Navigating healthcare and health coverage is very complex for people. When we are not well, and seeking care, we are typically lost in our fragmented system. There is no playbook for people about how to navigate care and coverage. Even the most informed people struggle to make sense of it when they are healthy. Imagine working two shifts, 60 hours a week, on a minimum wage, and sick.
Employers are trying to help their people with good health plans and broad provider networks and tens of digital programs. But the problem is that these programs are siloed and are not knit together. They are not personalized around members’ specific issues. This makes it very difficult for members to understand which ones will work for them at the moment, how these benefits work and how to make the best use of them for their needs. It is no surprise that we see suboptimal health outcomes for both members and plan owners.
Fixing this problem requires a different mindset and approach. Most advocacy and care navigation solutions are designed as glorified call centers where the ‘concierge’ team provides answers to questions like what’s covered and what’s not and points members to provider directories or links for their issues. Self-management is often touted as the right way to solve this issue. This is of course not right. Members are not supposed to know about the intricacies of how healthcare and coverage work, just the same way they don’t need to know how the airlines and airports work together to fly. Members should not have to be educated on how the plan works, The plan should work for them automatically by providing members the care and support they need. It is about providing people actionable support. Health care navigation and advocacy should solve specific problems and not just answer questions. They should be able to map out the next steps of each member’s unique journey, coordinate visits, help them with treatment plans, and resolve any billing or claim issues.
To make it happen, health plans and employers can leverage a modern digital health navigation solution that coordinates and optimizes the health system for all members. This solution provides a single point of access for all health care-related questions, services, and providers, enables end-to-end issue resolution, and provides a personalized, intuitive, proactive, and connected member experience across all channels. This cross-carrier solution works across multiple carriers, networks, plans, and benefits. With a digital front door, it provides a curated ecosystem for all members, no matter where they are on the spectrum of needs, by integrating medical, behavioral, and social care. It integrates disparate digital point solutions and connects members to the right solutions they can benefit from at the moment. The navigation platform is embedded with robust clinical solutions within advocacy to create all-encompassing support.
If you are an employer or a health plan, connect with us to learn how we can help you improve member experience as well as business results with a robust and configurable health care navigation solution that takes a full-serve approach to ensure each member’s needs are taken care of.