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A turning point for employer-sponsored healthcare support
When the California Department of Managed Health Care (DMHC) issued a $15 million fine against Anthem Blue Cross for “longstanding, widespread failures” in how the plan handles member appeals and grievances, it wasn’t just a regulatory headline — it was a warning flare for employers everywhere. The enforcement action detailed more than 15 years of repeated deficiencies, including failure to identify grievances, delays in resolving complaints, and missing or late communications.
The DMHC took action because breakdowns in communication with members, like the ones cited in this case, ultimately compromise access to care and leave members stranded when they need support the most. This example underscores a broader truth: relying solely on a carrier for care navigation is risky. Employers need an independent healthcare navigation model that puts unbiased advocacy, proactive support, and data-backed outcomes at the center of its approach.
Here are three reasons an independent healthcare navigation solution is essential to protect both the employer and their employees.
1. Carriers’ conflict of interest undermines true advocacy
Many navigation models tied to carriers or point solutions introduce barriers to care or subtly steer members toward network or cost‑containment objectives.
Alight’s Healthcare Navigation model is intentionally carrier‑agnostic, operating with no vested interests and no incentive to delay, gate, or redirect care. Our sole purpose is to guide each member to the best provider, best care path, and best outcome, every time.
This neutrality is a fundamental differentiator, and it’s why employers can trust Alight to advocate for what’s right for their people.
2. Independent healthcare navigation engages early...before costs and conditions escalate
While many solutions operate reactively, connecting only once a claim or crisis occurs, Alight focuses on early engagement, especially among the rising‑risk population that drives ~15% of future costs on average.
By proactively reaching members early in their care journey, Alight helps them avoid low‑value care, navigate options confidently, and choose high‑quality, cost‑effective providers before small issues become expensive problems.
This early‑intervention approach is central to Alight’s ability to deliver predictable, claims‑verified savings.
Healthcare Navigation
Smarter Care Decisions
Our healthcare navigation and concierge support help your people find providers, review costs of procedures and bills and understand their benefits plan.
3. Connect your entire benefits ecosystem
Both employers and employees alike are overwhelmed, as they are faced with a multitude of choices, providers, and experiences. This complexity is leading to a gap between the rising costs of health benefits and what is actually impactful for your business and your people.
Alight cuts through this complexity by acting as the front door to the entire benefits ecosystem. Navigation Health Pros and Medical Allies connect employees to the right resource at the right moment, across all programs and vendors, without relying on them knowing which door to open.
This is healthcare navigation as a connector — not a gatekeeper — and it will give your employees an experience they love, while providing the sustainable efficiency that your business needs.
Fixing the system, not just the problem
The Anthem Blue Cross fine is not an isolated incident — it's a sign of the structural limitations of relying on carriers to manage both coverage and care navigation. Employers need a healthcare navigation partner who:
- Works only for the employer and employee
- Has no conflicts of interest
- Engages early to prevent escalation
- Resolves issues before they become appeals
- Connects the entire benefits ecosystem
Independent healthcare navigation is a critical safeguard, and one of the most strategic investments employers can make to protect both their workforce and their healthcare dollars.
Health Benefits
Integrated Employee Health Solutions
Now your employees can engage with their health benefits in an impactful way. ROI guaranteed.
