We get a lot of blank stares when we tell people what we do for a living. Our title is unfamiliar, but once we explain what we do, heads begin to nod.
We are Patient Navigators, a health care position that has emerged recently and must be commonplace if we’re to adapt to the changes that health reform will soon bring. While this emerging profession may seem specialized, it can have important implications for patients, insurers and the overall effectiveness and efficiency of the system itself. That is, if policymakers, insurers and health providers take action.
Let us explain.
Patient Navigators, where they exist, are essential members of clinical teams, providing highly technical and interpersonal skills. They help patients – and providers – with a range of things: figuring out insurance eligibility and coverage options; ensuring medical records are correct and bills are paid; facilitating referrals to specialists outside the patient’s medical home; and providing interpretation services for patients who may not speak sufficient English – or English-speakers confused with complex medical jargon.
In a state like California, interpretation and cultural competency are important. According to the UCSF Center for the Health Professions, California’s health workers don’t adequately reflect the languages and cultural backgrounds of their patients. As many as half of the newly insured do not speak English very well.
When providers can’t communicate with patients, there’s an increased danger of misdiagnosis, which can lead to greater problems – and cost. And while language is critical, there is also evidence that patients trust and engage more with providers who reflect their cultural background.
Take Filipinos, for example, the country’s second largest Asian-American population. Their health problems are often understudied, so last fall Asian Health Services and Filipino Advocates for Justice presented survey results identifying the most pressing health problems and barriers facing Filipinos. One finding was the need for medical interpreters and bilingual doctors who spoke Tagalog. Even though many Filipinos speak English, the study revealed a preference for providers that also speak their language.
The survey prompted AHS to add Tagalog to the languages our Patient Navigators speak. The position is already making a big difference. We’ve recently helped clear up confusion for one Filipino patient who needed a colonoscopy but didn’t understand the instructions from a nearby hospital. Another Filipino patient lost her family’s Medi-cal coverage because of paperwork confusion, which we helped settle in time for necessary appointments.
Patient Navigators don’t just benefit people who struggle with English; they play vital roles assisting the chronically ill, poor and elderly. (As the enormous baby boomer population ages, older patients will need help deciphering confusing new coverage and payment options – and diagnoses and medical instructions.) By reducing confusion – for any patient – Patient Navigators can improve the efficiency and cost of care within the whole system.
Currently, Patient Navigators and other “professional enabling services” aren’t reimbursable through fee-for-service payment structures. That must change. The new coverage options and other changes coming when health reform is fully implemented in 2014 require us to plan ahead.
Services like Patient Navigators should be reimbursed for the value they provide patients and providers alike. Otherwise we’ll see more blank stares – not about our titles but rather patients dumbfounded by a complex, unhelpful health care system.
M. Stephanie Sario (Clinic Administration Specialist/Tagalog Interpreter) and Christine Solis (Filipino Patient Navigator) work at the Oakland-based Asian Health Services.