The right patient, at the right place, at the right time

Here’s what you should know about patient navigation services A recently-published U.S. study found that only 12% of patients have the skills required to navigate the healthcare system. This will come as no surprise to pharmacists. So many of the patients we see every day end up in our pharmacies searching for a way to get care, even if their current healthcare need is very far from what we ourselves can currently provide. At a time when many care providers, including community-based pharmacists, are looking at expanding their scope of practice, we now face a new problem: even people (such as telehealth nurses) who once were experts in sending patients toward specific services are being outpaced by the speed with which healthcare and the options for service have been evolving. This is especially true in recent months. Traditional navigation systems The problem of “where should we send this patient?” is by no means unique to Canada, and it existed well before the pandemic. In an attempt to meet this need, several companies have launched patient navigation services in recent years. At first, these systems were human powered; based mainly in the United States, they were aimed at private insurers. Enterprises such as Included Health, Accolade and Castlight were pioneers in this emerging industry. They operated by training healthcare and benefits staff and renting them to clients (health insurers, benefits consultants, employee assistance plans) who needed a way to nudge each patient toward the right virtual or in-person healthcare provider. But in many of these cases, figuring out what was meant by “the right provider” was—and still is—defined by these clients, not necessarily by patient need. Some systems were incentivized to send patients towards the least expensive care options, while others used different criteria. These companies and their services showed amazing efficiency results in multiple studies and white papers, but the high price point of their services and a not-so-clear return on investment have slowed their movement into single payor markets such as Canada. Read: The pros and cons of chat-based healthcare Enter AI-powered navigation systems Thanks to rapid advances in Artificial Intelligence (AI) development, a new way of handling patient navigation has emerged in recent years. Three major services: Buoy Health, Infermedica and Babylon can now be leveraged by payors at a lower cost to power white-labeled navigation services. As an example, Babylon’s AI, once used by the U.K. equivalent of Telehealth (called NHS 111), is now incorporated into Telus Health MyCare. This service allows patients to establish—without the need to call a human navigator—whether their current situation should be assessed by a doctor. Telus is now selling this capacity, among others, to employers and other payors. Navigation in the public sector Now that patient navigation has become more financially accessible in Canada, more provinces are showing interest in using AI-enabled services as a costcutting strategy. For instance, Quebec’s Ministry of Health recently launched its Primary Care Access Points service. People on the province’s waiting list for a family doctor can contact the Primary Care Access Point in their region to request a medical consultation. Their request is then analyzed and the system directs them to an appropriate professional or medical service. The service was launched just months after the completion of a pilot project that showed that using navigation systems, 50% of orphan patients can be safely directed toward a non-physician provider. Read: A new generation of health services marketplaces It will be interesting to see how B.C., with their HealthLink 811 human-led navigator system, will adapt to AI’s newest capacities. What is certain is that AI-based systems are always at risk of bias. Patient navigation is no exception. Should the pharmacy profession not be sufficiently considered by the algorithms used by these services, we may have an even harder time showing stakeholders how much value we can bring to the system. It is imperative that pharmacy is engaging with these companies to ensure that they are aware of the range of services that pharmacists can perform for patients. It’s equally important, as non-human systems begin to make decisions about directing patients to our care, that all of us perform at our full scope of practice. Alexandre Chagnon is a Quebec-based pharmacist and holds a post-graduate diploma in Health Informatics. He founded two Healthtech companies, acts as a consultant for health informatics organizations in Canada and in the US, and is in charge of a new fast-paced health informatics program aimed at working healthcare professionals at Université Laval.