Clinical navigation: Latest buzzword or necessary benefit?

Before joining Rightway in January 2022, I spent eight and a half years at Willis Towers Watson (WTW) as a practice leader and prior to that, several years as a regional consultant. My most recent role as a WTW National Practice Leader was to lead the regional health management consultants, provide thought leadership, deliver consultation on health management strategies to companies nationwide, and support the client teams on other health and benefits strategies. During that time, I would wake up every day, sit down at my computer with a large YETI of ice water, and … be flooded with emails from vendor partners.

As a consultant in the health and benefits space, I racked up—and slowly answered—hundreds of emails from vendors explaining why their point solution was the one my clients needed, whether it be for family planning, musculoskeletal conditions, telemedicine, mental health, etc. In addition to keeping track of these vendors, I had a goal of helping my clients and their employees navigate a healthcare system so complicated that 88% of U.S. adults can’t make sense of it. 

I'd spend hours trying to decipher which solutions could actually move the needle for my clients and their employees versus which were just hype. Over time, I began hearing more and more about clinical navigation, and I wondered: What was it, the latest healthcare buzzword, or a benefit that would finally disrupt the ecosystem as we knew it?

How underused point solutions cause trouble.

Consultants work hard to help clients vet and implement programs to mitigate costs by offering solutions to their employees that increase engagement and improve health outcomes. But if employees don’t actually use these tools, the spend can no longer be justified—and we know who usually gets blamed for that, the consultants.

For over 20 years, I acted as a health and benefits consultant to employers trying to optimize the well-being of their employees while decreasing their healthcare spend, so I’m attuned to all the overlapping pressures. I saw firsthand how great point solutions could go to waste when employees didn’t know how to use them or even realize they were offered by their employer. Inevitably, and however unfairly, it was the reputation of the advising insurance professional that suffered when these programs were unsuccessful. 

The problem, of course, is unmanaged healthcare complexity. In a recent survey conducted by Maestro Health, 70% of respondents reported feeling that today’s healthcare system is difficult to navigate, and 39% said they don’t feel they have the support they need when it comes to understanding their healthcare. 

Why employers need a single point of access to their benefits ecosystem.

This is where care navigation comes into play. Among the barrage of point solutions that were pitched to me regularly, care navigation was the only system uniquely equipped to move the needle for employers. Why? Because clinical navigation is not just another point solution, it is a platform that guides employees to the support they need, when they need it. Smarter clinical navigation serves as the front door to the broader healthcare ecosystem, simplifying healthcare and guiding health decisions through a clinician-led lens and ensuring employees are educated on the value of the benefits being offered to them.

It would be understandable to lose “care navigation” in the abyss of emails sent to consultants from vendors, but it would be a mistake. Three-fourths of consultants say that independent navigation specialists are best at providing care navigation services when compared to insurance companies and healthcare providers. And, a vast majority (90%) say that companies offering employees a single point of access to their benefits demonstrate meaningful savings on claims costs.

Health guides serve as more than just advocates; they’re healthcare educators. When approached by employees seeking to understand their healthcare, they act as trusted advisors with the expertise and the resources to triage and direct them to the right care at the right time.

Healthcare has reached a critical point. Employers are spending more money but getting less value as the health benefits landscape becomes increasingly crowded, leaving employees confused about the options available to them. Care navigation has risen to the top as the preferred solution for helping employers optimize their healthcare spend while guiding employees to the highest quality care and optimal medication at the lowest cost. A solution like this is changing the healthcare landscape for good—and if consultants fail to bring clinical navigation to clients and their employees, another consultant will.

What consultants should know about the healthcare revolution.

The monumental shifts brought by the pandemic have included a renewed examination of the healthcare industry and the ways it can be accessed and improved. My clients at WTW put an incredible amount of trust in me to help them develop health management programs that aligned with their overall goals of improving their employees’ healthcare experiences and their bottom line. How do we ensure that consultants are bringing the right solutions to their clients in the future?

I believe there will be a revolution in the industry, driven by consumers who are empowered to make better decisions along their unique healthcare journeys. New, innovative clinical navigation models will be the helping hand ushering in access to care—and these consumer-centric platforms will be the solutions that stand the test of time.

See how care navigation is transforming healthcare.