Reduction in cancer spending due to patient navigation.

Abstract

557 Background: Patient navigation strategies present a viable approach for enhancing care coordination and symptom management for patients with cancer, thereby achieving cost savings. Traditionally, these patient navigation programs are established by providers operating within their own health systems. We explore whether an independent, virtual patient navigation program deployed within the cancer patient population of Clover Health, a regional Medicare Advantage (MA) plan, can achieve reductions in total cost of care (TCOC). Methods: This retrospective cohort study used a difference-in-differences analysis of cancer patients on systemic treatment from September 2021 to February 2023 to analyze changes in TCOC as a result of enrollment into a third-party, virtual navigation intervention conducted by a team of nurses and lay navigators. A unique element was the assignment of an acuity score at the outset, combining disease and treatment factors, comorbidities, recent acute care utilization, and social determinants of health data, which allows for stratification of patient cohorts in analyses and a more personalized navigation approach. The primary outcome was TCOC for medium and high acuity patients who received the intervention to a control group of individuals, matched on acuity and diagnosis, and eligible but not enrolled in the intervention. Results: During the study period, the program population consisted of 482 members after matching, with 289 members in the treated group and 193 members in the control group. We find a significant -$1676.67 (95%CI, -$2,984.15 - $369.20) decrease in TCOC per patient for the treated group vs the control group, which corresponds to $639.75 PMPM savings. The PMPM savings was estimated by dividing -$1,676.67 by the average number of member months in the enrolled period (2.62). The bulk of this appears to be driven by the -$875.00 (95% CI, -$1,534.05 to -$215.96) reduction in costs related to acute care utilization for the treated group vs the control group, which corresponds to $333.97 PMPM savings. Conclusions: These findings suggest that a third-party virtual navigation intervention can improve health outcomes and reduce overall medical costs for the cancer population.