Navigating the U.S. health care system can be a challenge for anyone, especially for people who are older and have chronic health conditions. As beneficiary care is often delivered in a fragmented manner especially for those with multiple care needs, patient navigation offers a viable solution to facilitate a seamless flow for beneficiaries as they journey through the care continuum.

The Centers for Medicare & Medicaid Services (CMS) is committed to ensure that its beneficiaries receive safe, reliable, and high quality care. Aligned with its Person and Family Engagement Strategy, CMS partnered with two Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) to provide health care navigation support to Medicare beneficiaries who meets a defined needs criteria.

As one of the BFCC-QIOs that launched the Patient Navigation Program in October 2017, KEPRO helps Medicare patients who feel overwhelmed with the management of their chronic conditions by teaching them about the care that they need and the resources available to them. A great example of improving beneficiary service is when KEPRO Patient Navigators worked with a patient in Virginia who had a wound on his foot and was unable to go to therapy. Aside from not getting necessary care arrangements after hospital discharge, his wife was unable to physically get him to doctor appointments. Through the Patient Navigation program, the patient now has a primary care physician and podiatrist to come to his home and provide medical care for his wound. The beneficiary and his wife were thankful for the program as they did not know that some providers are available for home visits.

“KEPRO’s Patient Navigation program is a game changer for the many Medicare beneficiaries who need help to fully understand their condition and how to get needed resources, including how to navigate complex health care systems.”

Between October 2017 and December 2018, KEPRO completed Patient Navigation services with 5,490 Medicare beneficiaries and continued helping an additional 894 Medicare beneficiaries locate needed services. “KEPRO’s Patient Navigation program is a game changer for the many Medicare beneficiaries who need help to fully understand their condition and how to get needed resources, including how to navigate complex health care systems,” says Rita Bowling, Program Director. “We are constantly getting feedback from patients and families about how much the program has helped them and how grateful they are to have someone to turn to who can answer questions and provide guidance.”

Another instance when Patient Navigation can be useful is when a Medicare patient feels that they are not ready to leave the hospital, but they are being discharged. People with Medicare have the right to file an appeal if they think they are being sent home from the hospital too soon. Sometimes appeals are denied and Medicare patients are discharged without the ability to assume control over their own care. KEPRO uses its Patient Navigation program to help fill this void. Patient navigators assist patients and caregivers to make sure they have what they need to get better once they return home.

For example, a Medicare patient was in the hospital due to a collapsed lung, weakness and weight loss issues. After receiving appropriate care, the facility decided to discharge the patient which did not sit well with her daughter. The daughter filed a discharge appeal which was subsequently denied. Through KEPRO’s Patient Navigation program, the patient’s daughter was made aware of existing community resources that serve older adults. She also received help setting up a medical alert since her mom lived alone. The patient safely remained in her home while she fully recovered from her health condition.