Hospitals, health systems and group practices nationwide are finding value and effectiveness by partnering with an outsourced care guidance resource to extend clinical staff and strengthen care management support. The addition of a structured and highly scalable care guidance program that goes beyond mere navigation efforts provides a unique solution as a service proposition to comprehensively address many of the operational and financial challenges that directly affect the entire provider ecosystem.
An Extension of the Clinical Team Beyond Mere Patient Navigation
Modern care guidance is an evolution of patient navigation that combines a systematized assessment to support disease-specific clinical conditions with a tech-enabled, human-led solution. Care guidance serves as an extension of a hospital’s clinical team to support a range of service lines and support activities.
When properly designed and implemented, care guidance supports a myriad of clinical and non-clinical functions, including facilitating pre-and-post-discharge and continuation of care. While care coordination usually includes a limited set of commonly performed tasks like scheduling follow-up appointments, helping patients understand what the next step in their clinical journey should be, care guidance goes deeper into social determinants and the life factors that can impact a patient’s ability to stay on track.
An effective care guidance program depends on specially selected care guides who work to establish a peer-to-patient connection with patients and their families. This human-led approach builds trust, enhances a patient’s ability to communicate and helps to uncover issues that pose barriers to care. The support of care guides then works to resolve these issues and assist patients in the ongoing process of their care. However, while the human touch is vital, care guides are unlikely to meet efficiency goals without a technology platform that goes beyond logging into structured workflows and barrier resolution pathways.
As healthcare organizations experience the profound financial impact of nurse shortages, care guidance is providing an innovative and efficient solution. It provides truly effective supplementary support services, functioning as a lower-cost extension of clinical teams and freeing up labor, time and resources so that nurses can focus on high-value clinical tasks.
A successful care guidance program delivers a strong return on investment (ROI) by improving efficiencies, reducing time and resource allocation, and helping overutilized clinical care teams focus on truly clinical items, all while improving patient satisfaction and retention Care guidance is of especially high value in alleviating non-clinical tasks and of its ability to help identify and solve barriers embedded in the social determinants of health that have an outsized impact on the patient care continuum. When a guidance program is properly deployed, it functions to promptly identify and resolve non-clinical issues patients experience before they become clinically problematic and costly.
Value of a Technology-Enabled Care Guidance Resources
A technology-enabled care guidance resource offers the most effective patient activation solution. It seamlessly integrates with a health system’s care management team to reduce clinical resource use, improve patient experience, advance health equity and enhance value-based care and reimbursement.
The right mix and integration of human and tech elements support personalized and meaningful peer-to-patient relationships and personalized communication, providing patients and their families with the connected support they need to stay on track and engage in the management of their condition throughout their care continuum.
Integrating care guidance with information technology can significantly enhance the efficiency and effectiveness of healthcare services. By leveraging these technologies, care guidance programs become more agile, patient-centered and efficient. They facilitate quicker responses to patient needs, streamline administrative tasks and ultimately improve the overall patient experience within the healthcare system.
Collaborative Function of Care Guidance
Collaboration between provider teams supports a triad of care coordination and management. Hospitals and their clinical staff receive the extended support they need from a dedicated care guidance service.
- Reach and manage more patients, maintain their continuity of care.
- Remove non-clinical tasks from the workloads of nurses and clinical staff.
- Perform follow-ups and monitoring, conducting follow-up tasks and ensuring that potential issues and barriers are proactively identified and resolved.
- Schedule appointments, screenings, preventive care and annual wellness visits.
- Find financial resources, such as assistance programs, to alleviate medical costs.
- Arrange transportation and other logistics that enable a patient’s ability to receive care.
- Ensure compliance, adherence and medication management.
- Reduce unnecessary service utilization and avoidable readmissions.
Addressing Social Determinants of Health and Resolving Barriers to Care
As healthcare organizations prioritize to deliver equitable, patient-centric care they must consider the full spectrum of a patient’s condition, including non-clinical factors and socioeconomic characteristics that influence their ability to access, receive and adhere to care.
