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Guideway Care, Inc: Healthcare Patient Navigation

Care Guidance Capability, Revenue, and Quality Improvement Analysis for Your Hospital

Vizient® Awarded Supplier logo
Vizient Contract Number: SV2760

Executive Summary

Care quality and provider revenue performance rely largely on a patient’s compliance with a care pathway. When patients are compliant, they are engaged, show up to their appointments, and take the steps that are likely to lead to quality outcomes.
But compliance is complicated by a patient’s ability to adhere to a care path. The biggest obstacles are usually practical—like transportation, financial barriers, and education. And the best way to lower these barriers is through intelligent care guidance calibrated to operate at the lowest total cost of performance.
Guideway Care will go fully at-risk for performance under a value-based agreement. We only get paid if we deliver.
Guideway Care delivers Vizient members an end-to-end, tech-enabled, care navigation solution that drives patient compliance and value. We address the practical barriers (socioeconomic, education, communication, support) that increase risk and lead to poor patient outcomes. And we do this by combining disease-aligned protocols, appropriately skilled resources, and a smart care guidance platform to lower barriers, improve patient compliance, improve outcomes, and lower non-clinical demands on nursing staff.
The following summary provides a breakdown of the projected potential impact that Guideway Care’s solution can have on Your Hospital‘s readmission rate, patient leakage, Emergency Department (ED) uncompensated care, and patient satisfaction. This report is not meant to be prescriptive. Instead, the analysis illustrates how non-clinical care guidance can improve your performance and patient satisfaction. We welcome further discussion and would be happy to update this report with facility-specific data to provide additional views into potential gains.

Revenue and Quality Summary for Your Hospital

Projected Potential Savings

$BZ (S)
Your results represent estimated savings generated by the complete program.
A breakdown of the savings by program component (e.g., readmissions) is provided below.
Readmission

Patient Potential Savings Year 1

$S (P1)
Your results are calculated across pneumonia (PN), total hip/knee replacement (TH/K), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery bypass graft (CABG), and acute myocardial infarction (AMI). Penalty reductions are calculated for one year. Typically, clients completely eliminate the HRRP penalty within three years.

Patient Leakage

Estimated Revenue Retained

$BM (REV)
Your savings are based on a 10% reduction in patient leakage due to greater patient loyalty and compliance including greater appointment adherence across the managed population.

ED Overutilization and Uncompensated Care

Estimated Avoided Losses for the ED

$BC (ED)
Your savings are based on a 10% reduction in uncompensated ED care resulting from proactive patient navigation that helps drive down avoidable ED utilization and routes patients to the most appropriate site of care.

Patient Satisfaction

Improvement across communication and discharge domains

Above the 90th percentile
Your results are based on anticipated survey response improvements, especially in the areas of communication and understanding.

Lowest Total Cost of Performance Defined

Lowest total cost of performance is Guideway Care’s commitment to driving the highest value across target outcomes.
We do this by combining AI-enabled technology, proven protocols, and non-clinical resources that are aligned to the problem domain and patient population. We know that technology alone cannot fix healthcare. But people are expensive. That is why we carefully select our care guides and train them on motivational interviewing techniques that are actioned and operationalized through our GPS technology platform. Our people are equipped to effectively nudge patients onto the right path that will lead to the best outcome and the lowest total cost.

Your Hospital Analysis Details

Social, economic, behavioral, and emotional challenges drive patients off a care pathway and result in avoidable spend (e.g., readmission) and lost revenue (e.g., decreased patient loyalty). Guideway Care addresses these challenges using scalable, non-clinical resources who are supported by predictive technology and disease-aligned protocols to:
  • Reduce penalties
  • Improve net revenues
  • Free nursing capacity
  • Drive down rates of avoidable utilization
  • Increase patient satisfaction
When patients have questions, issues, anxiety, and a loss of orientation, they need real connection—and that connection must be genuine, timely, and lead to a positive outcome.
This is what we do and why we can keep patients on the best path that will lead to the best result.

Assumptions

Key performance measures are based on the latest CMS reported performance data.
Key performance measures are based on the latest CMS reported performance data. For all market analysis metrics, we leveraged information from Definitive Healthcare. The reported return on investment assumes the use of the most effective modalities aligned to patient population and outreach. We also assume risk stratification of the target population using Guideway Care’s AI-enabled analytics to drive the optimal resource allocation across the program. While Guideway Care can fully integrate into any EHR and workflow, we have not included integration cost in this analysis. However, IT lift and the associated costs are typically low for all of the target conditions and programs included in this analysis.

Readmissions Reduction

Many drivers behind avoidable readmissions stem from practical barriers that can be addressed with the right resources.
The Hospital Readmission Reduction Program (HRRP) has evolved over the years to account for patient complexity and the social barriers that are unique to a population. While healthcare’s understanding of readmissions has grown, the problem is consistent and can be hard to address cost-effectively. Care guidance has a history of successfully reducing readmissions by closing gaps that, if left unaddressed, can increase the risk of a return to the hospital.
The following analysis breaks down the potential impact that care guidance can have on HRRP targeted conditions and sepsis.

By lowering readmission rates across target conditions, Your Hospital can avoid $Estimated Avoided Penalty Year 1 (S)(P1) in penalties in year one. Guideway Care’s clients typically eliminate the total HRRP penalty over the course of three years.

