Healthcare Navigation Program Helps Medicare Patients Navigate the Healthcare System

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At some point in their lives, Medicare patients may need short-term nursing home services — also referred to as skilled nursing facilities or SNFs. For example, a beneficiary may be discharged from a hospital but may need short-term rehabilitation services prior to being discharged to home. Once back home, patients and their families are often on their own when it comes to coordinating needed health care. This can be burdensome and stressful, especially for those who aren’t familiar with how the health care system works.

The free Healthcare Navigation Program administered by the Quality Improvement Organization Program’s two Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) offers a solution to people with Medicare.

Through the Healthcare Navigation Program, KEPRO and Livanta, the BFCC-QIOs serving all 50 states and three territories, help people with Medicare coordinate their health care and connect them — as well as their families and caregivers — with the resources and support they need to understand the health care system at large, what care is needed and how to access it.

How does the program work? Following are two patient stories that show how the program can help people with fee-for-service Medicare. These particular examples show how the program benefited Medicare beneficiaries who were discharged from nursing homes.

A Medicare patient was ready to be discharged to home from a nursing home after completing rehabilitation. Since she wasn’t able to live at home alone safely due to a decline in her cognitive and functional status, the patient moved in with her daughter. Like many caregivers, the daughter was taking care of her parent while working a full-time job. The daughter heard about KEPRO’s Healthcare Navigation Program and contacted the organization to learn about resources and services for in-home companionship, respite and socialization. KEPRO was able to connect the daughter with needed services by making referrals on her and her mother’s behalf to the Programs of All-Inclusive Care for the Elderly (PACE), the Benjamin Rose Institute on Aging, and the Direction Home Area Agency on Aging. Because of the help provided by KEPRO, the patient and her daughter elected the hospice benefit with a hospice agency, and the patient was able to receive the care she needed to remain safely at home.

Having fallen and injured his hip, a 73-year-old man was receiving treatment at a skilled nursing facility. Upon receiving notice of his imminent discharge, the patient’s sister started the appeal process because he lived alone in a rural area and could not walk safely. Additionally, he was unable to get in and out of his wheelchair without assistance. Livanta collaborated with the patient, his sister and his social services manager to create a safe experience for him at home, including arranging a home health aide. In time, as the patient was able to regain his ability to walk, another Livanta patient advocate helped him access services from a registered nurse, physical therapist and occupational therapist. Since the man suffered from anxiety and the patient advocate knew the details of his case, a psychiatric nurse was requested and assigned.

As shown through these patient stories, this Healthcare Navigation Program creates direction for people with Medicare as they go through the health care system and are connected to care they need in various health care settings.

For more information about the Healthcare Navigation Program, visit the QIO Program website.