COPD Navigator:
The keystone of integration success
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COPD has reached critical status in the American healthcare system. According to the National Heart, Lung, and Blood Institute, Americans spent more than $32 billion on COPD-related patient care in 2010. And those costs are projected to increase to $49 billion by 2020.1
Readmission penalties pose a critical threat2
2,597
hospitals were penalized for patient readmissions in 2017, under the Medicare Hospital Readmissions Reduction Program (HRRP)
Over
528 million
in hospital payments were withheld
According to Gary Kauffman, COPD care can be even more effective when patients follow health directives and make positive healthy lifestyle choices. This is easier said than done, considering the large number of clinic visits a COPD patient typically makes, and the dozens of different medications and health directives given by the many doctors a COPD patient typically sees. Kauffman explains: it’s time to accept that the burden of COPD care doesn’t reside solely with the patient. Healthcare systems must manage patients across multiple settings and providers. Too often, patients slip through the cracks and reemerge with costly conditions because they lack continuity of care across the continuum. Thankfully, a new resource has emerged to help combat rising costs and improve quality of life for COPD patients – and it’s already making waves in the industry. It’s called the COPD navigator.
We’re now held accountable to the full continuum of care.”
Garry Kauffman, RRT, FAARC, MPA, FACHE
RT, Owner, Kauffman Consulting, LLC
Contributors
M. Bradley Drummond, MD, MHS
Clinical Associate Professor
University of North Carolina School of Medicine’s Division of Pulmonary Diseases and Critical Care Medicine
Garry Kauffman, MPA, RRT, FAARC, FACHE
RT, Owner
Kauffman Consulting LLC
Bobbie V. Kumar, MD, MBA, FAAFP
Medical Director, Swedish Edmonds Urgent Care Director, Complex Care Management for Vituity
Kimberly Palczynski, RRT
RT COPD Navigator Inova Health
Tammy Stucki, RRT-ACCS
Pulmonary Disease Navigator
Intermountain Healthcare, Dixie Regional Medical Center
What is a COPD navigator?
Our insiders illuminate: A COPD navigator accompanies the patient throughout the care journey – both within the clinical setting and at home. Navigators facilitate the longitudinal care process, advocating for the patient at every step. Through routine check-ins, they help make sure patients are aware of the medical and rehabilitation services available to them, and they ultimately empower patients to improve their own quality of life and overall health. When dealing with a disease that manifests differently in each individual, the navigator’s patient-centric approach can make a dramatic difference.
Navigators can:
Bridge care gaps
Reinforce continuity of care
Connect patients with key services
Integrate treaters across location
Ensure a holistic care approach
The COPD navigator model works, says Dr. Bobbie Kumar, because it builds a one-on-one educational rapport between the navigator and patient: “Patients feel empowered. They feel like they understand their disease. They feel like they’re connected to somebody who can get them to the resources that they need.” After all, when COPD care evolves to become patient-centric rather than discipline-centric, everyone wins.
Traditional COPD care model1
When each provider acts independently without communicating to coordinate care, care is more complex and less integrated. As a result, patients are more likely to diverge from the health directives and experience a worsening condition.
COPD navigator care model
When a navigator connects the patient and their various providers, the patient has a better understanding of the various elements involved in managing their own health. As a patient advocate, the navigator acts as the care process facilitator to help providers engage with one another and to ensure care plan information is being shared and broadly owned.
The trick is to get everyone to communicate around the patient across settings.”
Kimberly Palczynski
RT COPD Navigator, Inova Health
Navigating successfully
How should navigators engage? Where should they intervene, and where should they not? According to our insiders, here are two key behaviors that enhance a navigator’s value. Provide cross-disciplinary education A large part of a COPD navigator’s role is to educate patients and providers on COPD care overall. For instance, a respiratory therapist (RT) who acts as a navigator should also have a deep understanding of other areas of COPD care, including primary care, pulmonology, diet/nutrition, exercise, and mental health. Kumar believes that the more holistically educated a navigator is, the less likely a patient is to experience an acute health emergency: “It comes down to the clinicians themselves really having a fundamental understanding of what the different care disciplines offer,” she says, “and how they can each benefit COPD patients to really optimize their care at home, so they're not having to return to the ER.” Intervene early Success also depends on the navigator’s ability to intervene in COPD treatment early, before the patient reaches critical status. With early intervention, the navigator can assist the patient in advanced care planning. Tammy Stucki explains that advanced care planning is a long-term commitment between the navigator and patient: “It's not just 30 minutes talking with the patient about their code status. The conversations should cover a broad range of social lifestyle topics, as well as long-term conversations about managing their disease.” Early intervention in COPD care management is also important in other ways, she adds: “We need to hit them up early in their disease process. If we wait to talk about holistic care planning while they're in the hospital with an acute exacerbation or on death's door, that's too late in the game.”
