Navigators Steer Patients to Better Health

YOUNGSTOWN, Ohio – A shift in the health care culture has brought employment and entrepreneurial opportunities in a relatively new occupation: health care navigators.

In essence, health care navigators act as a liaison between patients and the medical infrastructure, including providers, support resources and insurance agencies. Part of their role is helping patients to find providers for their illnesses and to negotiate their medical payments.

While navigators aren’t a novel concept, Dr. Jeff Allen, dean of the Bitonte College of Health and Human Services at Youngstown State University, says there is an immediate need for health care navigators, or patient advocates, particularly with regard to preventive care.

Having a transdisciplinary approach to health care is key, he says. Allen, who holds a doctorate in clinical psychology, worked with professionals with various disciplines throughout his career. Working side-by-side presented opportunities where they could help each other with research efforts, he says.

Allen believes the principle can be applied with navigators. Patients would benefit from advisers knowledgeable in particular fields who could provide support in managing chronic illnesses, or putting patients on track to prevent such illnesses.

“Working in a transdisciplinary environment is how we most strongly impact patients, not just at the point of crisis intervention with a specific chronic or acute condition,” he says, “but also upstream in working on wellness and prevention of disease.”

Compliance with prevention can prove challenging, he says. Other patients simply have a lack of access or awareness for preventive measures, such as diagnostic screenings.

And it’s not always for lack of trying, says Dr. Nancy Landgraff, chairwoman of the department of physical therapy at YSU. Some patients have so much going on that exercising or eating a more healthful diet adds too much to their already full plates, she explains.

“They’re the ones [who] are kind of killing themselves [working] two, three jobs, just trying to make ends meet in some situations,” Landgraff says. “So, you go to the doctor and it’s ‘Fix me.’ ”

As such, having an understanding of the social determinants of health – housing, education and socioeconomic status – is vital.

In addition to connecting patients with needed services and guiding them through the processes, the navigator identifies what motivates a patient and helps to set personal health goals, Landgraff says. “For some people, the system is so foreign,” and the navigator brings the language down [so they] understand why doing certain things is beneficial, she says.

“It’s starting to make the patient more in charge of their own health,” Landgraff adds. “All of our students in this college receive training in that.”

Some health care providers put preventive care at the core of what they do. Mercy Health – Youngstown conducts preventive guidance at the primary care level, says Dr. Cindy Kravec, co-medical director, population health.

Within a patient’s electronic record, Mercy has “health maintenance” information based on a patient’s gender, age and disease state. “We try to make it easy for providers to remember to do those preventive care measures,” she says, such as cancer and diabetic screenings and vaccinations.

Keeping a patient out of the hospital through preventive care is in the best interests of the patient and the hospital, Kravec says. For patients, preventing disease through vaccinations and screenings and treating conditions in an ambulatory setting saves money.

From the hospital’s perspective, national contracts with insurers impose monetary penalties on providers if patients with those illnesses are admitted to the hospital where costs can add up.

“Ultimately, for conditions like CHS, COPD and diabetes, it’s our challenge to keep those patients out of our hospital with complications,” she says.

A team of individuals, including nurses, medical assistants and physicians, drives preventive care at Mercy. Population health specialists help by updating a patient’s records with data on procedures they’ve had at a non-Mercy site, such as colonoscopies or mammograms.

Through its mobile clinic and special program, Mercy engages low-income communities as well. An outreach team works with those populations to identify their concerns and connect them with providers for preventive care, says Kurt Williams, director of community health.

“The way we approach community work is around assessing the needs and ensuring we are providing services and programs that are taking steps toward whatever need the community has,” Williams says. “If they’re not connected with the health system, they’re not going to have positive outcomes.”

The Midlothian Free Health Clinic leverages alliances with area providers to furnish needed services, says Executive Director Dr. James Benedict, including the Mercy dental program, which comes in monthly.

Clinic patients are considered “working poor” – ages 19 to 65 who don’t qualify for Medicaid and can’t afford insurance.

“Some of them are service industry jobs that don’t pay enough money for people to get insurance or their employer doesn’t offer it,” Benedict says.

Most of the folks seen at the volunteer clinic have chronic diseases, such as heart disease, diabetes or respiratory problems. “We’ve tried to build our scope of services around managing those disease processes,” he says.

The clinic could put a health care navigator to work “pretty quickly,” he says. New patients undergo a health risk assessment to walk them through the available services.

“They have to tell us about their eating habits. They have to tell us about their level of activities on a daily or weekly basis,” Benedict says. “Then we make the referrals from the health risk assessment to the different services that we have.”

Compliance is a challenge, he says, which is why education is important. Many were reared to believe that some chronic illnesses are inevitable because of family history, he explains, but “we’re trying to show them that they can be healthier.

“Part of it is just convincing them and building that trust that we’re going to be there for them and we’re going to give them the resources they need to be healthier,” Benedict says. “The navigator is the person that’s going to tie this all together and ensure the patient’s needs are being met.”

Landgraff, a volunteer at the Midlothian Free Health Clinic, says social workers there help to keep patients on a preventive track. YSU students help the clinic’s staff by employing a transdisciplinary health care approach focused on nutrition, physical therapy, exercise science and dietetics.

“Even if you have a chronic disease, we can make it better with diet and exercise and proper management,” Landgraff says. Getting patients to think about their health holistically, “that’s where a navigator could come in handy. It’s a huge culture shift.”

And navigators are needed everywhere from hospitals to elder care centers, says YSU’s Allen. Typically, providers are interested in navigators with specific focuses, such as cancer. But there are also career opportunities outside of institutions, he says.

“There are opportunities for folks to be very entrepreneurial and open their own kind of private practices as [by] serving as health care navigators,” Allen says. “Depending on your kind of training and the way you market your services from the strictly private practice perspective, people are routinely making $40 to $200 an hour with this kind of work.”

Allen expects retired health care professionals would likely fit the navigator position, as well as individuals with public health experience and proper training and education.

Navigators can specialize in anything from pediatrics to elder care and everything in between, he says, as well as health diagnostics. And because there’s such a heavy need to know how to navigate the system, particularly the insurance side, individuals with some business education “could be quite effective in their role,” he says.

YSU offers a baccalaureate and master’s degree in public health and encourages students to take insurance courses at the Williamson College of Business Administration, Allen says. For those who earn degrees in public health, there need to be efforts to keep those individuals living and working in the regional communities, he says.

“That’s the type of individual that you want to keep here,” he says. “So much, particularly in this role, is locally based. They need to have awareness of all the local health systems, as well as just kind of the cultural intricacies of the local environment.”

Pictured: Health care navigators can specialize in anything from pediatrics to elder care and everything in between, as well as various diagnostics, say Drs. Jeff Allen and Nancy Landgraff of the Bitonte College of Health and Human Services at YSU.