Care Navigation is a term that many employers and advisors are hearing about as an effective strategy to support employee health and maximize benefit plans.
In this post, we’ll explain in detail what care navigation is, the best candidates, and key components of an effective program.
What is care navigation?
We all know that health care is complicated. In fact, I bet you could think about a personal situation right now.
The complexity often leaves people overwhelmed, frustrated, and unhappy. For most people, figuring out what to do and which doctor to see is difficult. What do we normally do? We ask friends and family members, we follow another doctor’s recommendation, or we search the internet and we cross our fingers that we’ve made the best decision.
Instead of hoping for the best, many people are turning to care navigation for assistance.
Care navigation refers to a service or program that helps people access appropriate, high-quality health care. It’s typically offered by a person’s employer as part of their health and wellbeing benefits.
With care navigation, employees and their eligible dependents can speak directly with a qualified care navigator who has access to quality and cost data. A care navigator works with the individual to learn more about them, including demographics, needs, and preferences. Then, they determine the best options.
Care navigation can be used to evaluate the need for, and locate services such as:
- General practitioners
- Surgery Centers
- Rehab Facilities
- In-Home Care
- Medical Equipment
Ultimately, individuals who take advantage of care navigation receive timely, evidence-based, unbiased guidance that helps them better understand their treatment options so they do what’s best for them.
Who are the best candidates?
Everybody can benefit from care navigation! You don’t have to be in the middle of a medical crisis or living with a chronic disease to get assistance. Anyone that has a question about their health or is seeking high-quality, affordable care is a good candidate.
It’s not uncommon for provider directories to be outdated. Care navigation is also useful for those who have a new health insurance plan (or who have not used their current plan) and want to make sure they’re seeing the best possible doctors in their network.
What should employers look for in a care navigation program?
Generally, care navigation isn’t a “stand-alone” program. In fact, for the greatest success, it should be part of a comprehensive integrated health solution.
When considering a care navigation partner, look for one who leads with medical expertise and offers additional supporting services. Look for:
- Medical Professionals
To be effective, care navigation and advocacy must be led by highly trained and experienced medical professionals. Why? Because they know clinical care and they’ve been on the inside of our health care system. At SentryHealth, every individual talks directly with a Registered Nurse Advocate who listens and helps them determine the best course of action. For example, it’s not uncommon for us to uncover that someone received the wrong diagnosis and was being led down a path that wasn’t going to solve their issue – and it was going to cost them more.
- Medical Advocacy
This takes care navigation a step further by not only guiding toward the right care at the right time, but Registered Nurse Advocates will advocate on behalf of each individual when necessary. They’re able to help with second opinions, alternative treatment options, billing issues, and more.
- Medication Management
A recent report by GoodRx notes that prescription drug prices are rising faster than inflation. In addition, insurance plans are covering fewer medications. And employers and employees are the ones left holding the bag. When you pair care navigation with medication management, people get the medications they need while reducing costs. In fact, we’ve seen savings on PBM payments up to 40%.
Precertification and utilization management services use Registered Nurse Advocates to review and approve procedures for medical necessity before they happen. So not only are individuals benefitting from the guidance of care navigators, they also know that their procedures have been approved and will be paid for properly.
- Case Management
Sometimes people need a little more assistance beyond care navigation. That’s where case management comes into play. Certified Case Managers support individuals with complex medical conditions, recent hospitalizations, unhealthy lifestyles, and high psychosocial risk factors so they get the best care throughout their health journey.
SentryHealth Care Navigation
If you’re looking for a partner who can offer care navigation, medical advocacy, and so much more, you should consider SentryHealth. We’re a driving force behind improving workforce health and reducing costs for employers. Our Medical Advocate Program helps employees and their families navigate benefits and our complex health care system to make more informed decisions that save money and improve health outcomes.