title: Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients With Cancer.
abstract: OBJECTIVE
  Lay navigators in the Patient Care Connect Program support patients with cancer from diagnosis through survivorship to end of life. They empower patients to engage in their health care and navigate them through the increasingly complex health care system. Navigation programs can improve access to care, enhance coordination of care, and overcome barriers to timely, high-quality health care. However, few data exist regarding the financial implications of implementing a lay navigation program.
  
  
  OBJECTIVE
  To examine the influence of lay navigation on health care spending and resource use among geriatric patients with cancer within The University of Alabama at Birmingham Health System Cancer Community Network.
  
  
  METHODS
  This observational study from January 1, 2012, through December 31, 2015, used propensity score-matched regression analysis to compare quarterly changes in the mean total Medicare costs and resource use between navigated patients and nonnavigated, matched comparison patients. The setting was The University of Alabama at Birmingham Health System Cancer Community Network, which includes 2 academic and 10 community cancer centers across Alabama, Georgia, Florida, Mississippi, and Tennessee. Participants were Medicare beneficiaries with cancer who received care at participating institutions from 2012 through 2015.
  
  
  METHODS
  The primary exposure was contact with a patient navigator. Navigated patients were matched to nonnavigated patients on age, race, sex, cancer acuity (high vs low), comorbidity score, and preenrollment characteristics (costs, emergency department visits, hospitalizations, intensive care unit admissions, and chemotherapy in the preenrollment quarter).
  
  
  METHODS
  Total costs to Medicare, components of cost, and resource use (emergency department visits, hospitalizations, and intensive care unit admissions).
  
  
  RESULTS
  In total, 12 428 patients (mean (SD) age at cancer diagnosis, 75 (7) years; 52.0% female) were propensity score matched, including 6214 patients in the navigated group and 6214 patients in the matched nonnavigated comparison group. Compared with the matched comparison group, the mean total costs declined by $781.29 more per quarter per navigated patient (β = -781.29, SE = 45.77, P < .001), for an estimated $19 million decline per year across the network. Inpatient and outpatient costs had the largest between-group quarterly declines, at $294 and $275, respectively, per patient. Emergency department visits, hospitalizations, and intensive care unit admissions decreased by 6.0%, 7.9%, and 10.6%, respectively, per quarter in navigated patients compared with matched comparison patients (P < .001).
  
  
  CONCLUSIONS
  Costs to Medicare and health care use from 2012 through 2015 declined significantly for navigated patients compared with matched comparison patients. Lay navigation programs should be expanded as health systems transition to value-based health care.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham2Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama at Birmingham.
authors.forename: Gabrielle B
authors.initials: GB
authors.lastname: Rocque
authors.affiliation: Division of Preventive Medicine, Department of Medicine, The University of Alabama at Birmingham.
authors.forename: Maria
authors.initials: M
authors.lastname: Pisu
authors.affiliation: Division of Preventive Medicine, Department of Medicine, The University of Alabama at Birmingham.
authors.forename: Bradford E
authors.initials: BE
authors.lastname: Jackson
authors.affiliation: Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama at Birmingham.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Kvale
authors.affiliation: Department of Nutrition Science, The University of Alabama at Birmingham.
authors.forename: Wendy
authors.initials: W
authors.lastname: Demark-Wahnefried
authors.affiliation: Division of Preventive Medicine, Department of Medicine, The University of Alabama at Birmingham5now with the Division of Preventive Medicine, The University of Tennessee Health Science Center, Memphis.
authors.forename: Michelle Y
authors.initials: MY
authors.lastname: Martin
authors.affiliation: School of Nursing, The University of Alabama at Birmingham.
authors.forename: Karen
authors.initials: K
authors.lastname: Meneses
authors.affiliation: Division of Preventive Medicine, Department of Medicine, The University of Alabama at Birmingham.
authors.forename: Yufeng
authors.initials: Y
authors.lastname: Li
authors.affiliation: School of Nursing, The University of Alabama at Birmingham.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Taylor
authors.affiliation: Division of Preventive Medicine, Department of Medicine, The University of Alabama at Birmingham.
authors.forename: Aras
authors.initials: A
authors.lastname: Acemgil
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham.
authors.forename: Courtney P
authors.initials: CP
authors.lastname: Williams
authors.affiliation: Division of Preventive Medicine, Department of Medicine, The University of Alabama at Birmingham.
authors.forename: Nedra
authors.initials: N
authors.lastname: Lisovicz
authors.affiliation: Division of Preventive Medicine, Department of Medicine, The University of Alabama at Birmingham.
authors.forename: Mona
authors.initials: M
authors.lastname: Fouad
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Kenzik
authors.affiliation: Division of Gynecologic Oncology, Department of Surgery, The University of Alabama at Birmingham.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Partridge
mesh_terms: D000368:Aged; D000407:Alabama; D003365:Costs and Cost Analysis; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D009369:Neoplasms / Q000191:economics*; D062526:Patient Navigation / Q000191:economics*; D012044:Regression Analysis; D012456:Salaries and Fringe Benefits; D014481:United States