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NaviCareAssociates PATIENT NAVIGATOR INSTITUTE

NaviCareAssociates

Patient Navigator Institute

Our mission is to develop knowledgeable and certified patient navigators throughout the United States.

NaviCareAssociatesPatient Navigator Institute

The problem:  As medical care becomes more complex, sophisticated, and costly, the question many face is “how does the patient diagnosed with a serious and complicated illness or a long term chronic condition overcome barriers to diagnosis, treatment, and services? 

How does one increase access and quality in an efficient and cost-effective manner? 

How can I understand what the doctor is saying?”

What is the Problem? Why do we need a Patient Navigator?

What is the Solution??

NaviCareAssociatesPatient Navigator Institute

The solution: 

As health care changes from “business centric procedure focused” to “patient-centered and valued based” – the answer is a patient navigator!  

The patient navigator is a member of the healthcare team, working with physicians, physician assistants, nurse practitioners, nurses, social workers, and medical assistants as they guide the patient and family through a complex health care continuum.

The patient navigator program  is designed to improve patient care and health compliance behavior. It increases efficiencies, reduces healthcare costs, and improves patient outcomes while facilitating relationships between healthcare organizations, physicians, insurance companies, social services, and patients.  

The Rationale: Affordable Care Act Where are the savings?

Patient-Centered Medical Home and Accountable Care OrganizationsPhysician-led primary care practices:  Urban Medical Group, Leon Medical Centers, CareMore Medical Group, and Redlands Family Practice: 

• Hospitalization rate 24% below average

• Hospital stays 38% shorter

• Amputation rate among diabetics 60% lower than average

• Overall member costs 18% below the industry average

NaviCareAssociatesPatient Navigator Institute

NaviCareAssociatesPatient Navigator Institute

RationaleWhere are the savings?

Much of the success of the Patient-Centered Medical Home (PCMH) and Accountable Care Organizations (ACO) revolves around   coordination.  

•    6% decrease in inpatient admissions

•    6% decrease in primary care visits

•   29% decrease in emergency department visits

•    5% more telephone calls vs visits

•   80% more secure messages (email) vs visits

Patient centered care coordination for the family in need:

I just got out of the hospital and I don’t know what the doctor said. Can you help me ? Do I take this medicine before breakfast or after? When do I take my sugar pill? I have two heart pills; I don’t think they help me and I can not afford them!

Why a Patient Navigator?  

What is a Patient Navigator?

Patient Navigators:

• Assist patients, families, and caregivers to overcome healthcare system barriers.

• Ensure timely access to quality medical and psychosocial care.  

• Foster patient autonomy by providing information and guidance

• Enhance a patient’s ability to make appropriate healthcare choices, receive appropriate medical care, and effectively use community resources to benefit overall health.

NaviCareAssociates

Patient Navigator Institute

Admission

Preferred Admission Requirements:

1. Bachelors degree (BA, BS, BSN) from an accredited four-year college or university 

2. Supply a transcript of a bachelor's degree 

3. Provide a current resume

4.   Supply two professional references 

NaviCareAssociates

Patient Navigator Institute

Admission

Alternative Admission Requirements - Some prospective students may not have a Bachelor’s degree, but may have experience in a healthcare field (e.g., Associates, LPN, ADN, CMA, etc.) or have health advocacy experience: 

1. A current resume 

2. A transcript of associates' degree or other professional training 

3. An essay (500 words or less) explaining why they should be admitted to the program 

4. Two professional references 

stics.

I just don’t understand this medical  statement!What’s  my deductible? What’s co-insurance?   

Doesn’t Medicare and/or TricCare  pay  for this treatment? 

Do I really need a Patient Navigator?

Program Course Format: The NaviCare Patient Navigator training program offers three formats.

1. 40 hour intensive (one – two week) in-class experience plus an additional 20 hours online reflection, review, and testing.  This may be followed by a 30-60 day internship as a Patient Navigator. 

2. 60 hour in-class and on-line experience spread over ten weeks. This is  may be followed by a 30-60 day internship as a Patient Navigator. 

3.    A customized training program designed to meet the specific needs of YOUR organization. 

.  NaviCareAssociates

Professional Patient Navigator Program

NaviCareAssociates

Patient Navigator Institute

The PNP course will prepare the student with the knowledge and competencies necessary to pursue a Certification from the 

Patient-Centered Education & Research Institute.

 

1. Overview – Rationale: Health Delivery System and the Affordable Care Act, and Tools To Empower Patients (to take responsibility for their healthcare.) – 4 hours

2. Communication – Professional, Personal, and Interpersonal -8 hours

a) Nonverbal (Body Language) and Verbal (active listening, paraphrasing, and empathizing)

b) Development Issues Continuum: Early Childhood to Older Adult

c) Motivational Interview technique (Primary Prevention, Secondary Prevention - Leading Response, Influencing Response

e) Trans Theoretical Motivation (TTM and categories of change.)

f) Team work 

NaviCareAsociates

Professional Patient Navigator Program

Curriculum

3. Clinical Care Continuum & Care Coordination – 16 Hours        (Each  of the following components will be tailored to the role as defined by 

the organization)

