rate 24% below average
• Hospital stays 38% shorter
• Amputation rate among diabetics 60% lower than average
• Overall member costs 18% below the industry average
NaviCareAssociates
Patient Navigator Institute
Rationale
Where are the savings?
Much of the success of the Patient-Centered Medical Home (PCMH)
and Accountable Care Organizations (ACO) revolves around
coordination.
• 6% decrease in inpatient admissions
• 6% decrease in primary care visits
• 29% decrease in emergency department visits
• 5% more telephone calls vs visits
• 80% more secure messages (email) vs visits
Why a Patient Navigator?
Patient centered care coordination for the family in need:
I just got out of the hospital and I don’t know what the doctor said.
Can you help me ? Do I take this medicine before breakfast or after?
When do I take my sugar pill? I have two heart pills; I don’t think
they help me and I can not afford them!
What is a Patient Navigator?
Patient Navigators:
• Assist patients, families, and caregivers
to overcome healthcare system barriers.
• Ensure timely access to quality medical
and psychosocial care.
• Foster patient autonomy by providing
information and guidance
• Enhance a patient’s ability to make
appropriate healthcare choices, receive
appropriate medical care, and effectively
use community resources to benefit
overall health.
NaviCareAssociates
Patient Navigator Institute
Admission
Preferred Admission Requirements:
1. Bachelors degree (BA, BS, BSN) from an accredited fouryear college or university
2. Supply a transcript of a bachelor's degree
3. Provide a current resume
4. Supply two professional references
NaviCareAssociates
Patient Navigator Institute
Admission
Alternative Admission Requirements - Some prospective students
may not have a Bachelor’s degree, but may have experience in a
healthcare field (e.g., Associates, LPN, ADN, CMA, etc.) or have health
advocacy experience:
1. A current resume
2. A transcript of associates' degree or other professional training
3. An essay (500 words or less) explaining why they should be
admitted to the program
4. Two professional references
stics.
Do I really need a Patient Navigator?
I just don’t understand this medical statement!
What’s my deductible? What’s co-insurance?
Doesn’t Medicare and/or TricCare pay for this treatment?
.
NaviCareAssociates
Professional Patient Navigator Program
Program Course Format: The NaviCare Patient Navigator training
program offers three formats.
1. 40 hour intensive (one – two week) in-class experience plus
an additional 20 hours online reflection, review, and testing.
This may be followed by a 30-60 day internship as a Patient
Navigator.
2. 60 hour in-class and on-line experience spread over ten
weeks. This is may be followed by a 30-60 day internship as a
Patient Navigator.
3. A customized training program designed to meet the specific
needs of YOUR organization.
NaviCareAssociates
Patient Navigator Institute
The PNP course will prepare the student with the knowledge and
competencies necessary to pursue a Certification from the
Patient-Centered Education & Research Institute.
NaviCareAsociates
Professional Patient Navigator Program
Curriculum
1. Overview – Rationale: Health Delivery System and the Affordable
Care Act, and Tools To Empower Patients (to take responsibility
for their healthcare.) – 4 hours
2. Communication – Professional, Personal, and Interpersonal -8 hours
a) Nonverbal (Body Language) and Verbal (active listening,
paraphrasing, and empathizing)
b) Development Issues Continuum: Early Childhood to Older Adult
c) Motivational Interview technique (Primary Prevention, Secondary
Prevention - Leading Response, Influencing Response
e) Trans Theoretical Motivation (TTM and categories of change.)
f) Team work
NaviCareAssociates
Patient Navigator Institute
Curriculum
3. Clinical Care Continuum & Care Coordination – 16 Hours
(Each of the following components will be tailored to the role as defined by
the organization)
a. Basic Understanding of the patient navigator role - The patient
navigator will recognize the basic need for the emerging role:
•Defining the role
Video
Discussion
b. Basic understanding of levels of care - The patient navigator will
identify the differences between acute, chronic, and post -acute care:
•Acute
•Chronic
•Post-acute
oMedical terminology
Discussion
Role playing
NaviCareAssociates
Patient Navigator Institute
Curriculum
3. Clinical Care Continuum & Care Coordination (cont’d) –
c. Basic comprehension of specific medical conditions - The patient navigator
will distinguish specific medical conditions:
•Hypertension
•Chronic obstructive pulmonary disease
•Congestive heart failure
•Pneumonia
•Diabetes
•Myocardial Infarction
•Pharmacology
•End stage renal disease
oPharmacology
oMental health
oMedical terminology
Discussion
Presentation
NaviCareAssociates
Patient Navigator Institute
Curriculum
3. Clinical Care Continuum & Care Coordination (cont’d) –
d. Basic application of assisting clients to self-manage- The patient
navigator will be prepared to help clients develop a plan to selfmanage:
•Defining patient goals
•Navigating the system
•Identifying resources
oMedical terminology
Discussion
Coaching tools
All material will be tailored to meet the needs of the clinical setting and the level of clinical
experience, i.e. hospital based RNs will have a more intense preparation. The clinical setting will
determine the role definition. If the navigator will be working with a specific population with
one disease process, i.e. cancer, the clinical competencies will be tailored to that population of
patients.
