What is Care Navigation?


What’s the first word that comes to mind when you think of our current healthcare system? Chances are it’s somewhere along the lines of complex, confusing, or unaffordable. The truth is, you’re not alone. The current system is not designed in a way that can be easily navigated when you find yourself in a situation that requires care. The CDC defines healthcare literacy as an individual’s ability to find, understand, and use information and services to inform health-related decisions. Low healthcare literacy in the U.S. is a widespread issue that helps perpetuate this broken system.

According to new data by the Harris Poll, 65% of Americans say coordinating and managing healthcare is overwhelming and time-consuming. Just over half of this surveyed group also said their health would improve if their providers helped them understand the healthcare system. To address these problems, employers are taking an increasingly assertive role to ensure employees and dependents get the right care. But the lift is large, and it requires the support of benefits partners to be successful. So, how can employers help their team members find the right care, at the right time, and at the right price? The answer is Care Navigation.

What is Care Navigation?

Care Navigation is a seamless solution that helps members access high-value specialty care in their communities, ensuring individuals and their families never have to navigate their healthcare needs alone. This helps solve for the confusing side of healthcare and cost ambiguity by leveraging outcomes and price data to guide members to high-quality, cost-effective providers and facilities that are in-network and accessible.

Concierge Support

Members cannot make informed healthcare decisions if they don’t understand their choices or know how to find the right specialist. That’s where care navigators come in: to provide a hands-on, guided experience that helps members seamlessly manage their care both before and after an appointment. Whether they’re helping them identify the best community specialists, scheduling visits, or working directly with their primary care physician, members can benefit from peace of mind knowing they have a trusted partner for guidance. Most consumers make healthcare decisions based on emotions, so it’s important for members to have another human to connect, build trust, and develop a relationship with.

Data Driven Referral Matching

Just like you can’t judge a book by its cover, you can’t judge hospitals or specialists by a single achievement. Hospitals may do everything, but that does not necessarily mean they are great at everything. The cost of a procedure may also be five to 10 times more expensive across facilities in any given market – a variance driven by care setting, not quality. To solve this, care navigators utilize best-in-class cost and quality data to guide members with specialty care needs to only the highest-value providers and facilities. This hands-on approach makes it easy to get the right care at the right price.

Key Benefits of Care Navigation

Benefits for members

Ask yourself this question – If you found yourself on the receiving end of a challenging healthcare diagnosis, would you want to speak with a robot to navigate your care journey? The answer is likely no. The key component to Care Navigation is how relatable and empathetic the person on the other end of the phone is. This is what makes all the difference in the experience for members; no provider roulette, no exhausting independent research, just someone that understands what you need, and can get you to the right place.

“My Care Navigator followed up consistently and ensured the specialist was attentive and the appointment was scheduled. I left a message for the specialist (twice) and they did not call me back to schedule, but it only took one call from the Care Navigator to make things happen.” – Member in California

Benefits for organizations

Directing members to the right providers and facilities can add up to significant savings for employers. As the healthcare space continues to evolve, care navigation plays a critical role in reducing medical spend. Based on an analysis of over 10 years of data by Healthcare Bluebook, employers can save up to 11% of total medical spend by ensuring members go to high-quality, cost-effective providers and facilities. Care navigators are the key to making this a reality.

Care Navigation delivers value to your organization by:

  • Lowering healthcare costs
  • Delivering exceptional member experiences
  • Ensuring members receive high-quality, cost-effective specialty care
  • Engaging members in their healthcare journeys
  • Providing unmatched member support and outreach

Optimizing Care for your Employees

Care Navigation is Premise Health’s hands-on approach that helps members seamlessly navigate the healthcare system. Regardless of your population’s existing healthcare literacy, we’re there for them before, during, and after care to create an exceptional experience. Our care navigators help members access care from high-quality providers and facilities while delivering significant savings for employers and optimal outcomes for members.

Learn how Premise can help optimize the care of your employees. Contact us today.


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