NaviCareAssociates

Patient Navigator Institute Curriculum

   a. Basic Understanding of the patient navigator role - The patient navigator will recognize the basic need for the emerging role: 

• Defining the roleVideoDiscussion

b. Basic understanding of levels of care - The patient navigator will identify the differences between acute, chronic, and post -acute care:

• Acute• Chronic• Post-acute

oMedical terminologyDiscussion Role playing

3. Clinical Care Continuum & Care Coordination (cont’d) – 

NaviCareAssociates Patient Navigator Institute

Curriculum

c. Basic comprehension of specific medical conditions - The patient navigator     will distinguish specific medical conditions: 

• Hypertension• Chronic obstructive pulmonary disease• Congestive heart failure• Pneumonia• Diabetes• Myocardial Infarction• Pharmacology• End stage renal disease

o Pharmacology oMental healthoMedical terminology

DiscussionPresentation

3. Clinical Care Continuum & Care Coordination (cont’d) – 

NaviCareAssociates

Patient Navigator Institute

Curriculum

d. Basic application of assisting clients to self-manage- The patient navigator will be prepared to help clients develop a plan to self-manage: 

• Defining patient goals• Navigating the system• Identifying resources

oMedical terminologyDiscussionCoaching tools

All material will be tailored to meet the needs of the clinical setting and the level of clinical experience, i.e. hospital based RNs will have a more intense preparation. The clinical setting will determine the role definition. If the navigator will be working with a specific population with one 

disease process, i.e. cancer, the clinical competencies will be tailored to that population of patients. 

4. Financial, Legal/Ethical –  8 hours

a. Financial Issues – Health delivery system • Reimbursement Issues: ACOs, Patient- Centered Medical 

Home  (P-CMH), Hospital Value-Based Programs (patient satisfaction), Bundled Payments, Billing /Coding. 

• Fraud & Abuse: Dishonest or deceitful practices:  falsifying credentials, billing for services not rendered, red flag issues

• Direct Payment Options• Insurance

•      TriCare•      Medicare A, B, & MCA, Medicare Supplemental

•Health Insurance Exchange•EOB , ERA•Mental Health Parity

NaviCareAssociates

Patient Navigator Institute Curriculum

b. Legal/Ethics –  

• Medical Record: Your Medical Record

• Consent: Expressed, Informed and Implies

• HIPPA & Patient’s Bill of Rights

• Privacy and Patient Confidentiality

• Medical Malpractice: Understand the areas liability, Medical Malpractice Preventions - what causes malpractice suits and how to prevent malpractice suits

• Older Adult Issues - Understand the diseases, conditions, and injuries (abuse & neglect)

• End-of-Life Issues - Advance Directives (Living Will, Health Care Surrogate, POA, DNR), Guardianship/Conservator)

NaviCareAssociates

Patient Navigator Institute

Curriculum

NaviCareAssociatesPatient Navigator Institute

Curriculum

5. Resources (tools in the toolbox) - 4 Hours  

PNs will learn to identify and use community resources to assist patients. 

• Sources for Resource Listings

• Financial Resources

• Transportation

• Mental Health

• Coordinated Care Options

• Critical Thinking  & Decision Making Tools

NaviCareAssociatesPatient Navigator Institute

Curriculum

5. Oncology: Nurse and Lay Patient Navigator   

Program will prepare you to serve in the role of either and Oncology Nurse Navigator or Oncology Patient Navigator to assist oncology patients across the continuum of care. 

NaviCareAssociatesPatient Navigator Institute

Curriculum5. Oncology: Nurse and Lay Patient Navigator (cont’d)  

• OBJECTIVES: • Obtain skill sets needed to assist patients as they traverse        clinical arena of care (provide education and support)

• Know how to assist in management of information needed       given complexity of care

• Communicate and collaborate with clinicians,                                                                       3rd party payers, and community or national resources

• Be able to proactively anticipate patient’s needs

• Initiate appropriate referrals

• Equip patients with knowledge and understanding to decrease their anxiety and stress

• Ability to assist patients to feel more in control of situation through self-advocacy and knowledge

Yikes, look at my hospital bill. I can’t pay my doctor bills, my insurance, co-pays, or deductibles!

NaviCareAssociates

Patient Navigator Institute 

MODULES (Prospective)

1. Gerontology  - Chronic Disease Management – pending

2. Clinical Care Coordination – Clinical R.N, MSN, NP

3. Mental Health 

4. Complementary Alternative/Integrative Care  

5. Special Programs Requested by Users

NaviCareAssociates

Patient Navigator Institute

Program Outcome

Prepare a strong core of certified professionals who know how to navigate the health system 

and measure outcomes.  

Patient Navigator Program

The Market and Competition? 

• Harold P. Freeman Institute,  Harlem, NY (onsite and online)• University of Miami - Alfus Patient Advocacy Program,  Florida (online)• Antioch University Midwest, Dayton, Ohio • UC Berkeley Extension Health Advocacy Program, California• Cleveland State University, Ohio (onsite)• Colorado Community College, Colorado (onsite)• EmpowerED UCLA Extensions, (online)• Sonoma State University,  California (onsite)• Sarah Lawrence College, NY, (onsite)• University of Illinois at Chicago, Illinois (onsite)• University of Toledo, Ohio (onsite)