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Referral navigators for high quality patient care

Lynn Lester, MD, Regional Medical Director for Cost and Care, Dallas-Fort Worth WellMed

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Seeing relationships between clinicians and patients as crucial to wellness, and with a vision for improving health care delivery for seniors, Dr. George Rapier III founded WellMed in 1990. 

Using the WellMed Care model, WellMed, a part of Optum, continuously strives to improve quality and lower costs.With a strong focus on primary and preventive care while using advanced informatics, WellMed produces high-quality outcomes, i.e., healthier patients.  

They have recently been recognized by The Joint Commission, the nation’s oldest and largest health care standard-setting and accrediting body, as an accredited Primary Care Medical Home and have been awarded the Gold Seal of Approval for Ambulatory Care.

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When a patient is facing a serious illness, we as clinicians want their energy spent on healing. 

As they make their way from urgent care to specialist to surgeon, patients are tested to keep medical visits organized, follow up with results, and make sure they communicate relevant information to each doctor. 

As health problems grow more complex, patients are challenged to learn the foreign language of health care terminology. 

New words like “computed tomography” (CT) scans, “platelet counts” and “adverse effects” are essential vocabulary, but difficult to make sense of and full of foreboding. 

We sometimes forget that our sick patients have a lot of responsibilities; managing their health care is only one of them. Their journey back to good health can take months, even years, and they often feel lost and overwhelmed along the way.

Referral navigators are professionals who work directly with a patient to provide support and schedule the logistical aspects of their treatment and care.

Navigating cancer

Cancer care, with its large teams of clinicians and profound life-changing effects, is the field with the most experience in offering referral navigators to patients. 

Evidence shows that with a navigator, patients are more likely to attend appointments, report important symptoms and receive timely screenings.*

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A human experience

When my sister was diagnosed with cancer, I saw firsthand the incredible challenge of managing your own care. A strong, intelligent and independent woman—she was stunned and overwhelmed by cancer. 

The psychological and emotional havoc of losing your health is so often underestimated, and it hit my sister hard. 

Her saving grace throughout treatment was her referral navigator. He took care of concrete tasks that were overwhelming to her. 

He scheduled her specialty visits and provided reminders for treatment follow up visits. He also checked in with her to assess any ongoing symptoms and ensured that she had the doctor-ordered routine surveillance.

Helping to overcome barriers

One snowy day, my sister was due to pick up her pathology slides from the hospital right across the street from her oncologist’s office. 

Those slides represented something potentially terrifying for her, and though her body could have made it, for my sister that one city street might as well have been the Grand Canyon.

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She told her referral navigator she could not get the slides for her first appointment with the oncologist. After a few questions to check in on her health, he recognized her emotional state and with her permission promptly delivered them across the street to her.

To this day, neither she nor I have ceased to be overwhelmed by the difference that short walk made and level of compassion that was demonstrated in that act of kindness that went beyond the call of duty.

The small gesture, the closing of a gap, and the extension of care specific to the needs of each particular patient, is where the power resides in the role of referral navigator.

Growing our program

WellMed plans to strengthen care coordination and improve care delivery with the addition of referral navigators. 

The ultimate goal of these navigators is to coordinate between Surgical Care Affiliates (SCA), MedExpress, specialists at USMD and primary care providers at both USMD and WellMed.

Complex care patients can benefit from a dedicated navigator who is able to make all referred appointments. They relay information about testing and update all team members with new patient information. 

Navigators even smooth wrinkles in transportation or challenges with prescription medication.

It is our hope that referral navigators will serve as a single point of contact that can put the patient in touch with the help they need.

Referral navigators meeting the quadruple aim

Every patient with complicated care—a malignancy, two or more specialists, regular testing or services such as dialysis—could benefit from a referral navigator. 

Our referral navigator program leads to better coordinated care, greater population access and an improved experience for the patient and doctor. Given this, I’m looking forward to changing lives for the better as this program is further developed and expanded.

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*Robinson-White, S., Conroy, B., Slavish, K. H., & Rosenzweig, M. (2010). Patient navigation in breast cancer: a systematic review. Cancer nursing, 33(2), 127-140.

This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice. 

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