Insurers to Expand Access to ‘Navigation Services’ for Cancer Patients

WASHINGTON — Seven of the nation’s largest health insurance companies are expanding access to so-called “navigation services” to help patients and their families navigate the myriad challenges that might arise during treatment for cancer and other serious illnesses.

The insurers involved are Aetna; Blue Cross Blue Shield of Minnesota; Elevance Health; Health Alliance Plan; Humana; Priority Health; and Select Health, which together serve more than 150 million patients.

Their commitment to adopt a new regime of navigation codes was announced by First Lady Dr. Jill Biden on Wednesday during a roundtable discussion related to the Biden administration’s Cancer Moonshot.

The moonshot, a resumption of an initiative then-Vice President Joe Biden oversaw during the Obama administration, is a marshaling of resources across the federal government to speed progress in cancer research and advances in cancer prevention.

The broad goal of the program is to prevent more than 4 million cancer deaths by 2046 and, in the administration’s words, “to improve the experience of people who are touched by cancer.”

“Navigators guide patients and their families through the complex and daunting world of cancer,” Dr. Biden said on Wednesday. “They help patients with everything from scheduling appointments to keeping track of medications to coordinating things like transportation and child care.

“When you have someone who knows the system by your side every step of the way, it changes everything,” the first lady added.

The problem — “for too long,” Dr. Biden said — is that these services simply haven’t been available to many Americans.

And the reason was gallingly bureaucratic — the proper billing codes simply didn’t exist.

“This meant that insurers couldn’t pay for patient navigation services, so most medical practices couldn’t provide them,” Dr. Biden said.

Through the Cancer Moonshot, the Biden administration put in place new billing codes that Medicare and other health insurers could use to pay for these services.

The first lady applauded the insurers who joined her in the Roosevelt Room of the White House for stepping up and buying into the new billing code regime.

“That choice will change lives — and save them,” she said.

“It’s not just the right thing to do for patients, it’s also the right thing for your businesses,” Biden continued. “Patients with navigators miss fewer appointments, are more likely to complete their treatment and are less likely to need to go to the emergency room or be hospitalized.”

In addition to the involvement of the insurers, Biden also announced that 40 comprehensive cancer centers and community oncology practices nationwide have committed to using the new navigation codes to provide patient navigation services to their patients who are battling cancer.

Specifically, the insurers, comprehensive cancer centers and community oncology practices have committed to:

• Provide and cover navigation services using appropriate coding, including CPT codes 99424-99427, and, as applicable, HCPCS codes G0023-G0024, as well as tracking utilization and reimbursement metrics for these codes.
• Capture utilization of navigation codes across patient demographics, including but not limited to geography, race and ethnicity, and sex and gender, where available.
• Track associated health outcomes of patients who are benefitting from navigation services, such as number of emergency room and urgent care visits, available patient-reported outcomes, and other care quality and experience measures.
• Support the provision of evidence-based navigation services to patients and caregivers in accordance with the Oncology Navigation Standards of Professional Practice, which describe the knowledge and practices navigators should provide in order to deliver high-quality, competent and ethical services to people affected by cancer.

According to Biden, these steps will have real-world benefits.

They include “the father who will be able to enroll in a cutting-edge clinical trial because his navigator helped him find it,” she said. “The student whose pain no longer keeps her from class, because her navigator is helping her control the side effects of her treatment. … The grandmother who can keep traveling and seeing her grandkids because a navigator helps her follow her treatment plan.

“Yes, the word cancer has the power to strike fear into our hearts. But, as we’ve seen today, we have power too,” the first lady said.

Along with the roundtable’s other announcements, Biden said that a number of national health plan and provider associations have pledged to educate their membership about how to use the new codes.

These associations include the Alliance of Community Health Plans; Association of American Cancer Institutes; Association of Cancer Care Centers; Blue Cross Blue Shield Association; Community Oncology Alliance; and Self-Insurance Institute of America.

Together, the associations represent more than 950 payer members and more than 2,750 cancer centers and independent oncology practices, which serve hundreds of millions of Americans.

“Through the Biden Cancer Moonshot, we’re building a world where our power is greater than ever before, where patients and their families have a trusted navigator by their side, where no person has to face cancer alone. And I can tell you from personal experience that it makes all the difference,” Biden said.

Dan can be reached at [email protected] and @DanMcCue