Paying for Colorectal Cancer Screening Navigation Toolkit Strategies for Payment and Sustainability 1 The Toolkit is divided into distinct chapters. These chapters are based on the specific focus areas that are most central to paying for and sustaining colorectal cancer screening patient navigation. Contents: Chapter 5 Quality and Accreditation Standards Introduction for Colorectal Cancer Screening Patient • General Introduction 58 Navigation • Definition of Patient Navigation • Goals and Objectives 02 • Contents and Audience of Toolkit • Background • How To Use The Toolkit • Accrediting Organizations • Patient Navigation as a Model • Non-Accrediting Organizations • Development of the Toolkit • Cancer Center Accreditation Initiatives Chapter 1 Chapter 6 Sustainability Framework Economic Analysis and Making the 08 • Goals and Objectives Business Case for Colorectal Cancer • Background 73 Screening Patient Navigation • Sustainability Central Tenants • Goals and Objectives • Background • Critical Questions and Chapter 2 Considerations Evidence Base for Colorectal Cancer • Cost Analysis Review 10 Screening Navigation • Stakeholders in Cost Analyses • Background • Measurement and Need for High • Sources of Evidence Cost Analyses • Patient Navigation Promoting • Measuring Intangibles to Society Equal Health Opportunities for All and Systems • Priority Populations for Colorectal • Partnering for Cost Analysis Cancer Screening Patient Navigation Chapter 7 • The role and Scope of Colorectal Policy Standards for Colorectal Cancer Screening Patient Navigation Screening Patient Navigation 85 • Goals and Objectives • Contextual Policy Background Chapter 3 • Federal and National Strategies Local, Regional and State • Recommendations for States and Colorectal Screening Patient Territories 25 Navigation Programs • Additional Policy Considerations º Institutions and Organizational • Goals and Objectives Policy • Background º Advocacy • Programs • Colorectal Cancer Screening and º New York City º New Hampshire Policy Work-Applying the Principles º Colorado º Alaska º South Carolina Chapter 8 Evaluation of Colorectal Cancer Screening Patient Navigation Chapter 4 97 • Goals and Objectives Payment Approaches for Colorectal • Background Cancer Screening Patient Navigation • Overview of Colorectal Cancer 41 Screening Navigation Measures, • Goals and Objectives Variables, Data Collection and • Background Source Information • National Agencies and • Benchmarks for Success Foundations for Funding • Colorectal Cancer Screening Data • Health Care Insurers Affordable Metric Tools Care Act • Medicaid Coding and Billing Chapter 9 Beyond the Affordable Care Act Closing and Supplemental Resources 1 102 The Paying for Colorectal Cancer Screening Patient Navigation Toolkit is designed to help Colorectal Cancer health care professionals at every stage of a navigation program plan for sustainability and Screening Patient find ways to seek reimbursement for colorectal cancer screening navigation. Of course, we want to keep top of mind that colorectal cancer screening Navigation Tookit navigation is designed to reduce health disparities and improve health outcomes for your patients. In Introduction our case, this means increasing colorectal cancer screening rates and reducing death and suffering from colorectal cancer. Lead Devloper: Andrea (Andi) Dwyer The Colorado School of Public Health Advisors: Dr. Betsy Risendal and Dr. Holly Wolf The Colorado School of Public Health 2 Definition of Patient Navigation To maximize the usefulness of the toolkit, we have • Describe and connect how the necessary adopted the following general concepts to provide components for a colorectal cancer screening a working definition for Patient Navigation and Patient Navigation can be sustainable. the framework for the toolkit. • Provide examples of evidence-based strategies • Patient Navigation is a model of care that and quality standards for colorectal cancer aims to reduce an existing health disparity as screening navigation. defined in a particular community. • Strategize for whom and how you will prioritize • Patient Navigation addresses a patient’s colorectal cancer screening navigation and individual barriers to care by linking them to priority populations for screening. existing local and regional resources, not by creating new resources or services. • Examine programs and approaches to colorectal cancer screening Patient Navigation • Patient Navigation is not just a patient throughout the U.S. and learn from their work navigator; navigation requires a team to understand payment models and methods approach: administrators to champion the for sustainability. program, supervisors to provide clinical and administrative support, and patient navigators • Analyze the direct