How to Choose a Care Navigation Program That Improves Healthcare Outcomes and Offers Effective Financial Incentives

The average cost of employer-provided health coverage exceeded $20,000 for a family plan last year. Employers covered around 71% of this cost while employees paid the rest. Conventional approaches to managing these high costs have failed and call for employers to become receptive to new, competitive programs that offer substantial medical benefits, improve health outcomes, and reduce costs. Care navigation is an emerging concept that represents the idea that individuals, services and teams must work together so that people can get access to the right help, at the right time, in the right place. 

Leading a company through a strategic transformation requires an employer to put together a combination of success drivers: the care navigation program that offers significant financial incentives, vendors that offer employee-focused tools and targeted employee education. 

Successful care navigation programs focus on:

Engaging and Empowering Employees

Care navigation programs are not about insulating employees from the real cost of healthcare. They are about engaging and empowering employees to make prudent healthcare purchasing decisions.

Instilling Accountability

Employers that encourage the adoption of care navigation programs by empowering employees to become accountable healthcare consumers must themselves become accountable for success by restricting existing cost-shifting practices.

Rewarding Efficiency

Providers who offer high-quality, low-cost services should be rewarded. An example of this is a tiered payment system. These networks can identify efficiency indirectly, using quality measures as in many value-based purchasing programs, or directly based on cost efficiency.

Reducing Need

Conventional cost-saving strategies fail to impact many basic healthcare inflation sources and therefore, don’t reduce utilization. Care navigation programs, on the other hand, encourage employees to utilize program offerings and reduce future utilization.

Creating Incentives 

People sometimes need incentives to do the ‘’right thing.’’ Rewards can include a cash bonus for taking a health risk assessment or reduced premiums for completing a smoking cessation program. 

Changing Behavior

Shifting healthcare costs to employees provides only short-term relief. Ultimately, any change initiative must address responsible employee healthcare utilization. 

Integrating Care Coordination

Employers need to view care navigation not as a plan add-on but as an incentive-based program to protect those with chronic conditions. Also, employees who complete health risk assessments must be encouraged to share results with their physicians. 

Building Blocks of a Care Navigation Program

A successful care navigation program typically includes these key elements:

Organization-wide Change Initiatives

Transforming a company’s care navigation program into one that embraces consumerism requires an organization-wide change initiative. This formal plan should include developing a new healthcare strategy and enforcing robust internal communications to facilitate the transformation. It is important to reflect on your care navigation strategy so that you can articulate it crisply. 

Account-based Plan Design

The most effective way to transform behavior is to make employees accountable for their healthcare utilization by leveraging an account-based plan design. While there are many vendor health plan options that flaunt the term ‘’consumer-focused,’’ adopting one that includes an accounts-based plan design is critical. 

Best-in-class Vendor Selection

While several vendors claim having a consumer-focused platform with resilient tools to engage employees in care navigation, not all vendor tool sets are equal. There are many elements that must work in sync to convert passive employees into involved consumers. For those program elements that don’t fulfill desired standards, top-rated specialty vendors may be integrated with the health plan administrator.

Defined Measures for Success

The concepts and theories behind healthcare navigation may sound promising to an employer but if it lacks specific success measures, a healthcare plan’s effectiveness will never be known. Companies should establish measures for:

• Utilization Impact
• Consumer Engagement
• Employer Cost Control
• Workforce Productivity
• Health Status Improvement

Improving Outcomes Using a Data-driven Approach

Based on emerging technology and trends, it is imperative that care will be organized around the consumer. The ability to bring together the right technology infrastructure and care delivery, positively impacts care coordination and drives greater margins. Care navigation programs that can assess, simplify, and improve results are also critical. 

Therefore, an enhanced transformation will leverage best practices in incorporating the various elements of  healthcare interventions to support an organization-wide change initiative. Innovaccer provides an integrated care navigation program for employers that delivers better employee healthcare and benefits management in a single place.

To learn how a FHIR-enabled Data Activation Platform can help revamp your employee care navigation strategy, get a demo.