A full-time community health worker helps a patient at Northpoint Health and Wellness Center in Minneapolis. Photo courtesy of the Minnesota Community Health Worker Program.

---

An ability to find your way through the health care maze could lead you to an encore career helping others as a paid “health navigator.”

The promise of cost savings is fueling the growth of a new category of jobs at hospitals and community health organizations helping patients understand medical advice, stick to their treatment plans and stay out of the hospital. The combination of healthier communities and lower costs creates a powerful encore career opportunity.

Health navigators, sometimes called patient navigators or community health workers, can be trained laypeople, or nurses or social workers. Some of the chores are routine, but invaluable to patients who are sick and often overwhelmed. Studies have found that patients recover better with a navigator to coordinate doctors' appointments, facilitate telephone contact between patients and doctors, arrange rides, help with insurance forms, and help patients prepare their questions for the doctor.

At the University of Maryland, for example, Anne McNerney helps the hospital's cancer patients with everything from arranging transportation to get to Baltimore for treatment to translating medical jargon into plain English. A cancer survivor now in her late 50s, she started as a volunteer at a hospital near her home; in 2005 she was hired as a patient navigator by the American Cancer Society, which shares her salary with the hospital.

"I almost wish we could call ourselves 'hope coaches,'" she told reporter Stephanie Desmon of the Baltimore Sun. "I think everyone has the opportunity to get better."

The first patient navigator program was launched in 1990 by Dr. Harold Freeman of the American Cancer Society in 1990 to address disparities in medical care for low-income, immigrant and other underserved populations. That’s still a major goal, but navigator programs are drawing new attention as policymakers search for health care cost reductions to pay for expanded health insurance coverage.

Patient navigators can help "anyone who finds the health-care system confusing and difficult to use, poor and rich alike," Dr. Kevin Fiscella of the University of Rochester told Parade magazine.

One target is costly return trips to the hospital, particularly for elderly patients. Such readmissions cost the federal government an estimated $17 billion a year, making them a prime target of cost-cutters, particularly if the solution keeps people healthier. President Obama’s health care plan projects savings of $8 billion by encouraging hospitals to reduce readmission rates.

The health navigator job category is growing rapidly, though exact data is hard to find. A 2007 study estimated there were approximately 121,000 community health workers in 2005, up 41 percent from 86,000 in 2000. More than 700 hospitals and other facilities have established patient navigator programs, including 120 run by the American Cancer Society. The federal Health Resources and Services Administration is running patient navigator pilot programs in Brooklyn and Los Angeles.

The federal Patient Navigator Outreach and Chronic Disease Prevention Act of 2005 authorized $25 million over five years for demonstration programs, and the federal economic stimulus package included billions of dollars for dozens of rural and community health programs. Next year, there will be a new category in Bureau of Labor statistics specifically for community health workers.

Community colleges and nonprofit organizations are stepping up to meet the growing demand. In Texas, one of the first states to certify community health workers, Houston Community College has a 160-hour training and certification program, and plans to add online courses to train people over age 50 for these roles.

In New York, a pilot program run by the encore career job-matching service ReServe at St. Luke’s Roosevelt hospitals trains retirees to help frail and isolated patients upon discharge. That led to a contract with New York City to supply Health Navigators at a half-dozen public hospitals. LaGuardia Community College is planning to train immigrants in New York City, particularly those with social service and health care experience in their native countries, to communicate critical health care information to non-English speakers.

Calculating cost reductions is complicated, but local studies have demonstrated significant savings. Among diabetes patients in Baltimore, intervention by a community health worker resulted in savings of $2,245 per patient, while costs for asthma patients in Hawaii were cut from $735 to $181 through reduced emergency room visits and improved quality of life. In Denver, case management by community health workers saved $2.28 for every $1 spent on the program.

As cost savings are documented and training and certification programs are established, pay rates for health navigators may improve. A federal study in 2007 found that after a few years on the job, more than half of community health workers earned at least $15 an hour. Some grassroots organizations rely on volunteer health navigators for outreach and health education.