[Answered]: Kamala knew that things had not gone well as she lay…

Kamala knew that things had not gone well as she lay in her hospital bed thinking back on how she ended up in the hospital with stage 4 breast cancer and tubes coming and going from almost everywhere. Her mind was clear even though her body was failing. She often wondered how she got to this point. She felt like she was in it on her own not understanding the complexities of the U.S. health system. “They couldn’t have invented a more complicated system if they had tried,” she thought to herself. Sandra, the woman in the next bed, was there to have breast cancer surgery too, but it was early, and she kept talking about Bonnie who she called her “health navigator.” What was health navigation, Kamala wondered. Sandra was ready and willing to fill her in. The U.S. health system, both preventive and therapeutic, is a complicated system not designed to be easily navigated even by those with a health background. The need for help navigating the health system has existed for decades. The need has been partially filled by nurses, medical social workers, and a range of other health professionals who have seen the need and extended their efforts beyond their formal professional responsibilities. Despite the complexity of the health system, however, it has not been anyone’s responsibility to see that the average person makes it through the maze. The people needing health navigation today range from those with limited English to those with limited health literacy; from those with complex diseases such as advanced cancer and HIV to those with complex social-economic problems; from those with no or with limited health insurance to those without an understanding of how to utilize their health insurance. In fact, it is increasingly difficult to find anyone who would not benefit from some help getting through the system. Health navigation is beginning to emerge as a health profession as part of the development of a comprehensive health system. The field today includes paid positions and a confusing mix of job titles. Three areas of focus, and associated job titles, have begun to emerge: community health worker, patient navigator, and health insurance navigator. As the names imply, community health workers are usually outpatient based and help patients obtain services in their home or community, often with an aim of preventing readmission. Patient navigators are often institution based, often hired by a hospital, to assist complicated patients navigating a large institution, including preventing unnecessary readmissions. health insurance navigators help the sick and the healthy identify and utilize available health insurance. Most individuals at some point in their lives need all three of these types of services. To fill these needs, health navigation professionals need to know about prevention and community health, the U.S. healthcare system, as well as its health insurance system. They also need to be able to access and analyze health information, have health communication skills, and have hands-on experience serving as a health navigation professional. Realizing the potential of health navigation still requires acceptance of health navigators as part of the healthcare team and efforts to make their work cost-effective. Nurses whose education is enhanced by additional knowledge of community health, the U.S. healthcare system, and the U.S. health insurance system can become excellent health navigation professionals. Therefore, it is not surprising that nursing programs are beginning to teach the special skills and knowledge needed for health navigation. After a few minutes of silence, Kamala said to Sandra, “So what could a health navigator have done for me?” “Are you ready? This might be painful,” Sandra said, “I’ll tell you all about it” and she did. Sandra told Kamala, “Health navigation professionals in the community often focus on ensuring that people like you get preventive services. Mammography—as well as a wide range of preventive services—are now covered by nearly all health insurance, so why not take advantage of this and detect the disease early? Health navigation professionals often encourage screening, arrange for appointments, and ensure that patients follow-up. There is growing evidence that health navigation increases the rates of screening and early diagnosis.” Sandra went on, “That’s not all that health navigators do: They help patients access and coordinate care. This is especially important for patients like you who have complex problems and need to coordinate care both before and after hospitalization. Hospitals are increasingly recognizing this and Medicaid has helped by creating a 30-day readmission rule that penalizes hospitals when patients are readmitted within 30 days for the same diagnosis. Helping the sick and the healthy get the right health insurance and maximizing its benefits is becoming an important part of the work of health insurance navigators. Health navig