Navigating health care systems and services

Strategy overview

  • Improving access and navigation: As health care systems continue to grow in size and complexity, patients require increasingly more knowledge, skill, and support to navigate health care systems. Strategies that help patients navigate health care systems and services include offering patient-centered, coordinated care; helping patients understand and make decisions about health information; hiring staff to help patients navigate their care; and connecting patients to social and legal services.
  • Coordinating care: The Patient-Centered Medical Home (PCMH) model provides patients with comprehensive, patient-centered, and coordinated care. In this model, primary care teams provide a wider range of services than in the traditional model, allowing patients to access pharmacists, nutritionists, and other professionals through their primary care team. When patients need specialized care, the primary care team takes responsibility for coordinating services with their counterparts across the health care system.
  • Hiring dedicated staff: Health care systems can hire patient navigators to guide patients through medical, insurance, and social support systems. Typically, navigators work with patients undergoing time-sensitive and complicated treatments, like cancer care. However, they can also be integrated into general primary care teams. For patients with limited English proficiency, health care systems and public health agencies can hire or contract for professional medical interpretation services. Professional medical interpreters typically have forty or more hours of classroom and on-the-job training in health care interpretation and can provide interpretation services in-person or remotely.
  • Increasing patients’ health literacy: Health literacy interventions aim to build patients’ capacity to find, process, and understand basic health information and services. Examples of such interventions include creating simple health education materials, improving patient-provider communication, and developing videos and online self-help tools.
  • Providing access to legal services: Medical-legal partnerships (MLPs) integrate legal services into health care settings. MLPs typically operate on-site and can be run in partnership with legal aid organizations, law schools, private firms, or other legal services providers. These programs can help patients address legal issues in areas like housing, social services, and food and utility assistance.
Target Population
Adults and families
Key Stakeholders
Health Care System Leadership Team, Patient Experience Department, Nonprofit Partners, Public Health Department, Program Evaluation Team

What evidence supports this strategy?

Proven

Multiple common practices for assisting residents with navigating health care systems and services demonstrated significant, positive effects on health outcomes, access, and quality when rigorously evaluated.

  • A 2018 research synthesis found that medical homes are associated with significant improvements in health care quality and access, increased use of preventative services, and reductions in hospitalizations.

  • A 2017 research synthesis found that professionally trained medical interpreters are associated with improved patient satisfaction and patient-provider communication.

  • A 2016 research synthesis found that patient navigators are associated with an increase in cancer screenings.

  • A 2019 research synthesis found that health literacy interventions can improve health-related knowledge and patients’ adherence to treatment; further research is needed to confirm effects.

  • A 2019 research synthesis found that medical-legal partnerships can improve access to legal services, improve health outcomes, and reduce stress; further research is needed to confirm effects.

How does assistance with navigating health care systems and services impact economic mobility?

  • Improving health outcomes: Residents who have limited knowledge of health information and care systems, face language barriers, or otherwise struggle to navigate the health care environment are more likely to have poor health outcomes. Since better health is linked to increased economic mobility, strategies that help residents navigate the health care system and related services can also increase their economic mobility.
  • Reducing catastrophic health care costs: Residents with higher health literacy or who receive primary care are less likely to use an emergency department. This helps residents reduce the likelihood that they will experience catastrophic health care costs, which are linked to downward mobility.

Best practices in implementation

  • Invest in training: Provide staff with dedicated time to receive training on new models or services. Training builds staff buy-in, reduces errors in program implementation, and prepares staff to integrate the new model or service into regular operations.
  • Identify varying needs: Provide programs targeted to meet the needs of specific groups, like older adults, teenage parents, and non-English speaking patients. Targeted programs promote patient engagement and advance equity for disadvantaged groups.
  • Develop partnerships: Developing partnerships across the health care systems allows staff to provide patients with comprehensive services. Examples of useful partnerships include leveraging the wide reach of primary care providers to disseminate health literacy interventions or incorporating social workers into medical-legal partnership programs to meet patients’ non-legal needs.
  • Integrate services into standard operations: Making patient navigation, medical interpretation, and legal services easily accessible promotes ease-of-use for both health care providers and patients. With providers often citing time constraints as a barrier to providing additional services, integrating new programs into existing operations is vital for them to be used with fidelity.

Evidence-based examples

Provides health outreach, education, referral and follow-up, case management, advocacy, and home visiting services
Supportive neighborhoods Stable and healthy families
Strong
Tailored health care to patients’ norms, beliefs, values, language, and literacy skills
Stable and healthy families
Proven
Assists uninsured individuals with health insurance needs
Stable and healthy families Supportive neighborhoods
Strong
Interventions that enable individuals to obtain, process, and understand basic health information and services
Stable and healthy families Supportive neighborhoods
Strong
Primary care providers and their teams coordinate care across the health care system, working with patients to address all of their health care needs
Stable and healthy families Supportive neighborhoods
Proven
Integration of legal services into health care settings
Stable and healthy families Supportive neighborhoods
Strong
Provide culturally sensitive assistance and care coordination in order to guide patients through available medical, insurance, and social support systems
Stable and healthy families Kindergarten readiness
Proven
Professionally trained staff provide interpretation services for patients with limited English proficiency
Stable and healthy families Supportive neighborhoods
Proven
Provides patients with text reminders, education, or self-management assistance
Stable and healthy families
Proven