payment methods to pay for with a defined role within the healthcare colorectal cancer screening Patient Navigation 1 team. and think about how to apply to your setting. • Patient Navigation promotes system-level • Explore making the business case for colorectal change to ensure connectivity between cancer screening Patient Navigation - including the need for screening, screening, and any patient outcomes, quality measures, and cost necessary follow-up services analysis. Understand the prime components and resources necessary to undertake this work, For Colorectal Cancer Screening Patient and apply what’s already been achieved in the Navigation, these primary elements are critical, field. and we will examine how these fundamental aims are integrated to ensure quality. The examples • Based on your setting, critically review the provided primarily focus on navigation into accreditation and quality measures that might endoscopic screening but also include examples be met with colorectal cancer screening of navigation for stool based testing (FIT and navigation in a variety of health care settings. FOBT). The following chapters will present evidence for screening Patient Navigation as an • Educate about the types of policy initiatives intervention and our deliberate intention to which have been utilized to help ignite or recommend this strategy to increase colorectal bolster work for colorectal cancer screening cancer screening rates. Patient Navigation. This Toolkit contains evidence-based and • Evaluate Patient Navigation programs with the experience-based examples, case studies, practical aim of continuous quality improvement. tools, and resources to help you: 3 Audience The toolkit was designed for a variety of health care professional including: • Administrators in primary care settings, gastroenterology centers, and community settings. • Program planners • Patient navigators • Policy advisors • Researchers • Business Managers • Insurers • State and National Program Planners Using the Toolkit As the name implies, the toolkit provides a selected set of tools and resources that are useful in different phases and aspects of navigation programs. Like a physical toolkit, you may not need to use every tool, or even read every chapter or section, you’ll use only the tools you need for your specific situation. Thus, we encourage you to begin by scanning each volume’s list of chapters in order to see what will be most relevant to your situation and need. Each chapter focuses on the key elements of sustainability relevant to its audience. You may choose to read our toolkit straight through, or pick out the chapters relevant to your cause and start from there to then further examine themes of sustainability in subsequent chapters. In some ways, this might be like a ‘Choose Your Own Colorectal Cancer Screening Navigation Adventure.' The design of this Toolkit is very similar to the use of icons and themes utilized in the Boston and Avon Toolkit, based on positive feedback from the Patient Navigation community. Special thanks to Dr. Tracy Battaglia and team for their support1. Please note, that because of the volume of information, many of the resources included are found online. 4 Each chapter is organized into printed resources, online resources, tasks, tools, templates, and case studies so that you can: READ MORE ABOUT IT Recommended published materials that address Patient Navigation in more depth or from other perspectives than those presented in the toolkit, including scientific articles, books, journal articles, training curricula, and websites FIND IT ONLINE Recommended online materials that supplement reading resources with free online information, tutorials, and other navigation program websites STOP AND DO IT Interactive tools where you will be asked to complete a task, reflect, or answer questions to guide learning and decision-making processes, such as checklists and Q&A sections USE IT “AS IS” OR ADAPT TO YOUR NEEDS User-friendly instruments that are adaptable, task-specific, and linked to evidence-based recommendations, such as diagrams, monitoring and evaluation tools, case, and other practical materials that you can use without alteration CUSTOMIZE FOR YOUR NEEDS Easy-to-adapt structured document that you can use for your own purposes as a tool to generate ideas or a template to mold to your needs, including blanks, ‘fillable’ forms, and example protocols SEE IT IN ACTION Case studies and descriptions based on true stories that illustrate a concept, explain how a tool is used, or identify pitfalls and solutions using lessons learned from our experience as well as observational research conducted on navigation programs FREQUENTLY ASKED QUESTIONS It’s all in the title! 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