BIRMINGHAM, Ala.–()–Guideway Care (Guideway), an innovative healthcare company dedicated to advancing health equity, optimizing patient outcomes and lowering total costs of care, is pleased to enthusiastically support the recent announcement that the Centers for Medicare & Medicaid Services (CMS) will pay for principal illness navigation (PIN) services to help patients and their families navigate cancer treatment and treatment for other serious illnesses. Six years in the making, this new payment policy builds upon a 2012 CMMI Innovation Grant awarded to Guideway’s co-founder, Ed Partridge, MD, who was the principal investigator for a study on non-clinical navigation during his tenure as Director of the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB). In 2017, Dr. Partridge and his team from UAB published their groundbreaking results in JAMA Oncology. The article articulated the finding that lay navigators in oncology were highly effective at addressing patients’ underlying social determinants, which negatively impact their health and increase healthcare costs. For a full summary of what the new CMS rule means for patients, providers and the healthcare system, click here.

“The new rule opens additional revenue opportunities for entities that can take advantage of the Principal Illness Navigation (CPT codes G0023 and G0024) and Social Determinants of Health (SDoH) Assessment opportunities (CPT code G0136),” said Craig Parker, Guideway’s CEO. “Our Guideway team has specialized in these two areas and has more than ten years of experience with care guidance, a broader set of patient interactions beyond mere navigation, as well as assessments in the areas of SDoH. In fact, Guideway is a national leader (recently recognized by the Deloitte Fast 500) in helping hospitals and practices find and solve non-clinical barriers embedded in the SDoH and can be a key partner to allow organizations to increase revenue in these two new areas.”

After CMS and researchers from NORC at the University of Chicago independently validated the CMMI grant results reported in JAMA Oncology, Guideway was formed with assistance from UAB and Dr. Partridge. Guideway has exceeded its original goal to continue the pioneering Patient Connect program in oncology by expanding it more broadly to over seventy specific diseases and conditions, while proving the ability to reduce readmissions and other avoidable utilization across diverse populations and in a variety of settings. What started out as a lay navigation concept has grown into something beyond mere navigation into a full suite of patient-activation centered interactions and partnerships with 150+ organizations.

“The challenge for healthcare providers is that taking advantage of the new revenue opportunities will require carefully trained care navigators with structured workflows and new documentation systems,” continued Parker. “In their decision to “build” or “buy” this expertise, many organizations are concluding that it is far more cost-and-time effective to outsource these responsibilities to an experienced care guidance organization that can provide turn-key operations with immediate implementation.”

Guideway solutions relieve overburdened clinical staff from addressing non-clinical challenges. It is estimated that clinical care, on average, has an impact on just 20 percent of health outcomes, whereas SDoH and other non-clinical issues can influence as much as 50 percent of health outcomes.

UAB Medicine’s Chief Strategy Officer, David Randall, said, “Since its pilot inception at UAB more than ten years ago, Guideway has been delivering proven approaches that modernize and significantly improve upon legacy patient navigation programs that frequently lack meaningful patient interactions and as a result are commonly ineffective at ensuring that the healthcare team is talking to the right patients about the right things for the right amount of time.”

Guideway’s trained and skilled care navigators provide a deeper, more effective solution to decrease care navigation expense, increase clinical capacity, raise patient satisfaction, grow profitable revenue, streamline appointment setting and improve patient acquisition and retention.

Download our full summary of the new rules and code changes here.

About Guideway Care

For more than 10 years Guideway Care has delivered scalable community health integration solutions that address social determinants of health, advance health equity, reduce readmissions, increase revenues and improve HCAHPS scores. Guideway delivers white-labeled turnkey solutions to hospitals/health systems, payers and provider organizations that help clients reduce health disparities, improve patient/member satisfaction and lower the total cost of care. Highly trained Care Guides, supported by a proprietary technology platform, build peer-to patient relationships that allow for the identification and resolution of non-clinical and clinical barriers to accessing quality care. By maximizing the patient care experience and resolving barriers that lead to avoidable deterioration and acute care utilization, the Guideway approach to patient activation achieves effective CHI, addresses SDoH and creates value for all stakeholders.