Community-based cancer navigation and support program: What are the activities and how much does it cost?

Abstract

Purpose

Michelle’s Place is a nonprofit cancer resource center in California, which offers patient navigation to patients with cancer. Michelle’s Place also provides education, support groups, and other activities to both clients and families. The objective of this paper is to describe activities conducted by patient navigators and to conduct a cost analysis to estimate the cost of a nonclinical patient navigation and cancer support program.

Methods

We collected salaries, time spent on various activities to support and conduct patient navigation, and costs of nonlabor activities. We separated the labor and nonlabor costs into core patient navigation activities (e.g. meeting with clients to conduct assessments; providing resources for financial assistance) and supplemental patient navigation activities (such as activities geared toward family members). We estimated labor and nonlabor costs for patient navigation, and costs per client navigated.

Results

We calculated cost per client navigated to be $639.23. The cost per client navigated for core patient navigation activities was $463.94 and for supplemental activities was $175.29.

Conclusions

Our findings provide an estimate of resources required to support a patient navigation program for patients with cancer. This study adds to the limited research on the cost of these programs in non-profit, community-based organizations.

Introduction

Patient navigation was initially designed in the 1990s to overcome patient barriers to breast cancer screening, diagnosis and treatment [1]. Patient navigators help patients overcome these barriers [2], and they can generally be categorized into nonclinical and clinical navigators based on their responsibilities and backgrounds. Non-clinical navigators focus on activities related to addressing logistical care coordination and psychological barriers to accessing care, while clinical navigators focus on shepherding patients through the clinical aspects of care, such as screening and treatment [3]. Non-clinical navigators include community health workers and peers who work in community-based or nonprofit organizations [3,4]. Clinical navigators tend to have nursing or social work degrees and backgrounds, and they are more likely to support patients in clinical settings, such as hospitals [3].

Many studies have shown that patient navigation has resulted in improvements along the cancer care continuum and across many cancers. Indicators such as time to diagnostic resolution, time to treatment from diagnosis, surveillance uptake, and treatment adherence have all been positive for patients who were navigated [5–9]. In addition, studies have generally indicated that patients with cancer have a higher satisfaction with care and the quality of their care when navigated, and cancer survivors are better able to make treatment decisions and have better health outcomes [7–9]. However, much of this research has been completed in clinical settings; there is a lack of research about patient navigation that occurs in non-clinical settings, such as non-profit, community-based organizations.

Until recently, organizations have been responsible for how to pay for program costs, often with grants and other funding [10]. Beginning in 2024, the Centers for Medicare and Medicaid Services (CMS) began reimbursing for principal illness navigation (approximately $600 annually). Reimbursement totaled $78 per patient for the initial month (60 min of support) and $48 per patient monthly (30 min of support) in 2024 [11]. This includes navigation for Medicare patients with serious conditions like cancer that can be provided in clinical and community settings [12]. Studies have shown that costs for patient navigation programs vary based on many factors. The type of navigation program has an impact on cost, whether the programs focus on screening, diagnosis, or treatment, as well as the population and setting of the navigation program [7,8,13,14]. Additional factors can include the backgrounds of navigators, their responsibilities, and the settings within which they practice [15–17]. Overall, patient navigation programs have generally been found to be cost-effective, although the type of navigation program and how cost was measured differed [7,8,13,14]. In our review, we have found a range of cost per person navigated in clinical patient navigation programs. Bensink et al. found that clinical-based patient navigation programs added about $275 (approximately $398 in 2025 dollars) to the cost of usual care [13,18]. The setting was nine sites included in a Research Program, and the population of focus included people who were medically underserved. A separate study focusing on five cancer care hospitals in a large city found that the cost per patient navigated during the program’s implementation and maintenance phase was $1,759 in 2019 (approximately $2,230 in 2025 dollars) [10,18].