Removing the barrier to meds
Cost can be a key barrier with medications. COPD navigators should be able to help.
“Patients are limited by their health system and what meds they have on formulary,” says Kumar. “Switching meds because of affordability can be a risk, because you can’t anticipate clinical response.” Brad Drummond says navigators should try to gain expertise in ways to help reduce the costs of meds, such as inhalers. Here are three ways:
Who is your navigator?
A COPD navigator can come from a variety of traditional roles: Nurse. RT. Pharmacist. Social worker. And others. The bigger question is: Which skill set best serves your system and population?
Getting started with a COPD navigator program
Ultimately, each system must determine the most fitting approach, based on the constructs of the organization and its patient population. But one thing is certain: A successful navigator program requires a fundamental shift in the organization’s approach to care.
I think the ‘right’ model should be whatever works within your institution and your area. Each of us plays a role, and the navigator, maybe more than anything, is really the glue, as opposed to being discipline specific.”
Garry Kauffman, MPA, RRT, FAARC, FACHE
RT, Owner, Kauffman Consulting, LLC
Here are 2 primary models for how your COPD navigators can function and engage.
Ultimately, each system must determine the most fitting approach, based on the constructs of the organization and its patient population. But one thing is certain: A successful navigator program requires a fundamental shift in the organization’s approach to care.
The chronic disease champion
Drummond explains: “It's the person who's not only helping navigate the patient, but also being a champion for the disease process. And, oftentimes, these champions may be chronic disease champions. Multiple models have started with a COPD navigator and a CHF navigator and a diabetes navigator and then realized that because of comorbidities, really what you need is a chronic care navigator or a chronic care champion. I think that's one model.”
The COPD navigator program at UNC
At Drummond’s pulmonary clinic, COPD navigators play the traditional role, but with specific nuances that are carefully refined.
COPD navigator Role Key functions “She sees the patient every visit and talks about the issues the patient is facing. For instance, they may not have reliable electricity in their home, so their nebulizer doesn’t work. Or they may be living in an unstable housing situation; maybe drug abuse has become a problem so that's why they're not doing x, y, or z.”
The humanistic champion
Sometimes the best model involves scaling back on the clinical aspects, says Kumar. This means deploying someone who takes a more humanistic approach and focuses more on relationships – possibly someone who has been a caregiver. She explains: “This is someone who can delve into patient issues beyond the clinical. They can establish relationships and connect with services to address needs, almost like a peer-level resource who can speak at the patient’s level of understanding” Kauffman adds: “Often, these people are formally trained by diverse specialists to be community care workers. With a peer-to-peer connection, they can get to more truth and better understand social determinants.”
The keystone of integration
Regardless of their background or function, or how their program is structured, COPD navigators help redefine the complex COPD care process. By focusing on building relationships, navigators have the unique ability to facilitate conversations with patients and providers that may not happen otherwise. Perhaps even more importantly, navigators have a holistic grasp of the care being provided and can use that to manage the process on behalf of the patient and the system. Imagine how much time, effort, and money can be saved – and how outcomes can be transformed – when care is integrated and everyone is collaborating around one overriding concern: the patient. .
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Further reading
COPD insider
References 1. “COPD National Action Plan”, National Institutes for Health, May 2017 (https://www.nhlbi.nih.gov/sites/default/files/media/docs/COPD%20National%20Action%20Plan%20508_0.pdf)
2. “2,573 hospitals will face readmission penalties this year. Is yours one of them?”; Advisory Board, August 7, 2017 (https://www.advisory.com/daily-briefing/2017/08/07/hospital-penalties)
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