Navigator program improves outcomes in high-risk population

CHICAGO – In January 2014, Methodist Le Bonheur Healthcare launched a community health navigator pilot program for people who frequently use the emergency department. The program, based in Memphis, Tennessee, include navigators who provided non-clinical support with 111 people to improve their health behaviors and decrease their healthcare utilization.

So far, the results have been promising, according to a panel of speakers who discussed the program on Monday at the American College of Healthcare Executives’ Congress on Healthcare Leadership.

People were eligible for the program if they lived in the 38109 zip code in Memphis and had at least 11 emergency department visits from May 2012 to April 2013. The average household income in that zip code is $38,687 compared with the national average of $69,637. Of the 111 people in this program, 97 percent are African Americans and 83 percent are younger than 60 years old.

The group accounts for $3.4 million in healthcare costs, and the top 15 highest cost patients contribute 50 percent of the costs. The majority of costs come from inpatient visits, according to the speakers.

The most common diagnoses for the group were heart failure, chronic obstruction pulmonary disease, diabetes, hypertension and chronic kidney disease. Approximately half of the people had between one and five comorbid conditions. They also had a higher 30-day readmission rate.

When a person in the group enters a Methodist Le Bonheur Healthcare hospital, a navigator receives a message through the person’s electronic medical record. The navigator then meets the person in the emergency department or hospital. Navigators are asked to build relationships with the patients and change their behaviors.

As of November 2014, the per patient cost was down 43 percent compared with a year earlier, according to Katie Nelson, MA, senior analyst of business development, market analytics and decision support at the University of Minnesota Physician Group. She was formerly a manager in planning research for Methodist Le Bonheur Healthcare.

Nelson said that as of August 2014, there were an average of 10.3 monthly inpatient encounters compared with 19 a year earlier. She added that during that same time period, the average monthly emergency department encounters decreased from 99 to 76.6 per month.

In addition, the average length of inpatient stay was similar to the year earlier, which she said may mean that patients are in need of hospital care and are not in the hospital because of poor chronic disease management.

“We know the system works,” said Razvan Marinescu, MD, director of planning and development for Methodist Le Bonheur Healthcare.

Marinescu said the program would be expanded to others within the same zip code. He is particularly interested in patients who are referred to home health services for ongoing care after a hospital stay. He also wants to work more closely with patients who are registered members of the Congregational Health Network, an initiative in which Methodist Le Bonheur Healthcare works with clergy in low-income zip codes in Memphis to improve access to care and improve their health.

The most important metrics to measure success, according to Marinescu, include reducing emergency department visits, hospital admissions and costs, increasing in the days between visits to an acute care provider and managing chronic disease through using telehealth services and personal support by a navigator.