Chronic diseases, such as cancer, require care beyond the initial treatment, and community organizations play an important role in supporting patients through their cancer journey and supplementing navigation offered in the clinical setting. It is important to understand the resources required to support community-based navigation. Cost is necessary to consider due to limited budgets and resources, particularly at the community level. The objective of this paper is to describe activities conducted by patient navigators and to conduct a cost analysis to estimate the cost of a nonclinical patient and patient support navigation program, which includes all staff that support it, at a community cancer center. We present activity-based costs to provide details on labor and nonlabor resources required to operate nonclinical community-based navigation to support other organizations in adopting similar programs to optimize cancer outcomes.

Methods

About Michelle’s Place.

Michelle’s Place Cancer Resource Center, a non-profit, community-based organization where clients with any type of cancer can find education and support about their diagnosis, treatment and survivorship care, opened in 2001. Michelle’s Place is funded through mostly donations and grants, and clients are self-referred or referred by their providers. There were 789 clients with cancer who were navigated at Michelle’s Place in 2023, the time period for this study.

Michelle’s Place is located in Temecula, California, and its mission is to empower cancer patients through education and support services [19]. Temecula is in southern California and has approximately 110,000 residents [20]. According to the American Community Survey reported by the Census Bureau, the population of Temecula is 57.0% White and 28.5% Hispanic; 6.7% are uninsured, and 7.4% are in poverty [20]. The individuals seeking support in Michelle’s Place reflect the population in the community they serve. Many services are offered free to clients of Michelle’s Place. The services include behavioral health services (provided by graduate students in the counseling fields and supervised by a licensed psychotherapist), support groups, art programs, wellness classes, one-on-one support, educational classes, and the provision of wigs and prostheses [19]. In addition, Michelle’s Place distributes holiday baskets and meals, back-to-school backpacks for clients’ children and grocery gift cards for clients and families in need [19].

The patient navigation team at Michelle’s Place consists of eight staff: two nonclinical patient navigators, a navigation assistant, a community health worker, three encouragement callers, and a program manager. The navigators are responsible for supporting clients through treatment and providing clients with information on where to access educational materials and resources specific to their cancer diagnoses. The navigation assistant and community health worker mainly provide information on transportation, financial resources and insurance, and help with ongoing programs and administration. The encouragement callers, who are volunteers and cancer survivors, are responsible for phoning clients to offer emotional support after their treatment. There is also a program manager who supervises the navigation program and creates the support groups and programs.

Data Collection and Analysis.

The research team tailored a validated cost data collection tool [21,22] specifically for Michelle’s Place to collect labor and nonlabor costs for calendar year 2023. Labor costs consisted of: staff who were involved in patient navigation activities and their salaries (including fringe), as well as the percentage of time staff spent on patient navigation activities. We assigned an hourly wage for volunteers with fringe to estimate the cost of encouragement callers in order to provide a comprehensive cost of the program. We included in the category of nonlabor costs the following: mortgage and utilities, transportation, computer software and hardware, and telephone usage to assist clients and the functioning of the program.

The research team trained the Executive Director of Michelle’s Place on how to collect the data from her staff and how to complete the cost data collection tool. Staff used timesheets with detailed activity listing to estimate time spent on various activities. This was a one-time retrospective data collection for the calendar year 2023. In addition, we had several conversations over Zoom with Michelle’s Place Executive Director for us to learn more about the program. We also had conversations over Zoom and via email to review the data provided by staff from Michelle’s Place and discuss the results from the analysis.

For the analysis, the research team calculated the cost of labor by employee for each reported patient navigation activity. In addition, with guidance from Michelle’s Place staff, we categorized the patient navigation activities as either ‘core patient navigation activities’ or ‘supplemental patient navigation activities’. We defined ‘core patient navigation activities’ as activities that are typically conducted to navigate patients, such as meeting with clients to conduct assessments and to discuss treatment options. The navigators at Michelle’s Place are resources for the clients with cancer and can provide them with information that helps them make decisions. We defined ‘supplemental patient navigation activities’ as additional support programs for clients and families. These are not activities that navigate clients with cancer per se, but activities that aim to improve quality of life for clients with cancer. For example, these activities include backpack drives to provide back-to-school backpacks for clients’ children; parties; and meals for holidays, such as Thanksgiving and Christmas. Similarly, we aggregated nonlabor costs and categorized them as ‘core nonlabor costs’ or ‘supplemental nonlabor costs’. We report the cost and percentage of total cost of core and supplemental labor activities, nonlabor items, and total annual costs. We also report the annual average cost per client navigated. All costs are reported for 2023, and data were collected and analyzed in Microsoft Excel.

