If you work in the healthcare or insurance industry, odds are that you’ve heard the phrase “healthcare navigation.” But what is it? When we talk about healthcare navigation, we’re talking about helping healthcare consumers find medical care based on cost, proximity, and quality - and often many other services to make the process of getting care easier and more efficient. This is all the more important in 2022 when healthcare resources are stretched, healthcare providers deal with multiplying plans and regulations, and turnover of office staff is high. These days it takes expert navigation to get care in the U.S.

Healthcare navigation can be offered in two ways.

• Through third-party patient advocates who listen to a healthcare consumer’s care needs, their budget, their insurance situation, and other specifications. The patient advocate then locates the best options for care based on what the consumer told them, and may even help set the appointment, transfer medical records, and arrange transportation. 

• Through self-service digital platforms that allows healthcare consumers to search-and-compare medical care, providers, and prescriptions on their own.

Why is it beneficial to healthcare consumers?

Healthcare navigation is beneficial to healthcare consumers because it allows them to actually know the cost (or at least an estimate) of the plannable, non-emergency care they need. Too often, Americans avoid medical care for fear of cost. In fact, one study found that:

• 51% of those surveyed have avoided medical care due to a lack of ability to pay.

• 78% have been afraid to go to the hospital because of cost.

This leads to complications in health issues and overall poorer health. With healthcare navigation, whether through a patient advocate or an app, healthcare consumers know the cost of care and therefore have the confidence to budget for and then receive the care they need.

Why is it beneficial for payers?

For health plans of all types, healthcare navigation is an important  tool to keep costs low. What plan wants their members to go to the most expensive option when they can get the exact same care (if not better) for half the cost down the street? In fact, one study found that “on average, patients bypassed 6 lower-priced providers between their homes and treatment locations.” Plus, offering healthcare navigation reflects positively on your health plan and the employers who offer them. Everyone loves a good deal, so if your members’ medical bills are consistently lower after utilizing healthcare navigation they’ll stay loyal. Plus, your members will feel cared for and supported. In fact, health plans that offer a patient advocacy service, like healthcare navigation, saw an average NPS growth of 16.5%.

Saving money is a win whether you’re a:

• Health share
• Discount medical plan
• Limited benefit medical plan
• Or large health plan

One of our own clients realized potential cost savings of 61% from healthcare navigation between 2015–2019. Savings of 61% give your organization a lot more room in your budget to improve plan offerings, hire more support teams for members, or even implement more digital solutions for members. All of which will help you retain members and acquire new ones. Plus, you’ll be making these upgrades without increasing members’ individual costs, which is another factor that makes members choose whether to leave a health plan.

Final thoughts.

Healthcare navigation makes healthcare easy to find, easy to understand, and easier to afford for your members. When members see that it’s your plan offerings that are giving them great deals on their medication or quickly finding the best place to get an MRI, they’ll renew their membership year after year. Not to mention, a happy member is one of the best ways to get word-of-mouth advertising, so you’ll likely see new member growth along with better member retention.