In this interview, Tracy Battaglia, MD, MPH, a primary care physician and 2-time cancer survivor, discusses how equity- and evidence-based patient navigation models can drive sustainable improvements in cancer care delivery and outlines key strategies, metrics, and policy advancements necessary for their long-term impact.

Please introduce yourself by stating your name, title, and any relevant clinical experience you’d like to share.

Tracy Battaglia, MD, MPH: My name is Tracy Battaglia. I am a primary care physician investigator scientist. The focus of my work has been steeped in women's health and access to care, and I am very passionate, as a 2-time cancer survivor myself, about equitable access to cancer care across the continuum. My clinical and academic work has been focused very largely in that space. I am also very passionate about the use of evidence-based patient navigation as one of the only proven health equity interventions in our health systems that we have to date. I will do anything I can to promote its implementation in a widespread manner.

What key factors distinguish a high-impact patient navigation model from a standard program?

Dr Battaglia: There are 2 words that come to mind for me. One is equity-based and the second is evidence-based. Navigation is a term that I grew up with, it's in the dictionary, we all think we understand what it is, but in the context of oncology care delivery and the evidence base around navigation, there is an evidence base. Because our health care system is so complex and fragmented, we have preconceived notions about what navigation is.

I'll quote one of the leaders of navigation, Dr Harold Freeman, "If navigation is everything, navigation is nothing." We have to adhere to the principles of navigation and there is a very strong evidence base about what essential components of navigation must be in place in order to have an impact.

The second part around the equity piece is that if we provide navigation for everyone, we're not going to address equity. So, when I say "equity-focused", I mean we don't want to give everybody the same thing. We want to make sure that, whatever health system or community we're working with, we understand where the access challenges are and for whom, and we target our navigation services to those groups.

What are the most critical data points or outcomes that should be tracked to assess the effectiveness of patient navigation?

Dr Battaglia: This isn't really a good answer because the answer is, it depends. As I started saying, you want to make sure you are targeting navigation in your community to where the problems lie. That may look differently in different communities.

In my community, when I started my work in Boston, one of the things I recognized—as a women's health primary care physician and a breast health specialist—was that we have really long delays in follow-up when there is an abnormal screening test. We looked to try to understand why that was and explain that. We found our patients who are coming to the academic health medical center for their care who were delayed were the ones coming from community health centers. So, we said, "Let's partner with our community health centers and target our navigation resources to the community health centers for women who are overdue for their follow-up to an abnormal screening."

In that case the outcome was obvious. We identified the problem and what we needed to improve to make sure that we had equity in follow-up to abnormal screening for all patients. I'll also add that the Academy of Oncology Nurse and Patient Navigators (AONN+) is the largest professional organization around navigation. They have been leading the way for decades in helping us with workforce development, competency-based training, and outcomes evaluation. They have a toolkit for metrics that I would refer people to.

What policy or structural changes could help enhance the sustainability of patient navigation models at a national level?

Dr Battaglia: I don't know that I ever would have thought, in my lifetime, we would see policy change that includes principal illness navigation in our physician fee schedule for Centers for Medicare & Medicaid Services (CMS). Now there is the opportunity to reimburse for navigation services. That's a major accomplishment that happened in 2024, but we're not done yet. It's only the beginning, because it only includes services for those with a diagnosis of cancer. It has pretty strict requirements that limit the ability to reimburse for navigation services that are required across the continuum. It's only for patients on Medicare.

From a policy perspective, really leaning in making sure that the fee schedule is sustained and adopted by Medicaid and our private payers so that all have access to navigation services [is important].

In addition to funding policy, the other [key area] is around workforce development and solidifying the navigation team members who are clinical and nonclinical, whether it be nurse navigators, social work navigators, or nonclinical navigators. Investing, from a policy perspective, in that workforce is really important. There is a lot of work that needs to be done there.

What are the most significant barriers to maintaining long-term patient navigation programs, particularly in resource-limited settings?

Dr Battaglia: That's a complicated one. There are many barriers to implementing navigation within any system, especially in resource-limited settings. There is a tool that was developed by the National Navigation Roundtable. If people are not familiar with the National Navigation Roundtable, I would refer you to learn about them. In recognition of the complexity, implementation challenges, and barriers to sustaining navigation long term, they adopted a patient navigation sustainability assessment tool from our colleagues at the University of Colorado. What it does is it helps us understand all of the interconnected levers required for a sustainable navigation model in any health system.

Funding is one piece of it, but it's also alignment with the capacity and the core values of the health system, community data, monitoring and evaluation, workforce development, and integration into existing systems and workflows. All of those are critical components that you have to get over in order to have a sustainable model.

There are a lot of great exemplars out there, but I don't think any one of us has gotten it right yet. It's an iterative process that requires prioritization from leadership and real integration into the operations of the system. That's not a one-off or just a side thing—it’s the core of how a health system or a community sees care delivery and having it as the north star of care delivery.

What advice would you give to institutions looking to develop or refine their navigation programs for maximum impact and longevity?

Dr Battaglia: I would say just do it. It may feel daunting and challenging, and you can have your sights set on the ideal, but small, incremental change that's aligned with the evidence base of navigation is where you should start.

Consistent with the other comments I made, if you align with the priorities of your health system, your payers, your value-based programs, and give them navigation evidence as a strategy for operations and care delivery systems, people will come along and they will follow with you.

Take advantage of the amazing resources that are out there by our colleagues across the country who are doing this work—from the American Cancer Society LION Program, AONN+, and the National Navigation Roundtable. A lot of our oncology professional organizations are leaning in and providing resources and support around navigation, whether it be ASCO, ACC, NCI—I’m leaving out large players and leaders—but it's a collective effort. The professional organizations in oncology recognize the potential impact of navigation if we are all successful at implementing it. We're learning from each other.