Quantifying and Maximizing the Impact of Digital Innovation in Cancer Patient Navigation
Sarah M Sheehan, MPA, Digital Medicine Society, Boston, Massachusetts, USA; Carl V. Asche, MBA, MSc, PhD, Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
Patient navigation and CancerX: A digital innovation accelerator within the Cancer Moonshot
The high costs and complexities of cancer treatment can exacerbate health disparities, undermine tailored treatment plans, and produce negative health and quality-of-life outcomes for patients. Patient navigation is an effective strategy for supporting patients and their families as they manage the clinical and financial side effects of cancer treatment but is too often unavailable to patients with cancer who may benefit due to health system resource constraints.
To address barriers in access to patient navigation services, The White House Cancer Moonshot, and its associated initiative CancerX, are investing in approaches to make patient navigation scalable and reimbursable. Patient navigation services are a focus of The White House Cancer Moonshot goals and are newly reimbursable under the 2024 Centers for Medicare & Medicaid Services (CMS) payment rule aimed at advancing equitable access to whole-person care.1,2 CancerX, a public-private partnership announced by The White House as a national accelerator to boost innovation in the fight against cancer, has also produced health system resources aimed at quantifying and maximizing the return on investment associated with digital patient navigation for health systems. These resources are freely available and demonstrate the capacity of economic modeling to support real-world decision making in the healthcare setting.
"Patient navigation services are a focus of The White House Cancer Moonshot goals and are newly reimbursable under the 2024 Centers for Medicare & Medicaid Services payment rule aimed at advancing equitable access to whole-person care."
The impact of patient navigation on measures that matter to patients and health systems
Patient navigation is a hallmark feature of modern, comprehensive cancer care. Navigation increases access to cancer screening and timely treatment and improves patient satisfaction and quality of life.3,4 Financial navigation, in particular, is shown to produce significant cost savings for patients, facilitating consistent appointment attendance, treatment plan adherence, access to needed medications, and, ultimately, improved survival outcomes.5 Navigation also produces health system benefits in the format of reduced resource use and spending on acute care and long-term hospitalizations.4 However, health systems are often using excess revenues from elsewhere in the budget to provide patient navigation services to patients with cancer who have acute issues, such as trouble getting to their next appointment.
Digital health platforms exist as a potential solution to the scalability and sustainability issues faced by health systems implementing patient navigation. They are effective in standardizing an approach to screening for patient distress. They are also proven to reduce emergency department use and administrative burden for providers and patient navigators, allowing each to work at top-of-license to solve more complex clinical issues.6 The benefits of digital navigation are documented in published literature but are not yet systematically quantified to support healthcare decision making around investment.
Quantifying the impact of digital patient navigation in cancer
To quantify the health system benefits associated with digital cancer navigation and support health system decision making around investment in digital solutions to scale navigation programming, CancerX has developed a customizable return-on-investment (ROI) calculator that forecasts the impact of these solutions on patient and health system outcomes. The conceptual framework for the ROI calculator suggests that digital patient navigation solutions that provide financial navigation to patients with cancer drive down rates of patient financial toxicity, thereby improving patient treatment adherence and reducing healthcare need, further reducing healthcare resource use and expenditures.
"CancerX has developed a customizable return on investment (ROI) calculator that forecasts the impact of these solutions on patient and health system outcomes."
The ROI calculator was developed through the collaboration, facilitated by the Digital Medicine Society (DiMe), of 24 CancerX member organizations, including ISPOR members (Chia Jie Tan, Ishfaq Rashid, and Carl Asche) from the University of Utah College of Pharmacy Pharmacotherapy Outcomes Research Center.7
The free ROI calculator is designed to be used by stakeholders that purchase or sell digital solutions to support comprehensive cancer patient navigation. In our effort to estimate the ROI generated from the example digital cancer navigation platform we selected, we found a positive return of 114% over 5 years, driven by the capacity of the platform to reduce financial toxicity for patients, thereby reducing rates of medication nonadherence and reducing healthcare resource use on hospitalization and outpatient visits.
Solutions for scaled digital patient navigation in cancer
CancerX has also developed free tools to support health systems in maximizing the ROI they generate from investing in the implementation of digital health solutions to support cancer navigation. The CancerX Digitally Enabled Patient Navigation Blueprint is designed to enable cancer patient navigation programming that is standardized, efficient, and reimbursable. It supports business case development for the implementation of digital patient navigation that improves access to care and reduces patient financial toxicity. It provides instruction on how to adapt existing health technology platforms (eg, Epic and Oracle Health) to support patient navigation. It also provides a standardized workflow for digital patient navigation and guidance on how patient navigation divisions should document and bill for their services, ensuring reimbursable, sustainable programming (Figure 1).
Conclusions
This work has several implications for health system decision makers within cancer centers. As they evaluate digital solutions for purchase, these decision makers are interested in the ROI that might accrue from investment in digital patient navigation solutions. Patient navigation programs enhance equal access to care, reduce patient financial toxicity, and improve health and quality-of-life outcomes for patients with cancer. However, resource constraints can hinder the widespread implementation of these programs. While digital solutions can help to address resource constraints, unknown total cost and ROI remain primary obstacles to adopting digital health solutions for cancer patient navigation.
Health systems and patients need support establishing and engaging in digital patient navigation programs to ensure efficient, effective, and equitable cancer care. Health system decision makers and cancer care navigators can use these freely available CancerX tools in the design and implementation of digital navigation programming to improve equity and reduce out-of-pocket costs for patients across their cancer journey. A recording of the launch event for these resources supported by the CancerX “Advancing Digital Innovation to Improve Equity and Reduce Financial Toxicity in Cancer Care Research” project can be found at Advancing Equity and Reducing Financial Toxicity in Cancer Care.7
References
- House TW. FACT SHEET: On One Year Anniversary of Reignited Cancer Moonshot, Biden-Harris Administration Announces New Actions to End Cancer as We Know It. The White House. February 2, 2023. Accessed September 1, 2024. https://www.whitehouse.gov/briefing-room/statements-releases/2023/02/02/fact-sheet-on-one-year-anniversary-of-reignited-cancer-moonshot-biden-harris-administration-announces-new-actions-to-end-cancer-as-we-know-it/
- Jacobs DB, Schreiber M, Seshamani M, Tsai D, Fowler E, Fleisher LA. Aligning quality measures across CMS—The Universal Foundation. N Engl J Med. 2023;388(9):776-779. doi:10.1056/NEJMp2215539
- Freund KM, Battaglia TA, Calhoun E, et al. Impact of patient navigation on timely cancer care: the Patient Navigation Research Program. J Natl Cancer Inst. 2014;106(6):dju115. doi:10.1093/jnci/dju115
- Kline RM, Rocque GB, Rohan EA, et al. Patient navigation in cancer: The business case to support clinical needs. J Oncol Pract. 2019;15(11):585-590. doi:10.1200/JOP.19.00230
- Financial Navigators Reduce the Cost of Cancer Care - NCI. April 21, 2023. Accessed July 24, 2024. https://www.cancer.gov/news-events/cancer-currents-blog/2023/cancer-care-financial-navigation-saves-money
- Miller MF, Zaleta AK, Allen ML, Nichols HM, Robinson DC. Impact of distress screening and referral on health care utilization and cost among breast cancer patients: a retrospective cohort study. J Psychosoc Oncol Res Pract. 2022;4(2):e070. doi:10.1097/OR9.0000000000000070
- Advancing Equity and Reducing Financial Toxicity in Cancer Care. 2024. Accessed September 1, 2024. https://www.youtube.com/watch?v=D_QS0ZoEknY