Typical Readmit Reduction Rates for Target Conditions

AMI: 20%

Typical Readmit Reduction

CABG: 30%

Typical Readmit Reduction

CHF: 30%

Typical Readmit Reduction

COPD: 30%

Typical Readmit Reduction

PN: 30%

Typical Readmit Reduction

THA/TKA: 10%

Typical Readmit Reduction

Sepsis: 40%

Typical Readmit Reduction

Patient Leakage

Your Hospital operates within a market characterized by Market Competition Definition (BK)(M) competition. Patient loyalty is affected by the perception of care, which is heavily influenced by communication. Care guidance can create a glue between Your Hospital and the patients you serve by delivering just-in-time, valuable communications that drive appointment adherence, satisfaction, and compliance while improving the overall experience of care.
Based on the level of competition within your market and the typical leakage that we observe in similar facilities, we estimate a revenue leakage opportunity of $Est. Leakage Opportunity (BL)(L). This dollar figure represents the potential revenue loss that could be avoided.
We have seen a sustained reduction of approximately 10% in lost revenue through the use of care guidance across a target population. We can tailor this outreach based on the types of patients that Your Hospital is losing to competitors and can help drive deeper insights into the programs and investments that can increase your positioning and market share.
Based on our initial analysis, we estimate that approximately $Est. Revenue Retained (BM) (REV) in patient leakage can be avoided through the implementation of Guideway Care’s guidance solution.

ED Uncompensated Care

With the Affordable Care Act, uncompensated ED care started to decrease. As more people obtained coverage and Medicaid expanded, providers saw a drop in ED overutilization and uncompensated claims. However, commercial payers have issued a blow in the fight over ED reimbursement, with the most recent statement coming from UnitedHealthcare. Under new policy guidelines, up to ten percent of ED claims could be deemed “non-emergent” and denied. This applies retroactively, although it is unclear how far back into historical claims the payer will go. UnitedHealthcare isn’t alone. They are just the latest in the commercial payer space to take a hardline stance on ED reimbursement. In 2017, Anthem announced a rollout in Indiana that expanded ED claims review and denials policy. At risk were approximately 300 codes considered non-emergent, which the company claims were developed with the input of board-certified ER physicians.
Care guidance can help by targeting high-risk and rising-risk individuals before they enter the ED to drive these patients to proactive, preventative care delivered within lower-cost care settings.
Based on Your Hospital’s estimated ED volume of Est Number of ER Visits (AZ)(ED2), we estimate that care guidance can save you $Estimated Avoided ED Cost (BC) (ED) in uncompensated ED care.
TABLE 2: ED Care Guidance
Estimated Number of ED Visits Est Number of ED Visits (AZ)(ED2)
Estimated Number of Uncompensated ED Visits1 Est # of Uncompensated ED Visits (BA)(ED3)
Estimated ED Visit Losses2 $Est Value of ED Uncompensated Visits (BB)(ED4)
Estimated Value of Avoided ED Cost $Est Avoided ED Cost (BC)(ED)

Patient Satisfaction

So much of patient satisfaction is driven by timely, clear, and consistent communication. By listening to a patient’s needs, aligning resources to address gaps, and driving follow up, providers can rapidly improve patient survey (HCAHPS) scores.
Guideway Care’s guidance solution has historically delivered improvements in HCAHPS scores above the 90th percentile. This is especially true for the measures that align to provider communication and discharge instructions. The following graph provides a breakdown of the HCAHPS survey and areas where care guidance can quickly improve Your Hospital’s survey scores.
Patient HCAHPS Survey Reported Experiences

Radiation Oncology Model

Your Hospital falls within a target zip code for the Radiation Oncology Model.
This new bundled payment will go live in January 2022 and will cover radiotherapy services furnished within a 90-day episode for 16 cancer types. Physician group practices, hospital outpatient departments, and freestanding radiation therapy centers are included in the model.
Guideway Care offers Vizient members a complete care guidance solution to maximize performance under the ROM by:
  • Specifically targeting quality measures and satisfaction measures related to depression screening and patient satisfaction
  • Removing non-clinical outreach and workload from clinical staff
  • Reducing avoidable utilization and deterioration through increased patient compliance with care plans
  • Improving patient understanding and satisfaction through education and connection
  • Driving compliance with quality metrics and outcome targets
Guideway Care does this through an approach that combines cancer type-aligned protocols, highly skilled, trained and managed resources, and a smart care guidance platform. We lower barriers, improve patient compliance, improve outcomes, and reduce non-clinical demands on nursing staff to drive performance under cancer bundles, including the ROM.

Total Return on Investment

Care guidance is one of the fastest and most effective paths to lowering barriers and activating patients. We deliver a proven, published solution that reduces costs, improves outcomes, increases patient satisfaction, and drives health equity at scale.
Through our partnership with Vizient, Guideway Care can provide contracted pricing that ensures the highest levels of return and value.
Our relationship with Vizient is predicated on the value we deliver for member providers.
Typical ROI for an equivalent facility 2-3X within the first year of program implementation.
Because we are confident in our ability to meet value-based performance goals, we are willing to go fully at-risk with Your Hospital based on agreed to performance goals.
We are happy to offer more information on projects with other Vizient members, anticipated value, and program components. Let us know when you would like to connect by contacting vizientbenefits@guidewaycare.com.

Get Started Today

If you are ready to talk in more detail, please reach out to us at vizientbenefits@guidewaycare.com.
Vizient Contract Number: SV2760
vizientbenefits@guidewaycare.com