Today’s typical health system may encompass a dozen or more acute care facilities and an even wider web of affiliated provider organizations, including skilled nursing facilities, imaging centers, urgent care clinics, and a thousand or more primary care and specialist physicians. Adding to the complexity are multiple electronic medical record (EMR) systems in addition to a myriad of unique practice patterns and preferences.
For patients, effectively navigating within this maze can be a daunting and stressful endeavor, with the American Journal of Managed Care linking insufficient patient care coordination to suboptimal care and poor outcomes. Expecting patients to self-navigate also packs a significant economic punch, with AJMC estimating a lack of cross continuum coordination adding an average cost for disease management of $4500 per patient over a three-year period.
Frustrated patients are also more inclined to take their business elsewhere, ultimately costing health systems up to 30% in lost follow-up care revenue, according to Definitive Health.
A case for patient navigation
Navigating patients along key inflection points in their care journey is proven to circumvent the clinical and economic pitfalls that are so prevalent in healthcare today and can be accomplished with a combination of technology and trained patient navigators. Managing the flow of patients and information between key access points can be solved with automation, creating a navigation “hub” between healthcare organizations and external providers. This platform serves as a guide for patient navigators to perform the tasks of care logistics, which includes arranging appointments and referrals, securing prior authorizations, and even arranging transportation, verifying insurance, and securing lab results.
The importance of adding a human touch cannot be overstated. Patients are often scared, compromised and at their most vulnerable and removing the necessity for self-navigation at a difficult time can go a long way in building trust while also minimizing gaps in care.
Patients must always have the option to self-navigate however doing so should never be a requirement.
Why outsourcing often makes sense
Effectively navigating patients and coordinating care across large scale healthcare delivery networks is beyond the scope of today’s hospital electronic health records (EHR) systems. They simply aren’t designed to manage patient flows across a shifting landscape consisting of hundreds (or thousands) of providers with varying degrees of affiliation while managing the service levels required by ACO’s and other risk adjudicators. An intelligent network navigation hub remedies this challenge, aggregating data feeds, shielding the navigators from complexity, and executing predefined workflows at scale.
Given today’s healthcare staffing shortages, which have been exacerbated by COVID-19, adding additional headcount to address the growing need for patient navigation can be challenging. Partnering with a technology-enabled expert to offload non-clinical care logistics tasks from your existing staff is a cost effective and low risk way to add capacity while improving network integrity and clinical outcomes.
Improving share of care
Ultimately, a comprehensive care navigation program will more than pay for itself, whether fee-for-service or value-based care. For example, our data indicates that patients discharged from the ED with a specialist follow-up recommendation spend an average of $2,200 in additional facility-based services during the 120 days following discharge. With an average network leakage rate of 30%, that’s $660 in lost revenue per patient discharged with a specialist follow-up recommendation absent navigation.
In a value-based care scenario, navigation reduces wasted effort and avoidable utilization. For example, we know from our internal data that admitted patients who receive timely post discharge follow-up care have a reduced readmission rate of as much as 21%.
More importantly, patient navigation improves clinical outcomes and the patient experience regardless of the payment model.
Gaining insight
Implementing an enterprise-wide patient navigation program also helps to improve visibility into the workings of healthcare networks, highlighting capacity constraints and opportunities for growth. For instance, you’ll see referrals patterns and average time to appointment across the network and gain insights into capacity constraints and physician recruitment opportunities.
Our focus
At Care Continuity our focus is on addressing the logistics challenge within large scale healthcare delivery networks. We navigate patients seamlessly, efficiently, and compliantly across complex healthcare eco-systems while ensuring provider alignment along the full span of the patient journey.
Want to learn more? Download the extensive whitepaper HERE. Watch our On-Demand webinar HERE. Ready to talk with an expert and schedule a demo? Schedule a meeting with us today.
