11 Reasons Why Healthcare Navigation is the Best Defense Against Surprise Medical Bills
What gets more expensive every year, and even outpaces inflation? Yep, you guessed it. Medical costs.
The No Surprises Act is great, in theory. But according to a top agency official at the Centers for Medicare & Medicaid Services (CMS), they’re dealing with an “astronomical” number of surprise billing arbitration dispute cases. Further, for insured individuals, the No Surprises Act only covers ER visits, hospital, and ambulatory services. So, what about everything else?
According to one study, carrier-provided resources could have gaps or delays in getting the most accurate information, and often don’t provide information like cost, quality, or condition-specific care. There’s got to be a better way.
Enter healthcare navigation
We’ve taken a deep dive into why healthcare navigation is the best way to save money for employers and employees, and what to look for in the right solution for your organization.
1. Cost analysis
Digital healthcare guidance is most effective when there is a cost analysis component. Especially when the solution can provide data from billions of real medical claims, updated directly from carriers on a regular basis (up to 2-3 times per week). This cost analysis could also provide a rating system of lowest to highest cost providers, so members can tell who the most cost-effective providers are, and more importantly, see if they are in-network for their specific plan.
2. Quality analysis
Like cost analysis, quality analysis can provide an easy-to-understand rating based on criteria of providers. This criteria, unlike reviews and testimonials online, provide objective quality measures. Such as experience based on condition, preventative care recommendations, medication management, and appropriate care based on diagnosis or chronic conditions.
3. CMS-certified solutions
Because of laws like the No Surprises Act, the CMS has new complex guidelines related to healthcare cost transparency. So, it’s vital to employ a solution certified by CMS to ensure that the tool is in compliance.
4. Location-specific recommendations
Location is cited as a primary reason people choose a provider. Shopping for a provider should be as easy for members as looking for a new restaurant recommendation. Employees should be able to easily identify high-quality, low-cost providers that are geographically near them. Providing members with information about cost and quality of their providers empowers them to make informed decisions. While the closest option may be convenient, there may be another provider or facility charging drastically less, or with superior clinical experience just 20 miles away. Choices that would only be made available with provider guidance.
5. Appointment booking services
Once a provider is chosen based on cost and quality analysis, there may be an option for members to use a concierge service to provide a preferred appointment time so a representative can schedule an appointment on their behalf.This saves time and frustration. Plus, representatives can confirm that the chosen provider is still in-network, avoiding surprise bills due to out-of-network care.
6. Integrates regardless of network complexity
An increasing number of plans are turning to new plan designs and tiering structures as a cost-saving methodology. But these strategies won’t work if members don’t know how to navigate the complexity to the right carve-out or benefit. Guidance is essential to achieving the potential benefits of the increased plan complexity. Finding a solution that integrates, regardless of complexity, is going to be paramount.
7. Steers towards point solutions if they’re more appropriate and cost-effective
How do employees know when using a point solution like Telemedicine or Nurseline is more appropriate than an urgent care or emergency room visit? Chances are, they don’t. Healthcare guidance can surface relevant point solutions for every search query—again, saving money in unnecessary ER bills, while offering benefits the employee is eligible for through their plan.
8. Ability to find an array of services
Besides the typical PCP, healthcare guidance can include different types of in-network specialists, including mental health providers, and even lab facilities and imaging centers. In some cases, the solution can intuitively recommend the right provider based on a specific condition or procedure search.
9. Available in Spanish, end-to-end
Making care easily accessible is critical to boosting health outcomes. And with over 41 million native Spanish speakers in the US, it’s imperative that our healthcare systems evolve to support non-English speakers. If your workforce includes Spanish-speaking individuals, it would be ideal if the solution were available in Spanish so they can benefit from it as well. That includes the entire process, from the search, through the appointment booking with a Spanish-speaking provider.
10. Increases year-round employee engagement
People need health care all year round, not just at open enrollment. When employees know this solution is available to them, they can self-serve and find a provider within the same platform they go to manage their benefits. It’s like a one-stop-shop that encourages them to engage with their benefits at their moment of need.
11. Provides personalized support for employers
After the solution has been implemented and used, the healthcare navigation service should be able to provide support and demonstrate the cost savings achieved by guiding members to point solutions and high-quality, cost-effective providers. You’ll know exactly how much bang for your buck you’re actually receiving, and know that the tools you’re providing are valuable.
When it comes to healthcare costs, every dollar counts. Directing employees to the right care, at the right time, starts with having the comprehensive tools in place to guide them.
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