The nurse navigator's role in health care reform and cost containment

The state of health care in our country is reaching crisis proportions as unemployment rates continue to rise and more Americans lose their employer-provided health insurance. Although COBRA is available, few can afford its high costs when they have no income to rely on other than unemployment. So, the cycle goes on until the stress itself leads to illness, maybe even cancer. The unemployed person is now the patient, but who is going to pay the bills? Will the patient even be able to seek treatment, and if they do, how will they pay for it and its associated costs, such as gas to get to doctor appointments? What about paying for the basic necessities of life, such as food for the family, and what choice is there when the patient must decide between paying the electric bill and paying for their medicine? These are some of the impossibly difficult choices that many Americans are facing. While the picture is very grim, and there is no easy answer in sight, oncology nurse navigators can provide a ray of hope.

Patient navigation is a discipline that is dedicated to the holistic care of patients with cancer, all of whom are in need of physical, mental, emotional, psychosocial, and spiritual support throughout the cancer care continuum. Their families also require many of the same support services. Although numerous health care professionals are involved in every patient’s care, only nurse navigators are there throughout the entire journey, navigating the patient and their family around barriers and identifying resources and services needed to improve quality of life and instill trust and satisfaction in the system.

In these economic times, and in the face of a renewed effort toward health care reform, it is essential that the oncology nurse navigators, oncology administrators, physicians, social workers, and lay patient navigators all understand the ways in which navigation can play an integral part in health care reform and cost containment. When a patient is navigated around the barriers to care, their ability to accept and remain in care is improved. This leads to better compliance, potentially less treatment, improved quality of life, more diligent follow-up, and earlier detection of complications or recurrence, all of which save precious health care dollars.

All patients with cancer, regardless of income or socioeconomic status, will need to use multiple resources throughout their care. Ideally, these patients should have access to a navigation team that includes all the personnel and professionals needed to address every aspect of patient care. This team should be led by an oncology nurse navigator, who serves as an educator, advocate, and resource point person during the patient’s journey. Because oncology nurse navigators are skilled in conducting psychosocial needs assessments and in making referrals to the professionals who are able to provide the most appropriate services, they are instrumental in ensuring cost effectiveness in heath care delivery. When resources are allocated appropriately and used effectively, complications are minimized and outcomes are improved, and these benefits extend far beyond the single patient. In the long run, they save everyone health care dollars and ensure more money is available to conduct research into disease causes, detection, treatment, and prevention.

All oncology nurse navigators should understand the economic impact of the work that they do and aim to facilitate the most appropriate use of resources. Oncology nurse navigators truly are poised not only to change the face of cancer care, but to lead the way in making a major contribution to health care reform.

Tina Beerman, RN, BS, is president and co-founder of the National Coalition of Oncology Nurse Navigators.