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As employers re-think benefits, integrating healthcare navigation is key to lower costs

Written by Fatima Karim-Murji

Amid America’s great reopening, many employers are focused on finding ways to attract and retain top talent with enhanced benefit offerings such as healthcare navigation.

In fact, 98% of human resource leaders and C-suite decision-makers plan to offer new, or expand at least one employee benefit. Additionally, 41% plan to expand their mental health benefits, as noted in a recent report by Care.com and LifeCare.

Balancing the cost of more robust benefit offerings with the inevitable rise in healthcare costs and changing workforce needs is not an easy task and can be overwhelming.

According to a recent survey by the Business Group on Health, large employers project their costs will increase 5.3% in 2021, and 31% will focus their strategy on moderating high-cost claims.

Expanded benefits are meant to improve health outcomes and lower costs.  However, they often only worsen an already fragmented and complicated healthcare journey, resulting in misdiagnoses, unnecessary treatments, higher costs, and low member satisfaction.

According to a 2018 survey by Health Advocate, 40% of HR professionals say that working with multiple benefit vendors led to a lack of utilization and caused confusion to the employees. 

When employees are not equipped with the knowledge and skills to effectively navigate the healthcare system and make informed choices, they often opt for inappropriate care or no care at all, which can further increase costs. The inappropriate or lack of care is attributed to a low health care literacy and understanding. And, foregoing care or delaying care can also cause an increase in sickness level, increase the cost of care when then do eventually see a doctor.

A report by Accenture found that low healthcare literacy resulted in an increase cost to health plans and employers of $4.82 billion annually.

To offset rising healthcare benefit expenditures many employers are looking to innovative healthcare navigation solutions, and the approach is paying off—resulting in improving utilization, engagement and outcomes.


What is healthcare navigation?

You can look at healthcare navigation as having two parts:

Healthcare advocacy solutions offered by an employer help their people:

  • learn about their health conditions and treatment plans,

  • identify the best providers,

  • help understand their benefits and costs, and

  • get to the right level of support, at the right time, for their journey back to work after an illness, accident, or surgery. 

In a fragmented healthcare journey, employees must call several individual companies for medical, behavioral, and pharmacy benefits. With healthcare advocacy solutions provide a single point of contact for all their benefits.  This approach makes their healthcare journey simple and easy to navigate.

As reported by Forbes, 92% of healthcare executives understand the value of a highly personalized experience and rank it as a top strategic priority.

Many businesses also offer claims advocacy, a benefit that helps employees understand the basics of their benefit.  Claims advocacy experts explain basics like out-of-pocket costs and deductibles while providing help in navigating frustrating billing problems and guiding employees through complex denials and appeals.

Claims advocacy is an essential service for today as medical billing is challenging even for those experienced in the healthcare system. As mentioned, when employees don’t understand their benefit, or get frustrated, they may simply forgo care, further inhibiting their ability to achieve better health and potentially impacting their financial well-being. It’s also an increasingly important benefit as some 50% of Americans reported medical debt in 2021; up from 46% in 2020. (Medical Debt Survey, debt.com)


Healthcare navigation example

Let’s examine how healthcare navigation works for the employee and their employer when it comes to one of the most common types of claims and high cost for many employer groups: musculoskeletal (MSK).

Approximately 20% of U.S. adults have chronic pain and 45%of employees say they have experienced back and joint pain since they started to work from home during the pandemic. 

Not only does chronic pain contribute to lost productivity and absenteeism,  it’s also a significant claims cost driver for employers.

According to the 2020 annual survey by the National Business Group on Health, 44 percent of employers say MSK issues are the top condition that impacts costs.

Take John, a 53-year-old man who has suffered for years with back pain and was diagnosed with degenerative disc disease. His physician recommended discectomy and spinal fusion surgery. However, John had questions. He wanted to ensure the diagnosis was correct and to learn more about treatment options.  

John’s employer partners with a healthcare navigation provider that offers a range of services, including analysis of claims data for benchmark comparisons and risk scoring as well as machine learning technologies to help identify top-performing local physicians and surgeons. Through the program John receives personalized, expert guidance from a nurse, is referred to three local, in-network, high quality physicians, and is given a list of questions to ask the provider he chooses for the second opinion.

During the virtual consult, John’s diagnosis is confirmed, and he is given more insights into his condition and treatment alternatives. Because he has become more informed, and engaged in the process, John chooses a non-surgical therapy to treat his back. Because of his decision he avoids not only lost work time but also the side effects of surgery.

For John’s employer, healthcare navigation improves productivity while preventing unnecessary absenteeism, inappropriate care and expensive treatments. The result? A healthier, more engaged employee and an impressive $37,000 in direct cost savings due to the avoidance of surgery and deciding a less invasive alternative treatment plan.


Healthcare navigation: solving for utilization, engagement and cost

A highly competitive job market, turbulent and evolving workforce, and rising healthcare costs will continue to vex employers. As they plan for the years ahead, partnering with proven healthcare navigation providers will be vital to improving utilization, engagement, and health outcomes while managing the rising costs of healthcare and enhanced benefits.

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