Clinician-driven care navigation: A key employee benefit.

Health benefits have always played an important role in employee compensation packages. However, today’s competitive labor market and economic factors, including inflation and increasing healthcare costs, have underscored the value of a comprehensive and competitive health benefits plan. It is the expectation that employers deliver an innovative benefits plan that provides holistic, high-quality care at a reasonable price.

Care navigation, a benefits solution that guides employees to the right care at the right time, is a way to keep costs down for employers and their employees while increasing the quality, timeliness, and suitability of care. These solutions typically involve experts who provide guidance throughout the entire healthcare journey by identifying the most effective care at the best price, ensuring no preventable expenditures are made. Within a navigation solution, care team personnel can be administrative or clinical. Dedicated health guides, billing specialists, and benefits specialists assist members in understanding their health benefits, disputing their bills, and finding in-network providers that meet their needs. Clinical guides are registered nurses or nurse practitioners who can provide real-time clinical guidance for members, develop tailored clinical care plans, and close care gaps as needed. The strongest solutions offer clinical-first care teams. Clinical guides understand how to perform the right triage to fully understand a member’s needs and help them make the right decisions. 

Despite their proven effectiveness, care navigation services are still far from being a universal benefit. However, employers are quickly recognizing the need to offer this solution to their employees. A 2022 study by McKinsey found that while only 11% of organizations surveyed currently offer access to care navigation services, 30% say they definitely will offer these services to their employees in the future.

With cost reduction and employee health at the top of minds for employers, why do they hesitate or fail to consider care navigation services as a solution? We’ve found three primary reasons, and while these reasons may have once been valid, new solutions exist in the market that alleviate these concerns:

• Fear of friction with health insurance carriers. Not all care navigation services seamlessly integrate with an employer's existing coverage. Some navigation operations may overlap with carrier processes in a way that makes them challenging to coexist, such as taking over key functions that are traditionally handled by the carrier, like pre-certification. Employers may be forced to switch carriers to implement care navigation or piece together workarounds that frustrate employees and result in conflicts with insurers.

• Concerns about cost. One instinctive reaction to adding care navigation is that it will increase the costs of the organization’s existing benefits plan. Some systems that provide full-clinical navigation are a hefty investment and can run upwards of $20 per employee per month. Companies should consider the value that each care navigation solution can bring to their employees before offering it as a benefit. 

• Belief that lower-cost solutions lack clinical depth. Employers may consider evaluating lower-cost alternatives if they determine they are priced out of more expensive care navigation services. Many of these less expensive, “light-weight” health navigation solutions don’t offer personalized clinical support, lessening the intended impact that a comprehensive clinical care navigation solution would deliver. The “health guide” may be a call-center representative who connects the member with other departments, as many “tech-enabled” navigation solutions are little more than chatbots with no clinical component.

The good news is that these concerns may no longer be relevant with affordable, clinically-led healthcare navigation solutions. 

Rightway was founded to create a frictionless full-clinical navigation solution at a fraction of the cost of other solutions. So, how can Rightway achieve this success when so many others cannot? Its system was designed to be mobile-first from day one in an industry full of antiquated legacy healthcare platforms. While many solutions fail to gather the full scope of a member’s health or function on an outdated, unengaging interface, Rightway’s mobile or desktop app button is a "digital front door" for members, connecting them directly to the right person on their dedicated care team.

Another crucial element in Rightway's success is strategic healthcare cost savings resulting from the intelligent use of data and effective allocation of resources. Rightway uses smart routing to assign members to a dedicated clinical guide who helps members with clinical triage, treatment decision support, care coordination, and overall well-being needs. This intelligent triage strategy directs members to the right person at the right time who can best address their needs without unnecessary hand-offs.

Finally, Rightway's core success comes from using smarter clinical navigation and proactive outreach to impact the moments that matter. While a member might contact their care team about a billing matter, if they don't have a primary care provider or are overdue for a yearly exam, their clinical guide will address those issues simultaneously. Since clinical guides have access to years' worth of patient history, every interaction is an opportunity to address any overdue preventive or follow-up care. Preventing health problems from developing or catching them early and encouraging adherence to any diagnosed issues are crucial to driving better care for members.

In 2023, employees will expect their benefits package to stay up-to-date with their evolving needs. Adding a modern, clinical care navigation solution like Rightway helps employers show their employees that they care, turning a standard health benefit offering into a highly valuable member experience. Care navigation is a win-win for employers and their employees, reducing costs, increasing member satisfaction with benefits, and improving overall health outcomes. 

Ready to provide a better employee experience with a high-tech, clinician-driven care solution? Talk to us.