NaviCareAssociates
Patient Navigator Institute
Curriculum
4. Financial, Legal/Ethical – 8 hours
a. Financial Issues – Health delivery system
• Reimbursement Issues: ACOs, Patient- Centered Medical
Home (P-CMH), Hospital Value-Based Programs (patient
satisfaction), Bundled Payments, Billing /Coding.
• Fraud & Abuse: Dishonest or deceitful practices: falsifying
credentials, billing for services not rendered, red flag issues
• Direct Payment Options
• Insurance
•
•
•
•
•
TriCare
Medicare A, B, & MCA, Medicare Supplemental
Health Insurance Exchange
EOB , ERA
Mental Health Parity
NaviCareAssociates
Patient Navigator Institute
Curriculum
b. Legal/Ethics –
• Medical Record: Your Medical Record
• Consent: Expressed, Informed and Implies
• HIPPA & Patient’s Bill of Rights
• Privacy and Patient Confidentiality
• Medical Malpractice: Understand the areas liability, Medical
Malpractice Preventions - what causes malpractice suits and how
to prevent malpractice suits
• Older Adult Issues - Understand the diseases, conditions, and
injuries (abuse & neglect)
• End-of-Life Issues - Advance Directives (Living Will, Health Care
Surrogate, POA, DNR), Guardianship/Conservator)
NaviCareAssociates
Patient Navigator Institute
Curriculum
5. Resources (tools in the toolbox) - 4 Hours
PNs will learn to identify and use community resources to assist
patients.
• Sources for Resource Listings
• Financial Resources
• Transportation
• Mental Health
• Coordinated Care Options
• Critical Thinking & Decision Making Tools
NaviCareAssociates
Patient Navigator Institute
Curriculum
5. Oncology: Nurse and Lay Patient Navigator
Program will prepare you to serve in the role
of either and Oncology Nurse Navigator or
Oncology Patient Navigator to assist oncology
patients across the continuum of care.
NaviCareAssociates
Patient Navigator Institute
Curriculum
5. Oncology: Nurse and Lay Patient Navigator (cont’d)
• OBJECTIVES:
•
Obtain skill sets needed to assist patients as they traverse
clinical arena of care (provide education and support)
•
Know how to assist in management of information needed
given complexity of care
•
Communicate and collaborate with clinicians,
3rd party payers, and community or national resources
•
Be able to proactively anticipate patient’s needs
•
Initiate appropriate referrals
•
Equip patients with knowledge and understanding to decrease their anxiety and stress
•
Ability to assist patients to feel more in control of situation through self-advocacy and
knowledge
Yikes, look at my hospital bill. I can’t pay my doctor
bills, my insurance, co-pays, or deductibles!
NaviCareAssociates
Patient Navigator Institute
MODULES (Prospective)
1. Gerontology - Chronic Disease Management – pending
2. Clinical Care Coordination – Clinical R.N, MSN, NP
3. Mental Health
4. Complementary Alternative/Integrative Care
5. Special Programs Requested by Users
NaviCareAssociates
Patient Navigator Institute
Program Outcome
Prepare a strong core of certified professionals
who know how to navigate the health system
and measure outcomes.
Patient Navigator Program
The Market and Competition?
•Harold P. Freeman Institute, Harlem, NY (onsite and online)
•University of Miami - Alfus Patient Advocacy Program, Florida (online)
•Antioch University Midwest, Dayton, Ohio
•UC Berkeley Extension Health Advocacy Program, California
•Cleveland State University, Ohio (onsite)
•Colorado Community College, Colorado (onsite)
•EmpowerED UCLA Extensions, (online)
•Sonoma State University, California (onsite)
•Sarah Lawrence College, NY, (onsite)
•University of Illinois at Chicago, Illinois (onsite)
•University of Toledo, Ohio (onsite)