Timely access to cancer care is often inadequate for underserved populations facing significant clinical and social barriers. Medicaid patients and other vulnerable groups consistently experience poorer cancer outcomes due to delays and gaps in receiving high-quality care after abnormal screenings or diagnoses. To address these disparities, the National Cancer Institute recommends comprehensive patient navigation as a standard of care to mitigate the social needs that impact treatment access. The Los Angeles County Department of Health Services (LA Health Services)—the nation’s second-largest public health system—serves over half a million patients annually. It delivers nearly 1 million specialty care visits, including 40,000 oncology appointments and 35,000 chemotherapy treatments. In May 2022, LA Health Services launched the Cancer Navigation Program across four acute medical centers and two dozen outpatient facilities. The program aims to provide equitable, patient-centered care for thousands of patients diagnosed or living with cancer. Since its inception, over 3,000 patients with breast, colorectal, gynecologic, and urologic cancers have been navigated through the system.

Program Design: The program adapts nationally validated patient navigation models to meet the specific needs of LA Health Services' safety-net population. Its key features include:

• Population-Based Coordination: Navigators identify patients at the earliest suspicion of cancer—often before a confirmed malignant pathology diagnosis—and provide tailored support throughout their treatment journey.
• Standardized Guidelines and Metrics: A multidisciplinary steering committee created evidence-based care guidelines and metrics aligned with National Comprehensive Cancer Network (NCCN) standards.
• Multidisciplinary Teams: Specialized oncology caseworkers and social worker supervisors collaborate with clinical teams to address logistical, clinical, and psychosocial barriers, ensuring adherence to treatment plans and connecting patients to essential resources.
• EHR-Driven Referrals: An electronic health record (EHR) system facilitates early referrals and efficient tracking of patients from diagnosis to survivorship.
• Data Dashboards: Advanced dashboards allow leadership to monitor key metrics, identify delays, and implement targeted improvements. Program Impacts: Health Equity: The Cancer Navigation Program addresses social determinants of health that often impede timely access to care. Navigators—culturally and linguistically aligned with patients—conduct psychosocial assessments to address barriers such as housing instability, food insecurity, and depression.

This patient-focused approach bridges care gaps and reduces regional disparities. Key results include reducing the time between diagnosis and first clinic visit from 27 days to 7 days and cutting treatment initiation time from over 100 days to 44 days, far exceeding national benchmarks like those set by the American College of Surgeons Commission on Cancer. Whole-Person Care: Integrating navigators with clinical, social work, and patient access teams leverages systemwide resources to deliver holistic, team-based care.

Beyond medical coordination, navigators provide emotional support and assist with logistical challenges, often accompanying patients and families to appointments. This comprehensive approach has improved patient satisfaction and reduced distress scores while increasing social work referrals by nearly 175% for navigated patients. It sets a new standard for person-centered care in safety-net systems. Utilization Management: Through standardized workflows and data-driven oversight, the program optimizes resource utilization and reduces delays. Its alignment across facilities improves adherence to guideline-based care while minimizing costs associated with fragmented or delayed treatment. This focus on efficiency ensures cost-effective solutions while addressing disparities in care delivery.

Summary: The Cancer Navigation program has reshaped cancer care delivery within LA Health Services by establishing systemwide adherence to evidence-based practices and outcomes. Its success serves as a scalable model for addressing other chronic conditions like diabetes-related complications and kidney disease. Plans are underway to expand navigation services to cover all new cancer diagnoses, advancing equitable access and high-quality care for more patients across our system.