Patient Navigators Reducing Readmissions under ACA

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February 23rd, 2015

Patient NavigatorsAs a value-based care environment begins to emerge under the ACA, reducing readmissions and unnecessary care through Patient Navigators becomes increasingly important. For years, readmissions have been an unnecessary high cost to healthcare payers throughout the USA. While there a multitude of factors contributing to this, a 2014 survey found that 75 percent of doctors blame their peers for readmissions and unnecessary care.

When the Affordable Care Act was passed, the health law introduced a new player to the US healthcare landscape – Patient Navigators. The role of the patient navigator was designed to help patients understand their coverage and assist them with gaining access to essential healthcare services.

After almost a year, providers are now beginning to realize the importance of patient navigators in significantly reducing the overuse of emergency departments and unnecessary hospital readmissions.

A recent pilot program allowed providers to investigate further the success of using patient navigators as the first barrier to healthcare. The team of navigators first had to undergo and pass a three-day, intensive certificate program in order to ensure they had the proper foundation for working with patients in the field. Each received specialized training for their assigned patient population at their designated location.

Once they had completed their training, navigators conducted patient follow-ups, connected patients to local care services and scheduled physician appointments. The impact of their efforts were recognized by hospital leaders including C-suite executives whom were very pleased by how patient navigator programs were able to improve outcomes, and essentially hospital bottom-lines.

The pilot program revealed a 43% reduction in non-emergency use of the emergency room and 60% reduction in 30-day readmissions for specific diagnosis-related groups. Furthermore, when patient navigators handled non-clinical tasks, physicians and other clinical workers had more time to focus on tasks that specifically require medical expertise.

While the success of this one pilot program is clearly quantified, further encouragement towards using patient navigators can be seen due to these positions emerging as a key role in healthcare. Care coordinators, navigators, and patient advocate job openings saw a noticeable rise throughout 2014.

As a part of our Case Management services, PayerFusion offers all of its groups and payers the opportunity to utilize our team of care coordinators for pre-admission and post-admission services. To learn more about how our care coordinators can help your covered individuals navigate US healthcare as well as arranging appointments, reviewing concurrent care decisions, or scheduling second medical opinions click here.