Why Employers Don’t Offer Care Navigation

Healthcare navigation, a solution for helping employees get the most from their health benefits, is a way to keep costs down for both employers and their employees while increasing the quality, timeliness, and suitability of care.

Navigation solutions typically include experts who guide members through their healthcare journey, helping them find the best care at the best price while eliminating preventable spend. Within a navigation solution, administrative guides educate members on their healthcare benefits, assist them with understanding or disputing bills, and help them find high-quality providers. Clinical guides, usually registered nurses or nurse practitioners, offer real-time healthcare guidance. The strongest solutions provide both types of healthcare navigator, each supported by access to data about the member’s history and needs.

Despite its proven effectiveness, healthcare navigation is still far from being a universal benefit. A 2021 study by Willis Towers Watson found that about a third (31%) of employers surveyed offered access to care navigation services, and another 25% were planning or considering doing so.

When controlling costs and keeping employees happy and healthy are crucial endeavors, what keeps employers on the fence about providing navigation or from seriously considering it at all? We’ve found three main reasons, and while these reasons may have once been valid, new solutions now exist in the market that remove these concerns:

Fear of friction with the health insurance carrier.

Not all healthcare navigation solutions integrate smoothly with an employer’s existing coverage. Some overlap with carrier processes in a way that makes it hard for them to coexist, like taking over key functions such as pre-certification that are typically owned by the carrier. Employers can be forced to either change carriers entirely in order to bring on navigation, or to patch together workarounds that can confuse their employees and cause conflict with the insurers.

Concerns about cost.

One knee-jerk reaction to adding healthcare navigation may be that it’s an additional cost on top of what the employer is already paying for other benefits solutions. Indeed, some traditional navigation systems that offer full-clinical navigation are a hefty investment, costing more than $20 per employee per month. Companies are wise to carefully evaluate the value of such an expensive system.

Belief that lower-cost solutions lack clinical depth.

If employers decide they are priced out of traditional navigation solutions, they may consider evaluating lower-cost alternatives. The challenge is that many of these cheaper, “light-weight” solutions don’t include personalized support from a clinician. Because many of the lower-cost healthcare navigation solutions are not clinical-first, they may not offer enough holistic support to be worthwhile. The “health guide” may simply be a call-center representative who connects the member with other departments. Many “tech-enabled” navigation solutions are little more than chatbots with no clinical component.

The good news is that with the arrival of new innovative healthcare navigation solutions, these concerns may no longer be relevant. Rightway was founded with the intent to create a full-clinical navigation solution with none of the friction, at a fraction of the cost of other solutions. How can Rightway achieve this when so many others cannot?

Part of it is timing. In a lumbering industry full of legacy healthcare solutions that are being updated all too slowly, Rightway’s system was designed from day one to be mobile-first. The “digital front door” for members is a button on a mobile or desktop app that connects them directly to the person they need to talk to via chat. Quick responses to asynchronous messages help keep members from wasting time on hold or from even having to make a call at all if they don’t want to.

Rightway also keeps costs lower through intelligent use of data and appropriate access to the right resources. Depending on the nature of the need, Rightway uses smart routing to assign each member either a health guide who can answer general questions or a dedicated clinical guide who can provide deeper, more personalized health assistance. Intelligent triage means the member reaches the person best able to address their needs at the right time, without unnecessary hand-offs.

Finally, Rightway’s true value comes from the way it uses smarter clinical navigation to impact the moments that matter. A member might call in with a benefits question, but if a clinical guide notices that they don’t have a primary care provider and are overdue for an annual physical, they will address the member’s question while also offering to schedule an appointment with a PCP. Since clinical guides have access to years’ worth of patient history, every interaction is an opportunity to not only address the chief complaint, but to flag any overdue preventive or follow-up care. Preventing health problems from developing or catching them early, along with encouraging adherence for any diagnosed issues, are key to keeping people healthy and costs low.

Going into 2022, there’s a developing expectation for employers to keep employees happy and healthy while also curbing healthcare spend. Adding a modern, clinical navigation solution like Rightway helps employers improve the member experience and reduce costs with minimal investment of time and resources.

Read more about how Rightway’s smart clinical healthcare navigation can deliver better care, happier people, and lower costs. Ready to make a change in healthcare? Talk to us about how we can help you make a decision that benefits everyone.