Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients With Cancer
Open accessAbstract
IMPORTANCE: Lay navigators in the Patient Care Connect Program support patients with cancer from diagnosis through survivorship to end of life. They empower patients to engage in their health care and navigate them through the increasingly complex health care system. Navigation programs can improve access to care, enhance coordination of care, and overcome barriers to timely, high-quality health care. However, few data exist regarding the financial implications of implementing a lay navigation program. OBJECTIVE: To examine the influence of lay navigation on health care spending and resource use among geriatric patients with cancer within The University of Alabama at Birmingham Health System Cancer Community Network. DESIGN, SETTING, AND PARTICIPANTS: This observational study from January 1, 2012, through December 31, 2015, used propensity score-matched regression analysis to compare quarterly changes in the mean total Medicare costs and resource use between navigated patients and nonnavigated, matched comparison patients. The setting was The University of Alabama at Birmingham Health System Cancer Community Network, which includes 2 academic and 10 community cancer centers across Alabama, Georgia, Florida, Mississippi, and Tennessee. Participants were Medicare beneficiaries with cancer who received care at participating institutions from 2012 through 2015. EXPOSURES: The primary exposure was contact with a patient navigator. Navigated patients were matched to nonnavigated patients on age, race, sex, cancer acuity (high vs low), comorbidity score, and preenrollment characteristics (costs, emergency department visits, hospitalizations, intensive care unit admissions, and chemotherapy in the preenrollment quarter). MAIN OUTCOMES AND MEASURES: Total costs to Medicare, components of cost, and resource use (emergency department visits, hospitalizations, and intensive care unit admissions). RESULTS: In total, 12 428 patients (mean (SD) age at cancer diagnosis, 75 (7) years; 52.0% female) were propensity score matched, including 6214 patients in the navigated group and 6214 patients in the matched nonnavigated comparison group. Compared with the matched comparison group, the mean total costs declined by $781.29 more per quarter per navigated patient (β = -781.29, SE = 45.77, P < .001), for an estimated $19 million decline per year across the network. Inpatient and outpatient costs had the largest between-group quarterly declines, at $294 and $275, respectively, per patient. Emergency department visits, hospitalizations, and intensive care unit admissions decreased by 6.0%, 7.9%, and 10.6%, respectively, per quarter in navigated patients compared with matched comparison patients (P < .001). CONCLUSIONS AND RELEVANCE: Costs to Medicare and health care use from 2012 through 2015 declined significantly for navigated patients compared with matched comparison patients. Lay navigation programs should be expanded as health systems transition to value-based health care.
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The cancer-specific risk stratification used in this study was adapted from a model developed by Rocque and colleagues.
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- Authors
- Rocque, G. B., Pisu, M., Jackson, B. E., Kvale, E. A., Demark-Wahnefried, W., Martin, M. Y., Meneses, K., Li, Y., Taylor, R. A., Acemgil, A., Williams, C. P., Lisovicz, N., Fouad, M., Kenzik, K. M., Partridge, E. E., & for the Patient Care Connect Group
- Affiliations
- University of Alabama at Birmingham (US)
- Department of Nutrition Science, The University of Alabama at Birmingham
- University of Tennessee Health Science Center (US)
- Corresponding author
- Rocque, Gabrielle B.
- ORCID
- Venue
- JAMA Oncology
- Publisher
- American Medical Association (AMA)
- Published
- 2017-06-01
- Volume
- 3
- Issue
- 6
- Pages
- 817
- ISSN
- 2374-2437 (ISSN-L)
- PMC
- PMC5540048
- OpenAlex
- W2580419378
- Cited by
- 166
- References
- 37
- Citations by year
- 2026: 12 · 2025: 16 · 2024: 15 · 2023: 12 · 2022: 18 · 2021: 16 · 2020: 16 · 2019: 29 · 2018: 21 · 2017: 11
- FWCI
- 37.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Oncology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (K12HS023009)
- National Cancer Institute (P30CA013148)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Keywords
- elderly cancer patients, Medicare spending, health care utilization, cost reduction, emergency department visits, hospitalization, intensive care unit admission, cancer survivorship, health care access, care coordination, community cancer centers, academic medical centers, racial disparities, socioeconomic disparities
- MeSH terms
- Aged, Alabama, Costs and Cost Analysis, Critical Care, Emergency Service, Hospital, Health Expenditures, Female, Medicare, Health Resources, Hospitalization, Humans, Male, Neoplasms, Regression Analysis, Salaries and Fringe Benefits, United States, Patient Navigation
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