Care guidance takes into account the role of social determinants of health (SDoH), with personalized services provided by skilled and trained care guides that recognize these non-clinical factors that influence an individual’s ability to access care and adhere to treatment. It’s this “human touch” that supports patients who are at-risk based upon SDoH characteristics. These patients frequently require amplified levels of activation and monitoring that cannot be addressed within the typical hospital’s resource capacity and clinical scope limitations.
SDoH are categorized by socioeconomic, education, cultural and environmental domains. Sub-standard conditions among these domains are shown to perpetuate patient health disparities, contribute to their unmet resources, services and transportation needs and widen health inequities, especially affecting those with chronic health conditions.
When non-clinical factors, which account for 80% of patient issues, are not promptly addressed and effectively resolved, they can lead to:
- Health deteriorations
- Excessive rates of clinical service utilization
- Extended hospitalizations and readmissions
- Higher total cost of care
Care guidance programs have proven to be effective in supporting disadvantaged and underserved patient populations who are at-risk for these complex health challenges.
Data Captures Provide Strategic Insights
Optimally, care guides are equipped with scalable, technology platforms that provide structured workflows and use evidence-based disease and condition-specific protocols to proactively identify and resolve practical and non-clinical barriers experienced during the care journey. A patient activation platform that augments a hospital’s care management workflow and automates protocols helps uncover both non-clinical and clinical issues and barriers. With this technological support, care guides ensure that non-clinical issues get promptly resolved and clinical issues are immediately escalated to proper clinical care teams.
An effective care guidance platform captures SDoH data and disparity-related barrier resolution, exceeding the capabilities of typical electronic health record (EHR) systems which are not specifically designed to facilitate the kind of resolution workflows that are needed to address health equity and SDoH issues. A specialized platform facilitates operational improvement by seamlessly exchanging relevant insights for each patient population.
How Information Technology is Utilized in Care Guidance:
- Resource Allocation: Data analytics help healthcare organizations allocate resources effectively based on patient needs, optimizing the patient navigation process.
- Machine Learning and AI: AI algorithms analyze patient data to offer personalized recommendations for treatments, lifestyle changes and support services.
- Interoperability: IT systems communicate across different platforms ensuring the smooth flow of patient information between healthcare providers and navigators, improving coordination of care.
- Data Analytics: By analyzing patient data, IT systems predict potential health issues, allowing providers to intervene early and prevent complications.
- Measuring Outcomes: Collect data to measure the effectiveness of their services, including patient satisfaction, adherence to treatment plans and health outcomes.
- Continuous Improvement: Based on collected data, patient navigation programs can be improved to better serve patients’ needs.
Data analytics within the platform provide insight into non-clinical issues, identify probable SDoH risks and facilitate personalized communication. AI and machine learning anticipate patient needs based upon condition-specific protocols that enable care guides to deliver an unprecedented level of vital, just-in-time communication. Led by this intelligence, care guides provide patients with the information they need to engage in the process of their care and empower each consumer to receive a better understanding of their treatment plan and options.
Why More Health Systems Are Considering Care Guidance Programs
Care guidance is now becoming a “must-have” addition to the service line portfolio of health systems, hospitals and provider organizations. It is at the nexus of managed care priorities where care guidance represents an innovative approach to connected care, advancing heath equity and delivering high-quality care.
A well-designed, scalable care guidance program offers a cost-effective, connected care solution, aligning with the “Triple Aim” goals of improving care, enhancing population health and reducing costs. Patients receive personalized, equitable care, clinical staff can focus on their core tasks and hospital administrators can improve financial and operational performance. This is where care guidance presents the most value and opportunity.
About Craig Parker, JD, CPA
Craig Parker, JD, CPA, CEO, Guideway Care, a company that partners with healthcare organizations to deliver on the promise of health equity through its unique combination of highly trained Care Guides and its patient activation platform. Craig Parker has a history of building innovative healthcare companies with business models that improve care delivery and provide better experiences for all involved. Before taking the helm at Guideway Care, Craig served as a senior leader in healthcare companies working in the patient experience and provider efficiency spaces. In his role as CEO, Craig serves as the company’s chief evangelist, spreading the message that Guideway Care’s services improve life for patients and providers alike.