Care navigation

We run care navigation for specialty practices.

Medicare began paying for care navigation in 2024, through the Community Health Integration and Principal Illness Navigation codes.

These codes ask far less of a practice than the previous generation. Chronic care management requires a comprehensive electronic care plan, round-the-clock access and clinical staff, and caps the time you can bill each month. It is hardly surprising that fewer than 4% of eligible Medicare beneficiaries receive it.1

Those hurdles largely don’t apply to the new codes. Adoption hasn’t caught up.

We run the programme so that a practice doesn't have to build one. We employ the care advocates and the clinicians and carry the operational and documentation load. The practice keeps its patients and its relationships.

Talk to us How it works

What we do

We keep patients on their care plan.

Outcomes depend on patients actually attending. We prevent missed follow-up and support adherence to the plan the practice has already set — and report back on what changed.

Keep patients in treatment. Fewer people quietly lost to follow-up.
Take work off your staff. The transport calls and the chasing come to us.
Recover revenue you’re losing. Visits that were already yours.

Find loss to follow-up

We identify patients who have quietly stopped attending — treated recently, nothing on the books. They never cancelled, so they appear in no standard report.

Remove the barrier

Our care advocates work on what keeps people from treatment: getting there, affording it, arranging it around a carer, and understanding why staying on the plan matters.

Carry the programme

We employ the staff, run the workflow and hold the documentation. The practice doesn't build a care management function to make this work.

Report back

Who engaged, who returned, and what changed on the schedule.

Who this is for

Long treatment courses, where missing a visit matters.

Specialty practices treating Medicare patients on long-running, appointment-dependent therapy — where skipping a visit has real clinical consequences, and where nobody on staff has the capacity to chase anyone.

Retina Dialysis

Who we are

Max Holle

Founder

Max has spent the last two years building and operating care navigation programs for Medicare patients. At Baba Care, he launched a program serving 500+ patients with a team of 30+ clinical staff. At Craniometrix, he helped scale a dementia care program to 4,000+ families across 15 states, managing a team of 40 care navigators.

Previously, Max worked with large health systems as a consultant at McKinsey and Recon Strategy. He holds an MSc in International Health Policy from the LSE.

1. Avalere Health, Chronic Care Management in Medicare: Optimizing Utilization, analysis of 100% Medicare fee-for-service data, citing HHS Assistant Secretary for Planning and Evaluation: fewer than 4% of eligible enrollees received CCM in 2019. Approximately 1.3 million beneficiaries received CCM in 2023. Source