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Care Navigation Using Condition-Specific Protocols

Resolving Patient Barriers Through
Care Guide Activation, Lowering Readmissions
in Value-Based Care

Case Study Snapshot

  • Client
    Large Non-Profit Healthcare System
  • Program
  • Year
  • Size
    3,514 Beds
  • Location
  • The Challenge
    Reducing Readmissions
  • The Solution
    Patient Navigation Program
  • The Success
    33% Reduction in HRRP Penalties

The Challenge

Reducing Readmissions
A large non-profit healthcare system with hospitals throughout Tennessee was required to reduce unnecessary readmissions, improve care coordination and enhance patient engagement and experience to improve its performance under the Hospital Readmissions Reduction Program (HRRP). Hospital readmissions contribute to a significant proportion of healthcare costs. Medicare reports that 2M patients are readmitted each year at a cost of $26B and estimates $17B of that comes from potentially avoidable readmissions. Research demonstrates that minority and other vulnerable populations are more likely to be readmitted for chronic conditions within 30 days of discharge. Findings showed that while not all readmissions are avoidable, a portion of unplanned readmissions may be prevented by addressing the barriers patients face before, during, and after admission and discharge.

The Solution

Patient Navigation Program

With a shared goal of improving health equity and removing barriers to social determinants of health, Guideway Care partnered with this health system to implement a patient navigation program. Guideway’s Service as a Solution approach utilizes highly trained “Care Guides” operating within a scalable, technology-enabled platform to activate patients and their families and uncover any issues and barriers experienced during their care journey. Care Guides follow structured, AI-assisted workflow protocols to ensure that clinical barriers are escalated to proper clinical care teams and proactive interventions are promptly initiated by the Care Guides to resolve non-clinical barriers to care.

Reducing unnecessary readmissions led to an approximate 33% reduction in HRRP penalties

The Success

33% reduction in HRRP penalties
This program demonstrated a high level of achievement by using a navigated Care Guide approach. Reducing unnecessary readmissions led to an approximate 33% reduction in HRRP penalties in year one, with the penalties almost or eliminated after three years. Additional improvements measured by value-based metrics validated the role of Care Guides and non-clinical interventions that reduced unnecessary utilization, improved patient care adherence, advanced health equity and enhanced patient experience.