Results

We present the 2023 annual labor costs for patient navigation activities by core patient navigation activities and supplemental patient navigation activities in Table 1. The total cost of all labor activities was $197,918.20, with 90.0% going toward core patient navigation activities and 10.0% for supplemental patient navigation activities. The largest components of core patient navigation activities consisted of meeting with clients inperson or over the phone to conduct assessments and discuss any surgeries and treatment options they have received from their providers (35.1%). These services were followed by the activities of providing resources to clients regarding financial assistance, transportation, diagnosis and treatment (19.2%) and administrative tasks (15.1%). Providing client guidance and support through treatment and organizing and implementing programs (such as health and wellness programs) for clients made up less than 10% of all costs (9.6% and 7.4%, respectively). Labor costs for conducting supplemental patient navigation activities totaled $19,785.97. Activities related to supplemental client programs and quality of life comprised 5.6% and 4.4% of total labor costs, respectively.

Table 1.

Annual labor costs for patient navigation activities at Michelle’s Place in 2023.

Core Patient Navigation Activities	Cost ($)	Percent
Meet with clients to conduct assessments and discuss options for surgery and treatment given by providers	69,452.61	35.1
Provide resources for financial assistance, transportation, diagnosis and treatment	37,994.54	19.2
Administrative tasks, including those related with recording and reporting patient interactions, trainings, internal meetings	29,795.01	15.1
Provide support through treatment	18,973.84	9.6
Organize and implement programs for clients	14,639.00	7.4
Prepare for meeting with clients	7277.23	3.7
Subtotal	178,132.23	90.0
Supplemental Patient Navigation Activities
Activities related to supplemental client programs (e.g. Purple Ribbon Program, After Life Program, other programs)	11,019.43	5.6
Activities related to clients’ quality of life (e.g. holiday party, Thanksgiving meal, back-to-school backpacks)	8766.54	4.4
Subtotal	19,785.97	10.0
Total	197,918.20

Note: Encouragement callers volunteered approximately 140 h each to run the navigation program.

In Table 2, we present the nonlabor costs for the patient navigation program at Michelle’s Place. The total of all nonlabor costs was $306,434.21. The total cost for core nonlabor costs, which consisted of mortgage and utilities, client transportation to medical appointments, telephone service, computer software and hardware for staff, was $189,920.21. The largest component was mortgage and utilities (53.2%) followed by transportation (5.0%). Supplemental nonlabor costs totaled $118,514.00, with the majority of costs for grocery gift cards (30.3%). Behavioral health sessions, wellness kits, classes, scholarships, holiday parties and back-to-school backpacks ranged from 0.5%−2.4% of the supplemental nonlabor costs.

Table 2.

Annual nonlabor cost for patient navigation at Michelle’s Place in 2023.

Core Nonlabor Costs Navigating Patients	Amount ($)	Percent
Mortgage and utilities	163,000.00	53.2
Transportation	15,250.21	5.0
Computer software and hardware	7000.00	2.3
Telephone	2670.00	0.9
Subtotal	189,920.21	61.3
Supplemental Nonlabor Costs
Grocery gift cards	92,700.00	30.3
Behavioral health sessions	7265.00	2.4
Wellness kits provided	5117.00	1.7
Classes	4613.00	1.5
Scholarships	4000.00	1.3
Holiday party	3192.00	1.0
Back-to-school backpacks	1627.00	0.5
Subtotal	118,514.00	38.7
Total	306,434.21

We show the results for the annual average cost per navigated client in Table 3. The total annual cost of the program was $504,352.41, and the annual average cost per client navigated was $639.23. We calculated that the total hours spent on all patient navigation activities was 7,113.02 in 2023, which translated into 9.0 h per client. When analyzing only core patient navigation labor activities and nonlabor costs, the total annual cost was $366,052.44, and the annual average cost per client navigated was $463.94. Supplemental labor and nonlabor costs were an additional $138,299.97, or $175.29 cost per client navigated.

