Aligning Resources to Patient Need and Provider Revenue
The answer to nurse staffing shortages is not more nurses. To drive operating costs down while maintaining and managing optimal patient outcomes, providers must better align resources to patient needs. This requires a deeper understanding of the challenges patients face and the type of resources needed to mitigate risk.
A patient’s health and wellness are largely determined by what happens outside the hospital. Nearly 60 percent of a patient’s risk is tied to social, environmental, and behavioral factors that fall outside the health system or care episode (Samantha Artiga, 2018). In a study of 1066 readmitted patients, more than half (52%) experienced difficulty in more than one self-care domain, including transportation, education, food insecurity, and housing instability (Greysen SR, 2017). In another study on the impact of a lay-health worker model on 30-day readmission rates in Appalachia, Kentucky, scheduling challenges, medication adherence, and transportation gaps were cited as the most common barriers to compliance with a prescribed care pathway (Roberto Cardarelli, 2018). And in a recent Guideway Care analysis of close to 1000 navigated patients, the two biggest drivers behind readmissions were scheduling follow-up appointments and medication adherence, both of which are heavily influenced by transportation needs and financial challenges.
More often than not, nursing resources are asked to find and address the practical concerns driving patients back into the hospital and contributing to avoidable deterioration. However, the model is unstainable, expensive, and adds to nursing stress and dissatisfaction.
Lay navigation delivered by non-clinical care guidance resources can mitigate the cost and quality challenges while serving as a 5x multiplier on existing nursing staff capacity. A recent cost comparison examined the patient impact and cost comparison between a nurse on staff (non-itinerant) and a lay navigator. Based on salary cost averages (adjusted for inflation) and patient volumes, lay navigation can address practical barriers at five times the volume and 20 percent the cost of a nurse resource.
| TABLE 1. PATIENT IMPACT AND COST COMAPRISON BETWEEN NON-ITINERANT STAFF NURSE AND A LAY NAVIGATOR |
| Resource |
Number of Patients |
Cost/Patient |
| Per Month |
Annually |
| Nurse |
50 |
600 |
$162.50 |
| Lay Navigator |
250 |
3,000 |
$35.00 |
An additional analysis of lay navigated patients showed that care guides addressed more than 80 percent of the practical barriers identified. And of that proportion of barriers identified, more than 98 percent were fully resolved.
Lay navigation also effectively addresses transition of care and communication challenges, such as not fully understanding discharge instructions. In two months, care guides increased patient satisfaction scores by an average of 10 points, which resulted in an average percentage improvement in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores of more than 15 percent.
The benefits extend to practices that can leverage care guides to ensure appointment adherence, manage referrals and patient questions, and navigate insurance pre-authorizations. In a recent analysis of managed and un-managed patients, participating providers realized a 12 percent increase in kept appointments. And new patient pipeline for elective surgery consults increased by 15 percent.
