Effective Patient Navigation is Key to Optimizing Healthcare Delivery
Amongst all healthcare stakeholders, there is consensus that everyone would like to achieve lower cost of care, better patient outcomes and an overall healthier population. While the best approach to achieving these lofty goals is debatable, the simple concept of delivering the right care to the right patient at the right time is a strategy that a growing number of constituents are embracing to optimize the effectiveness of the entire healthcare ecosystem.
Effective patient navigation means optimally matching a patient in need to the best provider and setting for their given condition. With continuous improvements in digital health and virtual care technologies, a utopian healthcare ecosystem where everyone is perfectly navigated to the ideal setting is becoming more of a reality.
When provider, patient and setting are optimally matched, everybody wins. The optimal match means that the patient is getting the best care possible, the provider organizations are utilizing their most efficient and effective clinical resources and the risk-bearers are experiencing a lower cost of care and healthier population.
The idea of effective navigation has evolved dramatically in the last twenty years. Through much of American healthcare history, the primary goal of healthcare navigation was a patient reaching a physician as quickly as possible. How the patient found that physician was generally determined through their own relationships, other provider relationships or through local marketing. This relationship-driven approach generally led to multiple phone calls, long travel times, overworked providers, inequities in access, too many trips to the ER and ultimately less effective healthcare delivery.
Today, through digital front door initiatives, synchronous and asynchronous virtual care, remote patient monitoring, intra-hospital transfer technology and intelligent discharge processes, a patient can be navigated much more effectively. These technologies continue to improve through deep analytics and clinical input from leading providers.
Despite technological enhancements, patients still have difficulty accessing the healthcare system and providers still have difficulty finding the right setting for their patients. In an ideal future-state healthcare ecosystem, a navigating technology will follow and guide patients through each step in their journey.
Stages of Healthcare Access
The art of the patient navigation process looks different at different stages of the healthcare journey – whether the patient is: (i) on the front end accessing new clinical resources; (ii) already within a healthcare network; or (iii) leaving a healthcare network for home or other step-down care. Each step of the journey can be triggered by the patient, a clinician, or an informal caregiver like a family member and requires different logical triage mechanisms and access points to make the process simple, fast and effective.
Patients still struggle with the simple question “Where do I go to find the right care for my condition?” There are so many disparate access points into the healthcare system – family practitioners, online directories, telehealth, urgent care, the ER, etc. – it is difficult for patients to make the right judgement call on where to seek care. Front-end triage tools that use AI-driven branching logic to make access recommendations are now becoming more prevalent. For instance, the branching logic can be used to help patients and their caregivers identify and contact specialty providers who are well suited to a specific care goal, rather than simply forcing individuals to make do with the closest provider geographically. Similarly, the branching logic can identify settings of care that are both clinically well suited to the patient’s needs and more cost-effective: including if that care setting is a virtual visit.
Once a patient is within a healthcare network and requires additional services, getting them to the best specialist resources is critical. Large healthcare systems are difficult to navigate even for physicians or hospital administrators. Providers require the right technology tools to recommend the right care at the right time and allow them to efficiently transfer patients to different settings. Without these strategies and technologies, health systems are unlikely to maximize the full power of their networks.
Once a patient is ready for discharge, they should be sent to the right step-down facility or home. Proficient navigation also includes patients understanding their discharge instructions, who to follow up with and ongoing monitoring requirements.
Effective patient navigation is a win-win for all stakeholders. Patients receive better care faster with intelligent assistance to navigate the complex healthcare ecosystem. The healthcare experience becomes more convenient with less travel time. Most importantly, patients stay healthier through better healthcare access.
A profitable healthcare provider requires optimizing the time of scarce clinical resources, capturing the right patients and allowing providers to practice at the top of their license. When patients are navigated appropriately, providers maximize all these strategic goals.
Lastly, successful patient navigation means patients are getting the right resources in the lowest cost setting and with the optimal provider. For payors, employers or the government, that means patients are kept healthier by getting to the right care faster, leading to lower overall costs of care.
Adam Heller is a Director in Ziegler’s Corporate Finance Practice. Adam provides M&A and capital raising advisory for middle-market healthcare companies. He has a specific focus on digital health and virtual care and has completed multiple transactions in these sectors since joining Ziegler over five years ago. Prior to joining Ziegler, Adam spent nearly nine years as an investment banker at KPMG, William Blair and Bank of America Merrill Lynch. Adam has raised over $5 billion in capital and advised on over 75 transactions throughout his career.
Ziegler is a privately held, national boutique investment bank, capital markets and proprietary investments firm. It has a unique focus on healthcare, senior living and education sectors, as well as general municipal and structured finance. Headquartered in Chicago with regional and branch offices throughout the U.S., Ziegler provides its clients with capital raising, strategic advisory services, fixed income sales, underwriting and trading as well as Ziegler Credit, Surveillance and Analytics.
Ziegler published a white paper on telehealth, “Deconstructing the Telehealth Industry: Part III.” To obtain a copy of the white paper, please visit: https://www.ziegler.com/telehealth-part-iii.
This document may contain forward-looking statements, which may or may not come to fruition depending on certain circumstances. Information contained or referenced in this document is for informational purposes only and is not intended to be a solicitation of any security or services. B.C. Ziegler and Company | Member SIPC & FINRA