CMS GUIDE Program

Medication Optimization. Zero Added Workload.

NavRx integrates directly into the CMS GUIDE model to automate medication risk identification, reduce high-risk prescriptions, and lower readmission rates. Your clinicians keep doing their jobs. NavRx handles the medication layer.

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$528 Billion

Spent on medication-related costs in the U.S. every year. This is not a niche inefficiency. It is the largest preventable cost category in healthcare, and most health plans are managing it reactively.

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1 in 3

Hospital admissions are directly tied to medication issues. Adverse events, dangerous drug interactions, and poor adherence are driving your readmission numbers. The root cause is already in your data.

1.5 Million

Emergency room visits each year are caused by adverse drug events. The majority of these patients had visible warning signs in their prescription history before the crisis. The signals were there. The system did not act on them.

500,000

Hospitalizations annually trace back to medication problems. These were not sudden events. They were preventable with earlier intervention, earlier risk identification, and an earlier touchpoint in the care network.

65,000+

Retail pharmacies are already embedded in your patients' lives, seeing them consistently, at population scale. That network has been invisible to health plans. NavRx activates it. Your patients are already there.

The data to solve this problem already exists. What has been missing is a single connected view, with enough time left to act. That is what NavRx provides.

Automated at Every Step. Invisible to Your Clinicians.

How NavRx integrates into the GUIDE model

NavRx connects three data layers that health plans already have access to but rarely see in one place: patient biology and prescription history, real-time pharmacy workflow signals, and claims and outcomes. The platform synthesizes these into a Medication Risk Index score for every patient, then routes interventions automatically to the right point in the care network.

Patient biology and medication history scored continuously via the Medication Risk Index, not just at intake
High-risk flags routed to retail pharmacists already in your patients' network, no new referrals required
Outcomes tracked and reported back to your GUIDE team, closing the loop without adding documentation burden
No EHR build required to get started. NavRx operates alongside your existing systems.

Step 1

Patient Data

Step 2

Medication Risk Index

Step 3

Intervention and Outcomes

What GUIDE Participants Are Seeing

Measured outcomes across active NavRx deployments

15-25%

Reduction in high-risk medication use among enrolled dementia patients

5-8%

Fewer hospital readmissions in the first 90 days post-enrollment

10-15%

Decrease in measurable caregiver burden scores

These outcomes reflect NavRx deployments inside live GUIDE programs. They are achieved without adding clinical staff, modifying existing workflows, or requiring new patient-facing technology.

Built for the GUIDE Model. Designed for Scale.

Why health plans and health systems are choosing NavRx as their GUIDE medication layer

Zero workflow disruption: NavRx operates in the background. Your clinical team receives only the interventions that matter, already prioritized and ready to act on.

Population-scale reach: Connected to 65,000+ retail pharmacies, NavRx puts a qualified medication touchpoint inside most patients' existing care routine without adding a new referral step.

Continuous risk scoring: The Medication Risk Index scores every patient in real time, not just at intake. Risk changes as prescriptions change. NavRx keeps pace.

GUIDE-aligned reporting: Outcomes are delivered in the format GUIDE model requirements expect, reducing administrative lift at reporting time and keeping your team focused on care.

Fast activation: NavRx is deployed and operational in weeks, not quarters. No EHR build required. Integration begins with your existing data.

See What NavRx Can Do for Your GUIDE Program