Where did patient navigation come from?

Patient navigation began in 1990 at Harlem Hospital Center in New York. Dr. Harold P. Freeman, a surgeon, started it after the American Cancer Society’s 1989 National Hearings on Cancer in the Poor found that poor patients met barriers at every step from an abnormal finding to treatment. Freeman and Rian Rodriguez set out the model’s history and principles in Cancer in 2011. They define navigation as a community-based intervention that removes barriers to timely diagnosis and treatment.

Congress first funded navigation through the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005 (Public Law 109-18). It created a Health Resources and Services Administration (HRSA) grant program for navigators in underserved communities.

Does patient navigation work?

Patient navigation shortens delays in cancer care, most where delays are worst. The strongest evidence is the National Cancer Institute’s Patient Navigation Research Program, reported by Freund and colleagues in the Journal of the National Cancer Institute in 2014. Across 10,521 patients with abnormal screening results and 2,105 with a cancer or precancer diagnosis, navigation made no difference in the first 90 days but sped up diagnosis and treatment from day 91 to day 365. Centers with the longest delays under usual care benefited most. Most participants were from racial or ethnic minority groups and were publicly insured or uninsured.

What is oncology navigation?

Oncology navigation is patient navigation within cancer care, and it has its own professional standards. In 2022, a task force of professional bodies, including the Oncology Nursing Society (ONS), AONN+, and the Association of Oncology Social Work, published the Oncology Navigation Standards of Professional Practice. The standards recognize three professional roles:

• Clinical oncology nurse navigators: Registered nurses who handle clinical education, symptom triage, and care coordination.
• Social work navigators: Licensed social workers who address psychosocial, financial, and family barriers.
• Patient navigators: Non-clinical navigators who handle scheduling, logistics, and connections to community resources.

Accreditation also shapes the work. The Commission on Cancer’s 2020 Standards include Standard 8.1, Addressing Barriers to Care. Under it, an accredited program’s cancer committee must identify at least one barrier to care its patients face and put a plan in place to address it. Navigation is usually how that plan gets delivered.

What does a patient navigation program include?

A patient navigation program includes navigators, a way to decide which patients need the most help, a list of resources to refer patients to, and a set of metrics.

• Staffing: Usually nurse navigators for clinical questions and non-clinical navigators for practical and logistical work. But programs have been using lay navigations and social workers to fill these positions amid staffing shortages.
• Acuity: An acuity score rates how much help each patient needs, so caseloads can be balanced. AONN+ has developed a National Oncology Navigation Acuity Tool for this.
• Metrics: AONN+ and the American Cancer Society published the Navigation Metrics Toolkit in 2020. It gives standard definitions so programs can compare results.
• Resources: Current, vetted options for the barriers patients report, such as grants, rides, lodging, and help at home. Keeping that list current is ongoing work, as Navigating the maze describes.

Many programs track caseload and acuity with oncology navigation software.

How AI is Being Used in Patient Navigation

AI Patient Navigation is We Are Here’s patient navigation model, in which AI-assisted technology matches each patient to vetted resources and a survivor-led team provides the human support, so the patient gets a personalized plan within hours, sometimes minutes. It runs alongside a cancer program’s own navigators in five steps:

1. Capture: The patient or a navigator records needs in a short intake. 87% of users self-onboard.
2. Match: AI-assisted matching builds a short, prioritized list from thousands of vetted resources across over 30 cancer resource categories, in minutes instead of days.
3. Guide: A dedicated We Are Here Guide works through the plan with the patient by phone, email, or text.
4. Check in: Automated check-ins ask whether the patient actually received the help and pick up new needs, so a referral counts as closed when the help arrives, not when it is sent.
5. Report: Program managers see which resources were recommended, which were used, and which needs went unmet.

The model extends the capacity of a program’s clinical navigators rather than replacing them. 86% of patients are still active after 12 months. It has helped non-profit and for-profit health system improve their patient navigation programs and help patients get timely help while allowing the health systems track and monitor exactly which resources help and how much help were they able to provide.

Who pays for patient navigation?

Hospitals long paid for patient navigation from operating budgets or grants. Since January 1, 2024, Medicare pays for it directly. In its CY 2024 Physician Fee Schedule, CMS created Principal Illness Navigation (PIN) codes G0023 and G0024. These codes pay for navigation of patients with a serious, high-risk condition such as cancer, delivered by trained auxiliary staff under a billing practitioner’s direction. Billing requires an initiating visit and the patient’s documented consent. The requirements are covered in Principal Illness Navigation codes.