A New Caregiving Crisis Meets a New Policy Unlock

Picture a scenario we all know too well: an older adult with multiple diagnoses trying to manage a maze of appointments, referrals, transportation challenges, and insurance requirements. What looks like “one medical issue” quickly turns into a full-time coordination job. This is now the norm in aging America. Older adults face rising medical complexity, but the bigger threat is often logistical failure. Without help identifying specialists, scheduling care, arranging transportation, or navigating community resources, outcomes deteriorate fast. Older adults without adequate support are 34 percent more likely to be hospitalized, driving $37B in avoidable annual costs.

This burden increasingly shifts to families. The caregiver ratio has collapsed from 7:1 in 2010 to 4:1 today, heading toward 3:1 or lower. Care coordination becomes a second job: navigating referrals, solving transportation gaps, handling paperwork, and managing social needs. For patients with dementia, schizophrenia, cancer, substance use disorders, or chronic illness, this work is overwhelming. When layered with social determinants like food insecurity or language barriers, it becomes nearly impossible.

For decades, Medicare reimbursed the clinical encounter but ignored the navigation required to reach it. That changes now. In 2024, CMS introduced Principal Illness Navigation (PIN) and Community Health Integration (CHI); the first benefits designed to reimburse care coordination itself, not just care delivery.

Cracking the Codes

Together, PIN and CHI cover a wide range of high-value tasks that have long gone unfunded:

• Connecting patients to home- and community-based services
• Scheduling and coordinating medical care
• Providing health education and self-advocacy coaching
• Addressing Social Determinants of Health (SDOH) barriers like food, transportation, and housing
• Supporting behavioral change and treatment adherence
• Offering ongoing social and emotional support

Coverage applies to patients with a serious condition lasting at least three months or those facing key SDOH barriers. After a physician’s initiating visit, all subsequent services can be delivered by trained non-clinical personnel, typically virtually, with reimbursement averaging $100 per hour and no explicit frequency caps. All services, including the initiating visit, can even be billed without face-to-face interaction.

Technology as the Infrastructure Layer for PIN and CHI

At first glance, it might seem like PIN and CHI’s hourly reimbursement model leaves little incentive to automate. If time drives revenue, why streamline the work? In reality, the opposite is true. These codes debut at a moment when the U.S. is facing a profound caregiver and navigator shortage. Millions of older adults are left to manage complex conditions alone, and there simply are not enough people to support them. Automation becomes the only way to extend the reach of each navigator, allowing them to take on far more patients than would be possible manually.

Technology also acts as a force multiplier around the hourly tasks themselves. Even if the core activities are completed by humans, software can strengthen and elevate the entire offering: maintaining accurate vendor directories, optimizing insurance benefits, managing documentation and billing, surfacing community resources in real time, and ensuring information flows cleanly across the care team. These layers don’t reduce the reimbursable work, they enhance its quality, consistency, and scale.

Against that backdrop, PIN and CHI create a blueprint for leveraging technology to operationalize what has historically been fragmented, manual, and inconsistent. Nearly every reimbursable workflow involves information gathering, communication, logistics, or education, domains where technology excels.

1. Transforming intake information into actionable care plans

Digital systems can ingest clinical history, physician notes, and patient priorities, summarize them, and generate structured next steps. What once required hours of manual review becomes a streamlined workflow, enabling navigators to deliver personalized care plans quickly and consistently.

2. Streamlining appointment coordination and preparation

Scheduling is one of the most time-consuming parts of navigation. Automated agents can handle outreach to providers, confirm appointments, track prep requirements, and flag transportation needs. Reminders keep patients and caregivers aligned, reducing missed visits and improving adherence.

3. Maintaining up-to-date community and vendor resources

PIN and CHI emphasize linking patients to regional supports. Technology can maintain continuously updated directories of community programs, service providers, and local resources, eliminating the manual search process that overwhelms families and care teams alike.

4. Navigating insurance and financial barriers

Coverage questions and claim issues often derail care. Automated tools can review benefits, detect errors, draft appeals, and manage payer follow-ups.

5. Bringing consistency to emotional and social support

While human connection is irreplaceable, software can flag risk signals, suggest check-in protocols, and provide resources that help navigators deliver more structured, reliable support.

Looking Ahead

Hourly reimbursement does not diminish the role of automation, it heightens it. Automation expands capacity; infrastructure improves quality; and together they create a scalable model that can actually meet the needs implied by PIN and CHI.

These codes represent the first meaningful funding mechanism for navigation, coordination, and social support. Technology now has the chance to build the backbone beneath it: the workflows, intelligence, and systems that allow navigators to do more, reach more people, and operate at a level of consistency that manual models have never achieved.