The landscape of oncology patient care is evolving with the introduction of new navigation services and payment models, as highlighted at the Patient-Centered Oncology Care® (PCOC) 2024 conference in Nashville, Tennessee. Industry leaders gathered to discuss innovative approaches to enhance patient care quality and outcomes through structured navigation programs.
New Navigation Codes and Implementation Framework
CMS's recent introduction of new navigation codes marks a significant shift in oncology care delivery. These codes, specifically designed for the Enhancing Oncology Model, require healthcare providers to dedicate 60 minutes monthly per patient to qualify for billing. The American Cancer Society has developed a certification program for navigators without advanced degrees, expanding the workforce capable of providing these essential services.
"We're excited about the new navigation codes that CMS released earlier this year," states Dr. Lalan Wilfong, Senior Vice President at Thyme Care and PCOC cochair. "The codes require 60 minutes of work a month for a patient in order to be billed, which is quite a bit of time spent with these patients."
Impact on Patient Outcomes and Cost Management
Patient navigation services demonstrate particular value for high-risk populations facing social determinants of health challenges. These patients typically experience higher rates of hospitalization and emergency department visits, making targeted support crucial for improving outcomes.
The implementation of navigation services presents a complex balance between service delivery and cost management. While these services can reduce emergency department visits and improve medication adherence, their costs factor into total care expenses, potentially affecting shared savings in risk-based payment models.
Future Directions and Challenges
Healthcare leaders advocate for more flexible payment models that can adapt to varying patient needs throughout their cancer journey. "What I would like to see happen with navigation over time is instead of a static 60-minute billing code that we have to do is to make it more flexible, because our patients' needs will vary over time," explains Dr. Wilfong.
The evolution of patient navigation services requires careful evaluation of their effectiveness and value. Key metrics for assessment include:
- Reduction in emergency department visits
- Decrease in avoidable hospitalizations
- Improved access to care
- Enhanced medication adherence
Innovation and Networking at PCOC 2024
Susan Sabo-Wagner, MSN, RN, OCN, NEA-BC, vice president of clinical innovation at the American Oncology Network and conference cochair, emphasized the importance of cross-industry collaboration. "PCOC really brings [together] quite a large group of very interesting people across the oncology spectrum," she noted, highlighting the conference's role in addressing reimbursement challenges and innovative solutions in oncology care.
