Drive financial and operational excellence by delivering true, whole person care

A groundbreaking shift from CMS is enhancing care and unlocking value for practices

Lean budgets and people resources can make supporting patients with non-medical needs feel daunting, but CMS’s groundbreaking shift in 2024 is unlocking new opportunities for oncology practices to invest in delivering holistic, patient-centered care and Patient Discovery can help.

What are the new codes and how are they impacting care delivery?

CMS understands that treating the whole patient requires investment in people and technology resources. The new codes released in 2024 reinforce their commitment to supporting practices by expanding reimbursement to investments made in standardized SDoH risk assessment tools and services delivered by the broader care team, including non-clinical staff.

SDoH risk assessment via a standardized tool


Prioritizes the need
to identify social needs
that may influence care or treatment decisions.

CPT Code G0136
5-15 minutes every 6 months

Community Health Integration (CHI) services


Supports resolution of social needs by reimbursing for actions taken by non-clinical staff including community health workers as they educate patients, build self-advocacy, and address identified needs.

CPT Code G0019
60 minutes per month

CPT Codes G0019 + G0022
For each additional 30 minutes per month

Principal Illness Navigation (PIN) services


Focuses on ensuring access for patients as they navigate the healthcare system, including patients without social needs. Works in parallel to CHI and reimburses non-clinical staff who support activities like care coordination, health education, patient advocacy, and referrals.

CPT Code G0023
60 minutes per month

CPT Codes G0023 + G0024
For each additional 30 minutes per month

Taken holistically, these are some of the largest changes ever towards a Medicare that recognizes people with Medicare as whole persons, with their own families and unique life stories. After all, people are more than the sum of their ailments and diagnoses.
— Meena Seshamani, MD; CMS Deputy Administrator and Director of the Center for Medicare

How Patient Discovery can help your practice

Patient Discovery is a clinically validated, standardized tool designed to maximize care team resources and deliver patient support at scale, improving the patient experience and enhancing the operational health of the practice.

Integrated into the clinical workflow, Patient Discovery:

  • Proactively engages patients to communicate what matters most for their treatment and care plan

  • Administers a comprehensive SDoH risk assessment to efficiently identify unmet needs impacting patient diagnosis and treatment

  • Intelligently automates referrals to patient support resources, allowing social workers and navigators the time they need to provide help where it’s needed most

  • Captures the activities of the expanded care team to meet payer reimbursement requirements

A female doctor talks to a young male patient while referring to the Patient Discovery app on her laptop screen.

Novel, longitudinal patient insights increase care quality and drive down the total cost of care

Patient Discovery is uniquely focused on understanding the non-medical patient preferences, priorities, and challenges influencing treatment access and adherence. Our equitable care platform captures and delivers a novel longitudinal view of the patient journey that enhances how we see and understand patients, ensuring high-impact, quality care delivery that drives down the total cost of care.

Ready to learn more?