Why the US needs healthcare navigation

US healthcare has never been more advanced — and never been more difficult to navigate.

For many people, getting care is no longer as simple as visiting a doctor, receiving a prescription, and going home. An older adult may have a primary-care doctor, two or three specialists, several medications, a recent hospital visit, and appointments scattered across different healthcare organizations. Add a transportation problem, a tight food or medication budget, or the absence of nearby family, and even an excellent medical plan becomes very difficult to follow.

This problem is becoming urgent for a simple reason: the US is getting older.

Today, about 70 million Americans are enrolled in Medicare, and more than nine in ten Medicare beneficiaries are 65 or older. By 2030, every Baby Boomer will be at least 65. By 2034, older adults are projected to outnumber children in the United States for the first time in the country's history.

Aging itself is not a problem. But aging usually means a more complicated relationship with healthcare. About two-thirds of people in Traditional Medicare live with two or more chronic conditions — a person may be managing diabetes, heart disease, kidney disease and more, simultaneously. Each condition brings its own doctors, medications, tests and appointments.

A healthcare navigator is someone who helps a patient understand and move through the healthcare system. They might schedule the appointment, find the ride, connect community resources, translate what needs to happen after a hospital discharge, coordinate between providers who don't talk to each other, and follow up when something quietly falls through a crack.

The navigator does not replace the doctor. The doctor provides the medical care. The navigator makes sure the patient can actually reach and follow that care. The distinction matters because most of what derails treatment happens outside the doctor's office: in 2022, CMS data showed that 17% of community-dwelling Medicare beneficiaries experienced food insecurity, and 14% reported difficulty getting places — a figure that climbs higher still among those 85 and older.

Consider the simplest possible example. A doctor tells an older patient:

“You need to see a cardiologist next week.”— The doctor — medically, entirely correct

“I don't have a car.”— The patient — practically, entirely stuck

The problem is no longer medical knowledge. The problem is getting one human being to one appointment. If nobody owns that problem, the treatment plan fails — even though the doctor did everything right.

Medicare has increasingly recognized that these barriers decide medical outcomes. In 2024, CMS introduced two new categories of reimbursable services: Community Health Integration (CHI) and Principal Illness Navigation (PIN).

• CHI targets health-related social needs that interfere with care — navigators help patients connect with community resources, overcome practical barriers, coordinate services and advocate for themselves.
• PIN serves people with serious, high-risk illnesses who need help navigating the complicated journey around their condition — the appointments, the coordination, the follow-through.

Both services encode one important admission into the Medicare fee schedule itself: medical care does not happen only inside a doctor's office. Someone has to help the patient navigate everything before, between and after the visits — and CMS explicitly opened these services to community health workers, patient navigators and peer-support specialists, the people who have always done this work informally.

This is not a theory waiting to be tested. CMS ran the test — a national experiment called the Accountable Health Communities Model, which screened more than 1.1 million Medicare and Medicaid beneficiaries for food insecurity, housing instability, transportation problems, utility needs and interpersonal violence, then connected the people who screened positive with help.

The final evaluation found roughly $219.6 million in net savings after accounting for the full cost of the intervention — savings driven largely by reductions in the most expensive kind of healthcare: the avoidable emergency visit, the preventable readmission. The progression that followed is how good policy is supposed to work: identify the problem, help the patient, measure the results, and fold what works into Medicare. CHI and PIN are that final step.

Watch what a single hospitalization sets in motion for an older patient. A follow-up specialist appointment. A changed medication. A pharmacy visit. A ride that needs arranging. A test that needs scheduling. A caregiver who needs to understand the new plan. None of these tasks is enormous on its own.

Doctors, nurses, hospitals, medications and technology are essential — and they cannot solve every barrier a patient faces. A doctor can prescribe. A hospital can treat. A specialist can recommend. A pharmacy can dispense. Someone still has to help the patient put it all together, and as the US grows older and healthcare grows more complex, that someone becomes less optional every year.

Healthcare should not end with telling a patient what to do. It should include helping them understand what to do next — and making it possible to actually do it. That is the idea behind CHI and PIN, and it's the idea Navigate Care is built on. Reduced to one sentence: good healthcare is not only about providing the right care — it's about making sure the patient can reach it.