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For years, our industry has been engaged in a vital conversation about empowering employees to truly 鈥渘avigate鈥� the labyrinth that is the healthcare system. We all understand how daunting it can be to find a primary care doctor or a specialist, not to mention making sense of the multitude of treatment options available. It鈥檚 not just a series of decisions; it鈥檚 a journey that profoundly impacts a member鈥檚 health, finances, and overall peace of mind.

Consider this staggering statistic: in the U.S. is wasteful. With a jaw-dropping expenditure of $4.9 trillion in 2023, there鈥檚 a golden opportunity here鈥攇uiding members to the right health care choices could save an estimated $3,687 per member each year while helping them make informed decisions with confidence.

Now, healthcare navigation services are more than a figure of speech, with the U.S. market generating over per year in revenue and growing. These companies promise to guide plan members to the highest quality providers and necessary care while steering them away from unneeded, potentially risky, and often expensive treatments. A by Employee Benefit News found that 37% of employers offer some sort of navigation assistance.

For employers, navigation is a way to increase employee satisfaction, improve health outcomes, and save money. But not all navigation programs are equal. Some fail to engage employees or deliver the promised guidance. In our experience, however, a well-designed program can reduce healthcare expenditures by $240-$480 per member per year.

Here are eight guidelines and accompanying practices that are most likely to make care navigation successful.

1. Encourage action

It's not enough simply to offer members access to provider quality ratings or self-service tools. By itself, this information will likely overwhelm members already confused about their options.

Best Practice: Design your program to simplify the process of getting good health care and actively assist members in overcoming the barriers they face.

2. Provide guidance that combines cost and quality

In the past decade, the federal government and many private research organizations have started gathering data about treatment outcomes and other measures of health care provider quality. One conclusion: Cost is unrelated to quality. (Pricing, in fact, is generally related to the size and market power of the healthcare organization.)

Best Practice: Structure your program to point members to providers with better outcomes and appropriate care standards at lower costs 鈥� and discourage the use of expensive providers with low-quality ratings.

3. Create incentives to encourage the use of high-quality, low-cost providers

Some plans offer small financial rewards or contest entries for registering with their navigation service. It may be better to design a plan with incentives for selecting high-quality, low-cost providers, much as most plans today offer lower costs for selecting generic drugs and in-network providers.

Best Practice: Offer lower premiums, copays, or deductibles for members who choose providers recommended by the navigation vendor. For high-deductible plans, offer a higher employer contribution to the health savings accounts of those who use recommended providers. Many navigation vendors now have the ability to reward employees at point of service with lower deductibles, copays, coinsurance.

4. Select a vendor that provides independent advice

Large health carriers increasingly offer their own navigation services. These promise the simplicity of an integrated program to members and employers. Still, members are often wary of providing too much personal information to insurance companies, undercutting the value of the advice they receive. Employers may also wonder, reasonably, if carrier guidance is influenced by their own profit margins.

Best Practice: Work with vendors that aren鈥檛 owned by a carrier or health system, and that publish clear criteria for their provider recommendations.

5. Combine automated and human service

Some care navigation issues can be effectively handled by apps and websites, especially those featuring recent AI advances. But they might not be the answer for members who are uncomfortable with self-service solutions and have more complicated cases.

Best Practice: Use a hybrid model that offers human assistance in addition to online tools. Well-trained navigators can offer more personal advice and more effective follow-up care. They also can make appointments for members, arrange for second opinions, and help with other practical issues that can delay care.

6. Integrate all your health benefits

If care navigation is just another item on a long list of benefits, it's not performing its most important function: making it easier for members to get the care they need. And if the navigators don't have detailed access to all member benefits, they can't provide the most helpful advice.

Best Practice: Use your navigation service as the front door to all your health benefits. A good navigation solution should become the hub for all things health and welfare. Replace the carrier鈥檚 provider directory with the one from your navigation vendor, which incorporates cost and quality data. Select a vendor that can integrate with your other providers and other point solutions.

7. Emphasize education and trust

Clear and consistent communication is needed to help members understand what navigation is, how to use it, and why they should follow the advice they get.

Best Practice: Incorporate navigation into your communication at open enrollment and throughout the year, showing members how starting with the navigation service can simplify most of their health benefits issues. Demonstrate how navigation provides additional value to them (rather than removing choices or benefits). Explain the independence, privacy protections, and experience of the navigator to help overcome mistrust. Emphasize that these tools are meant to get employees to the best doctors, not the least expensive ones.

8. Personalize service to meet members鈥� needs

Your navigation program must account for the many challenges members face, including so-called social determinants of health (). Some members, for example, may need to find providers who speak their language, have offices on public transportation routes, or offer hours compatible with work schedules.

Best Practice: Ensure your navigation provider incorporates SDH in its guidance. Some vendors collect this information during member intake through questionnaires or chatbots and use it to customize recommendations.

How Alliant can help

At its best, care navigation is not simply a convenience service employers provide but part of an approach to benefit plan design that encourages members to get the care they need while avoiding unnecessary care and expense. Often, employers who adopt this perspective also take measures to expand access to providers and encourage members to get primary and preventive care.

Alliant works with hundreds of employers to design health plans that appeal to employees, keep them healthy, and manage costs. Our sophisticated analytics can pinpoint the needs of your member population. Alliant鈥檚 dedicated team has vetted the leading health navigation solutions and manages an active library to support finding the right fit to drive more value for your plan.

Get in touch with one of our seasoned employee benefits consultants to find out more.