Why ignoring care navigation hinders your benefits goals.

Between soaring costs and a complex healthcare system, optimizing your employee benefits package isn't just advantageous, it's essential to meet your benefits goals. For the second consecutive year, healthcare costs are projected to surge over 7% in 2024. Further, a staggering 85% of employees report being confused about their benefits. Benefits leaders are spending extensive time helping their teams, from explaining healthcare basics to supporting them through costly, complex healthcare needs. How can you address these challenges head-on?

Today’s healthcare navigation solutions vary in the services they provide. Effective care navigation services use clinical-first teams to direct members to the highest-value care. Live, dedicated clinical guides offer complete support for members by answering benefits questions, providing decision support, and performing time-consuming healthcare tasks to simplify the care journey and control costs. When high-touch care teams manage these tasks, they free up valuable time for benefits leaders to meet their goals.

While the advantages of healthcare navigation services are clear, some benefits leaders are nervous about whether care navigation can actually make a difference for their employees, their own workload, and their bottom line. However, skipping care navigation impacts employees' health and inflates avoidable spending. Outsourcing care decisions to a care navigation company may seem like an avoidable expense, but doing nothing is actually the most expensive option. Here's why:

1. Your employees overuse low-value care.

Unnecessary emergency room (ER), hospital, and intensive care unit (ICU) utilization contributes an enormous amount of wasteful spending. Without care navigation, employees frequently resort to these costly facilities even when unnecessary. A study conducted among teams without healthcare navigation revealed an increase in ER visits by 6%, hospitalizations by 8%, and ICU admissions by 11% compared to those with it. A healthcare navigator redirects members to non-emergent, high-value provider options when needed to control healthcare costs.

2. Cancer screenings that are crucial for your team are being skipped.

Cancer is one of the top drivers of healthcare costs for employers and is projected to be the number one cause of death by 2025. Preventive screening and early detection are key to lowering healthcare costs and improving outcomes. Healthcare navigation solutions identify members with cancer risk factors who are behind on screenings, steer them to preventive care, and coordinate follow-up care if needed. Without navigation, patients are up to 17% less likely to receive a cancer screening and up to 30% less likely to receive necessary follow-up care compared to those with navigation. 

3. Less than half of your employees are seeing a primary care provider.

Primary care providers (PCPs) are shown to improve health outcomes and lower costs. However, only 42% of patients without care navigation services visited a primary care provider compared to 90% of those with them. Healthcare navigators guide and empower members to visit a PCP by identifying high-value providers, providing cost breakdowns, and scheduling appointments for them to take on the burden of healthcare management to improve utilization.

4. Your team is overpaying for the healthcare they use.

Up to 80% of medical bills in the United States contain errors, costing members without navigation an average of $1,300 on bills over $10,000. Care navigation services with billing and claims advocacy provide comprehensive assistance to members with their medical bills, whether answering a simple question, fixing an error, or disputing an insurance claim denial. They take on all the legwork for the member by coordinating with billing offices and carriers to correct and resubmit bills, reducing unnecessary spend.

The evidence is clear. Healthcare navigation is not only a smart choice but a necessary one. Benefits leaders can direct their employees to healthcare navigators who provide complete support for all their healthcare needs, no matter how complex, freeing up valuable time. Through personalized, proactive clinical guidance, care navigation services steer members toward healthcare decisions that can drive your team's benefits goals. It’s time to take the tactical step and invest in care navigation to increase value and improve outcomes across every step of your employees’ healthcare journey.

Get in touch to explore how Rightway can guide your company toward a healthier, more cost-effective future.