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Care Navigators and You by Curaspan

Posted on 11/10/2015 by NTOCC ®

This article is reposted with permission from Curaspan, an NTOCC Partners Council member, following our "Navigating A Value-Based Market With A Care Transitions Focus" webinar last month.

October was a busy month for Curaspan. Amidst a flurry of regional ACMA events, our very own Cheri Bankston and Eric Chetwynd joined NTOCC for a webinar titled ‘Navigating A Value-Based Market With A Care Transitions Focus.’ The session was well attended – and there were a lot of questions about the role of Care Navigators in health care today. We thought we’d take the opportunity to do a multi-part blog series that takes a deeper dive into the role of Care Navigators. For the first installment, we’ll cover some of the basic facts about Care Navigators — who they are, what they do and where they fit. In future posts we’ll look at the tools Care Navigators use and how to advocate for a Care Navigator program at your organization.

 

So, what is a Care Navigator?
What do we mean when we refer to a Care Navigator? A quick Google search will yield an overwhelming number of results and provide various definitions about what Care Navigators are. Through conversations with our clients (thanks Ryan Marsh) and our own research and experience, we’ve settled on the following definition:

A Care Navigator is responsible for tracking and monitoring a patient as he or she transitions across the care continuum, from acute to post-acute settings. They are tasked with making sure the right care plan is executed through continued communication with the patient, the patient’s family and providers to assist in the coordination of services.

Do they have a clinical background?

Many of the webinar attendees had questions about the qualifications, training and background of a typical Care Navigator. The answer is, “It depends.” Our research has shown that Care Navigators are typically licensed Registered Nurses (RNs) with a background in nursing or social work. With that said, Case Management departments and ACOs are tackling population management in different ways and there are examples of teams using non-clinical staff as adjuncts to clinical. In this model, Navigators are overseen by licensed clinicians and do not render care. They arrange care and make sure care is received.

Okay, so Care Navigator is just a new term for Case Manager?

Not really. While there is a bit of overlap in responsibility between Care Navigators and Case Managers (CMs), the scope of work for the Navigator is more narrowly focused on getting the patient to the right setting at the right time. The clinical CM would have oversight and the Navigator would function as support to the CM staff. A better comparison for a Care Navigator is a Community Case Manager.

How do Care Navigators fit into a team?

We’ve seen organizations have success with blended models that use both licensed clinical staff and non-licensed support staff. It goes back to the population you’re trying to manage. For complex patients that are transitioning to skilled nursing facilities, it might make sense to have a RN oversee their care. If someone is transitioning home with services, a non-clinical navigator may be able to make follow-up phone calls, check in or help the patient book follow-up care and get prescriptions filled.

What we’re really trying to say is:

  1. Care Navigators will play an increasingly critical role in managing the care transitions for complex patients.
  2. With proper oversight, non-clinical staff can help overburdened Case Management teams manage larger populations.
  3. The role of Care Navigators in your organization will depend on the specific population you serve and your health goals for that population.

Watch the full presentation for more information on how organizations are navigating Value Based Care.