ACO’s Comprehensive Patient Navigation Can Reduce Costs, Increase Satisfaction
January 1, 2023 3 minutes read
By Melinda Young
Surprisingly, accountable care organization (ACO) enrollees who are given fewer choices but better navigation assistance in making decisions are happier with their healthcare access, researchers found.1
As managed care organizations and ACOs continue to seek ways to help patients receive quality care more efficiently, one solution is to offer a selective narrow network. This means fewer specialists and other ambulatory providers to choose. Patients’ hospital choices were the same as the group without a selective narrow network.
“You have to take a risk if you’re going to get a lower patient, per member capitation rate,” says Timothy T. Brown, PhD, lead study author and an associate professor in the School of Public Health at the University of California, Berkeley. “When we did a survey, we found people were a lot happier with the narrower network and with navigation, and they actually used less care. They perceived they had better access, and it was easier for them to find a specialist — and even mental healthcare.”
Patient Satisfaction, Trust Increases
What people gained was a little help in finding the provider they needed. From the one managed care company’s perspective, the program worked well. People enrolled in the selective network used 15% less care, saving the company about $1,200 to $1,500 per year, per patient.
“All you needed was a simple phone call,” Brown notes. “It made it easier for patients.”
One possible reason for the positive results is the navigators speaking with patients built trust through shared decision-making. “When you share all these options, people will think about it, and they’ll trust you more,” Brown says.
Brown and colleagues did not measure patients’ trust of the navigators and providers, but other research suggested this could be a reason people were more satisfied and used less care. “The patient navigation system is what’s driving this,” he says. “Patient navigation will find them a provider; they call one number, say what they need, and they find it.”
The navigator connects patients to the provider office in a warm handoff. The navigation support team included nurses, pharmacists, pharmacy technicians, health coaches, social workers, and customer representatives. Their goal was to help enrollees find a new physician or specialist within the network, continue receiving care, learn answers to questions about the physician’s instructions and about medications, to understand their health benefits, and to transfer medical records and prescriptions.
“At least one of the physician organizations had a special set-up to make sure people could connect to mental health if they needed it,” Brown says.
Enrollees benefitted from one central phone number to call for questions and access to the provider they needed. “People who were in this narrow network were more likely to say they got a referral from a primary care provider and more likely to see a specialist as soon as needed, and they were much less likely to state that a specialist they wanted to see was not in the network,” Brown explains. “They were a lot more satisfied with the healthcare they received.”
Comprehensive Navigation
When comparing the two groups, the only difference was one group had fewer choices and access to a comprehensive patient navigation system. “But they seemed happier, even though they had fewer choices, and the only thing we can see causing this was the patient navigation system,” Brown says. “I’m astonished at how effective it was.”
The study results show it is a win-win for patients and providers. “Providers are able to spend their time actually helping people who need to be helped, and it lets their focus go where it’s supposed to go. It’s a big efficiency mechanism,” Brown explains. “If I were an insurer, I’d definitely put this in place — and the larger the organization, the more efficiency you’ll get out of it.”
REFERENCE
- Brown TT, Hague E, Neumann A, et al. Impact of a selective narrow network with comprehensive patient navigation on access, utilization, expenditures, and enrollee experience. Health Serv Res 2022; Sep 16. doi: 10.1111/1475-6773.14066. [Online ahead of print].
Surprisingly, accountable care organization enrollees who are given fewer choices but better navigation assistance in making decisions are happier with their healthcare access, researchers found.
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