Addressing the challenge of high healthcare spending by a few members, savvy employers are turning to healthcare navigation programs. These programs assist members in understanding their care, navigating treatments, and accessing relevant resources.
High-cost claimants (HCCs) significantly contribute to an employer’s annual healthcare spending, often up to 31%. This financial impact is primarily due to traumatic events, serious illnesses, or chronic conditions affecting these members.
Healthcare navigation, supported by predictive models and data-driven algorithms, offers a solution. It enhances care for all members, fosters engagement, advocates for cost reductions, and improves care coordination and utilization management. This approach not only empowers individuals but also yields cost savings for employers.
Traditional care management models face challenges such as late or insufficient member identification, low engagement rates with outreach efforts, and a lack of holistic approaches, often relying solely on healthcare navigation by registered nurses.
Healthcare navigation services, essential in a patient-centric health system, help companies and their employees navigate the complexities of the healthcare system, enrollment processes, benefits packages, and ongoing care. Navigators prioritize improving health outcomes by coordinating cost-effective care considering clinical, lifestyle, mental health, and various determinants of health.
At CheckGoBenefits, our dedicated Care Navigation team ensures a thorough review of policyholders’ health benefits, covering options and critical provider data like claims, prior authorization, eligibility, engagement, and utilization. This meticulous approach consistently identifies opportunities to streamline healthcare costs while enhancing and personalizing the patient experience.
The philosophy of Care Navigation centers around meeting members where they are, empowering them with impactful information and guidance for their long-term well-being. Accepting self-referrals, regardless of specific criteria, allows for early interventions, recognizing that members are the best judges of their health situations.
This program places a strong emphasis on prevention, not just treatment, addressing members’ individual health goals and ensuring positive primary care relationships, up-to-date vaccinations, regular screenings, and foundational health promotion services.
Recognizing the multidimensional nature of health challenges, the program remains disease-agnostic, prioritizing what matters most to each member, acknowledging that successful management of one condition may be hindered by other factors.
The reasons to implement health navigation are clear: personalizing healthcare interactions improves care quality and lowers costs for healthcare organizations. The CheckGoBenefits ecosystem facilitates seamless care management, incorporating features like viewing and scheduling referrals and providing reminders for routine appointments.
Healthcare navigators at CheckGoBenefits consist of interdisciplinary experts, including clinical specialists and non-clinicians, fostering trust, engagement, and a comprehensive approach to addressing members’ concerns.
Key elements of the clinical programs include holistic data analytics, building trust, and intervening with interdisciplinary care teams, ensuring a more effective and supportive approach.
When implemented, healthcare navigation enables patients to access treatments, understand their conditions, and make informed decisions. It works to alleviate physical, geographical, and emotional struggles, addressing financial needs and avoiding costly emergency interventions resulting from system inefficiencies.
Healthcare navigation interventions cover prescription drug optimization, site of care charges, coverage assistance and optimization, gaps in care closure, and medication management. These interventions contribute to cost savings and improved patient outcomes.
CheckGoBenefits dynamic care navigation capabilities encompass a wide range of patient needs, fostering positive relationships and high engagement rates. If you’re interested in learning more about how CheckGoBenefits’ healthcare navigation services can enhance care and your bottom line, please contact us today.