How to guide your health plan members to quality, cost-effective care

June 4, 2021
Josie Rasberry

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We talk about healthcare navigation a lot, and for good reason! In non-emergency situations, healthcare navigation is necessary to help lower members’ out-of-pocket costs. Not only does it help with cost, but quality too. Taking the time to research which providers have great outcomes at affordable prices can mean the difference between a manageable medical bill and one that sends a member into debt or worse, bankruptcy.

Stats and facts.

One study found that between 2013 and 2015, non-clinical healthcare navigators reduced average costs for patients by $781.29 per patient per quarter. And for the entire network, that amounted to $19 million in annual savings. Plus, patients with access to healthcare navigators also had a reduction in:

  • ER visits.
  • Hospitalizations.
  • ICU admissions.

And as we all know, emergency room visits are one of the costliest forms of care. Even in our own studies, we found that one of our clients saw an average savings of 61% per member based on our healthcare navigation recommendations over a four-year period. 

Lower healthcare bills are a big win not only for individuals but for health plans too. After all, everyone loves a good deal. When your health plan offers healthcare navigation tools, it leads members to cost-effective care solutions and reflects positively on your plan. In fact, health plans with healthcare navigation services saw an average NPS growth of 16%.

Confidence restored.

Healthcare navigation is obviously beneficial for lowering members’ costs, but it’s also beneficial to their health. Healthcare is getting more and more expensive, and as a result, many Americans are avoiding care. The average deductible for employer plans more than doubled between 2008 and 2017, from $869 to $1,808. Plus, a Commonwealth Fund survey reported that only 62% of insured adults were very or somewhat confident in their ability to afford health care. Fear of expensive medical bills are a huge problem when:

All these issues can be boiled down to misunderstanding and fear. That’s where healthcare navigation comes in. A patient advocate will look at a member’s specific health plan, their care needs, their location, and their financial needs and find the best options to fit all those needs. Members no longer have to fear a huge bill or bad care because with healthcare navigation they’ll know what they’ve signed up for. Even our shop-and-compare app makes it easier for members to plan their care ahead of time and realize that they can in fact afford an MRI and not have to keep living in pain.

Final thoughts.

No one should be avoiding medical care for fear of cost, especially those with insurance. But expensive medical care and confusion hold your members back from realizing cost savings and better health. Healthcare navigation is the path to lower members’ healthcare costs and improve their overall health.

Download The Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download the Complete Guide to Growing Your Health Plan Membership

Learn the best strategies and tips for growing your members while keeping costs low.

Download the Complete Guide to Retaining Health Plan Members.

Learn the best strategies and tips for retaining your members while keeping costs low.

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