Breaking Down Barriers to Care: Cancer Navigation Program

The Cancer Navigation program offered through the Florida Alliance for Healthcare Value has helped our members better understand their benefits when they are confronted with a cancer diagnosis, helping them to make more informed choices. It has also given them someone outside the District to help with questions and concerns about care and services.”

— Beth Curran, Senior Director, Risk Management, Orange County Public Schools

“Through participation in the Cancer Navigation program, employers can bring great value to individual employees living with cancer by supporting their medical and financial needs in ways that were not possible before. This unique partnership between the Florida Alliance for Healthcare Value and the Patient Advocate Foundation also provides an opportunity for continued process improvements.”

— Fran Castellow, MSEd, President, Operations, Patient Advocate Foundation

The Pharmacy Benefit Management Institute (PBMI) awarded its 2020 Care Management Strategies Excellence Award to the Florida Alliance for Healthcare Value and the Patient Advocate Foundation for the Cancer Navigation Program.

The Challenge

  • Cancer surpassed cardiovascular disease as the leading cause of death in Florida in 2011, but it had been the top killer in Orange County since 2007. — Florida Department of Vital Statistics
  • The growing burden of cancer on the population has led to increasing costs for Florida employers. Based on the Florida Alliance for Healthcare Value’s surveys of health plan sponsors, cancer treatment costs exceeded 15% of total medical and pharmacy expenditures in 2013, up from 5-6% in 2005.
  • Cancer was also reported to be the leading cause of short- and long-term disability for our employer members. More specifically, employers found that employees were:
    • Increasingly frustrated navigating the cancer care system
    • Wanted more information about treatment options
    • Not fully aware of benefits available through their employer
    • Needed advice and assistance with non-medical needs in support of their cancer treatment

Subsequently, the Florida Alliance for Healthcare Value implemented a pilot project that embedded a nurse navigator in a benefits department.

  • Engagement in the health plan’s medical case management program increased eight-fold from 46 the prior year to 434 in the first year of the new program.
  • Per month per member cost/medical claims for cancer dropped 18.1%. The cost savings were attributed to decreased use of the emergency room and fewer hospitalizations.
  • Program participants rated the benefit of the services an average 9.3 out of 10, and 100% would recommend the program to others.

These findings informed the development of our Cancer Navigation Program.

Our Solution: Providing Direct, Compassionate and Effective Support and Education

To scale our efforts, we partnered with the Patient Advocate Foundation (PAF), a national 501(c)3 non-profit organization that provides case management services and financial aid to Americans with chronic, life-threatening and debilitating illnesses. Our Cancer Navigation Program provides each participating employer with a specially trained navigator to serve as a trusted resource for that employer, helping patients overcome the physical, emotional, social and financial barriers to receiving timely cancer treatment. Specific program goals include:

  • Improving employees’ understanding and utilization of their benefits
  • Reducing financial and emotional stress
  • Increasing access and adherence to care
  • Making a positive impact on employee productivity and satisfaction

The Cancer Navigation program complements the medical case management programs typically offered by health plans and providers. In addition to the support provided, the Florida Alliance for Healthcare Value serves a continuous quality improvement role, addressing specific barriers to care that are identified by the individual Cancer Navigators, including:

  • Benefit design issues
  • Individual provider concerns
  • Prior authorization process challenges

As we address individual cases and challenges that impact a single patient or employer, we are working to improve policies and procedures that benefit all. 

Launched in 2019, the Cancer Navigation Program is available as a benefit offering to all Florida Alliance for Healthcare Value employer members.

Genentech and Amgen generously fund the development and evaluation of the Cancer Navigation Program.

Contact

For more information on our program, please visit https://mybenefitnavigator.org/ or contact Karen van Caulil, PhD.