naviHealth Focuses on Transitions for Medically Fragile Seniors
Ensuring a seamless continuum of care for medically fragile seniors can be complicated. Enter naviHealth, a national leader in care transitions. Founded in 2011, the Nashville-based healthcare company works with health plans and risk-bearing health systems to provide an improved experience for seniors as they move from acute care to post acute and back to independent living.
"In healthcare, there's a movement toward value-based care, and we enable that for payers and providers," said naviHealth Chief Medical Officer Jay LaBine, MD.
LaBine joined the company in 2018, but he previously spent five years as a naviHealth client while serving as CMO of a Michigan-based health plan. "We brought naviHealth in because we wanted a solution for improving care in nursing home facilities and improving efficiency of care for our member patients," he noted.
"From a patient perspective, the industry is extremely fragmented, causing significant frustration. During the transition from acute care hospitals to skilled nursing facilities, there's a lack of information exchange and data to evaluate the quality of care, the risk of readmission and the progression to independent living at home," he explained.
LaBine said misaligned industry incentives are also to blame: Hospitals are financially incentivized to move patients out quickly, while post-acute care facilities are typically paid on volume. "naviHealth bridges that fragmentation by giving caregivers, patients and families a better idea of what to expect in post-acute care," LaBine said.
The naviHealth approach is simple - the company works with Medicare Advantage plans, more than four million covered lives, using real people embedded in facilities in more than 47 states (and growing). Their 1,000-plus local care coordinators work alongside patients, payers and healthcare organizations, utilizing naviHealth's propriety, evidence-based care planning tools. The database of over four million patients lets clients know what to expect in terms of each patient's recovery and long-term trajectory once at home. The decision support tool provides clinicians with a better data-driven choice for each patient and has been shown to be highly accurate.
"We're unique in that we have a differentiated solution in the way our clinical care coordinators work with data around the functional gain of patients and set performance benchmarks for skilled nursing facilities, so we're able to show customers how well facilities are doing based on individual patient-adjusted benchmarks," LaBine said.
From a payer perspective, LaBine said naviHealth provides solutions - and medical cost savings - in response to Medicare requirements demonstrating patients are receiving the right care in the right setting.
"We're fully delegated the authorization process to get patients into the right setting of care," he said. "Health plans and all our customers get a detailed report card on who's doing a good job of taking care of seniors in post-acute care and use that report card to develop a high-performing network. We have a patient- and provider-centric model that takes into account each patient's local environment."
The company's commitment to local care has earned naviHealth a patient satisfaction rating of over 90 percent. "We've demonstrated gains in daily activity and mobility, and we're giving patients extra days at home each year because we're helping to choose the right setting of care," LaBine said, noting that the right setting of care decreases costs and ensures more efficient transition through the system. "We're also financially aligned with risk-bearing health systems, and we get paid when outcomes are better for patients and share that value with our customers."
naviHealth's care transition platform is utilized by large health systems, health plans and post-acute providers across the nation. naviHealth has experienced year-over-year growth and now has almost 500 employees based in the Greater Nashville area. In fact, the company was recognized as the third largest area healthcare IT company by the Nashville Business Journal in April 2019.
LaBine credits growth to the company's mission of continually improving health and lives for seniors. "We're redesigning post-acute care," said LaBine. "We work closely with providers in the sweet spot of health plans and risk-bearing health systems. Our patients consistently show functional improvements that decrease the length of stay required to get them back to full function."