Table 3.

Annual average cost per client navigated at Michelle’s Place in 2023.

Costs	Total Annual Costs ($)	Annual Average Cost Per Client Navigated ($)
Core Activities
Labor	178,132.23	225.77
Non-Labor	187,920.21	238.18
Total Core	366,052.44	463.94
Supplemental Activities
Labor	19,785.97	25.08
Non-Labor	118,514.00	150.21
Total Supplemental	138,299.97	175.29
Overall Total	504,352.41	639.23
Total Hours for Patient Navigation Activities		7113.0
Annual Average Hours per Client Navigated		9.0

Discussion

Michelle’s Place is a non-profit cancer resource center in southern California that offers numerous services to its clients who have cancer. Patient navigation is one of the services the center offers, and our findings indicate that the total support provided totaled approximately $639.23 per client navigated annually: $463.94 per client navigated for core patient navigation costs and $175.29 for supplemental activities. Michelle’s Place offers grocery gift cards, holiday parties, and school backpacks for children, which may not traditionally be considered patient navigation. These items can be particularly important for families, as studies have shown patients with cancer face financial hardships [23,24].

There are a limited number of studies that have focused on the cost of patient navigation programs generally and patient navigation programs in community-based organizations, in particular. Most studies have reported on costs of patient navigation programs in the clinical settings; the cost of patient navigation in a community setting is more novel. Navigation in the community setting is particularly important for addressing social needs and barriers along with supporting patients beyond their engagement with the cancer treatment centers.

Since 2024, CMS has paid for patient navigation for its Medicare patients who have a high-risk condition, such as cancer, dementia, and chronic obstructive pulmonary disorder, among others [11]. This change in policy has the potential to have large impacts on Medicare beneficiaries and the general population. First, Medicare is a large driver of health policy: it covers approximately 67 million people (20% of the population in the United States), and it makes up a substantial portion of the federal budget and national health care spending, 12% and 21%, respectively [25]. The number of Medicare beneficiaries who could avail themselves of patient navigation might be significant. Second, Medicare can be a harbinger of changes that will occur for people with private insurance [26,27]. Just months after CMS announced its change in its patient navigation policy for Medicare beneficiaries, seven large private insurers announced that they would cover patient navigation services [28]. This expansion in coverage of patient navigation may provide an opportunity for community-based and nonprofit organizations to seek reimbursement for their patient navigation programs through Medicare or private insurance. Our study found that the cost of patient navigation and support services was approximately $639 per person navigated, which is comparable to CMS reimbursement of approximately $600 annually [11].

We did have some limitations in this study. This study focuses on only one cancer resource center in southern California; therefore, the results are specific to this one location in this geographic area. In addition, we were not able to collect data that could distinguish between new and established clients, which may have implications on time spent with clients, and therefore, the overall costs. It is also challenging for many community-based organizations to collect data for research purposes due to staff capacity. While we do not suspect this had an impact on results, there may be recall bias in the hours per activity estimated. Furthermore, the cost estimates presented in this study may not be applicable to other underserved groups and future studies should assess the costs of patient navigation in diverse community settings. As indicated, there are few studies describing the costs of patient navigation programs in community-based organizations.

The purpose of this paper was to estimate the cost of a patient navigation program and to describe the resource requirements necessary to support the program in a community-based setting. While studies have indicated that patient navigation is effective for supporting patients through treatment and survivorship, there is limited information on the costs of community-based programs providing these services, which is important as the federal government has begun to reimburse for some patient navigation services. Future studies are needed to determine both the costs and the effectiveness in terms of patient outcomes of community-based patient navigation and cancer support programs. Additionally, future research could assess the differential benefits of core and supplementation patient support program activities as well as similar programs offered in different community settings.