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        5 min read

        5 Signs You Need a Healthcare Navigation Solution

        Photo of someone holding a smartphone with HealthJoy on the screen

        A healthcare navigation platform connects people with the right providers, services, and support at the right moment in their healthcare journey to positively impact both their health and the cost of care. If you’re unsure whether this type of solution is right for your company, consider whether any of these scenarios apply to you.

        1. Your Plan Costs Are Going Up Every Year

        Employer healthcare costs are climbing. In 2021, the cost to insure employees topped $22,000. Costs have climbed 22% over the last five years and 47% over the last 10 years, outpacing both wages and inflation, according to the Kaiser Family Foundation (KFF).

        At the same time, enrollment in high-deductible health plans is increasing year over year, raising the stakes for employee finances. In a 2019 KFF study, 30% of covered workers were enrolled in High Deductible Health Plans (HDHPs), up from 20% in 2015.

        Many industry experts are now acknowledging that HDHP’s are failing in what they set out to do. One reason is that employees don’t have the knowledge they need to navigate their healthcare plans. Most can’t define basic health insurance terms like deductible and copay. When they choose low-value care, they’re on the hook for unnecessary expenses — and so are you.

        If your plan costs are consistently rising, you need a healthcare navigation solution that helps employees find high-value care — balancing both cost and quality — at the right moment in their care journey. 

         

        2. Employees Are Asking HR Questions About Their Healthcare Benefits

        HR benefits professionals  surveyed for our 2021 State of the Benefits Experience Report said, on average, that they spent nearly one-quarter of their weeks answering benefits questions.

        Employees aren’t in the wrong when they ask questions. The process of finding high-value healthcare is overwhelming for most of us. Healthcare literacy rates are incredibly low; one study found that just 12% of adults have the health literacy necessary to navigate the system.

        In order to navigate their High-Deductible Health Plans (HDHPs) employees NEED support. But HR is juggling many other priorities, and may not be equipped to help employees find exactly what they need. 

        If your HR department is buried in benefits questions, take that as a strong sign you’re in need of a healthcare navigation solution. It can surface the best providers to meet your employees needs, so you no longer have to help them find a doctor or direct them to your insurance company’s provider database. It can prompt them to find savings on everyday healthcare needs, like prescription medications, and use their under-utilized preventive care benefits, like vision and dental screenings. 

        Best of all, it comes with the expert support of a skilled healthcare concierge team. These healthcare benefit experts are always on hand to answer questions and provide steerage based on your unique benefits package. Unlike you, they can answer questions and redirect employees on nights, weekends, and holidays. 

        Clients share the same response, emphasizing that after implementation, they saw a steep drop in the number of questions routed to HR. With a healthcare navigation solution on hand, our client Instructure “never [heard] benefits questions from employees again,” according to Senior Benefits Manager Alli Mauss. “It was like a one-stop-shop; it was like a switch.” 

        Implementing a healthcare navigation solution saved another 850-life HealthJoy client in the education sector over $3,000 HR hours over the course of a year. That’s on top of a projected savings of $357 per employee — derived from savings through concierge guidance, virtual primary care steerage, and medical bill review.

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        3. Your Employees Are Remote

        According to a Gartner forecast, over half of knowledge workers and nearly one-third of all workers around the world will be remote in 2022. Gartner projected the highest rates of remote work in the US. 

        In a release highlighting the projections, Senior Research Director Ranjit Atwal said: “Through 2024, organizations will be forced to bring forward digital business transformation plans by at least five years. Those plans will have to adapt to a post-COVID-19 world that involves permanently higher adoption of remote work and digital touchpoints.”

        In other words, remote workers need support to transition to a digital-first workplace located in their living room, closet, or spare bedroom. And just as they’ll need better tools to access remote meetings and company documents, they’ll need a new, digital first way to navigate their healthcare, too. 

        Remote workers need healthcare navigation tools. 

        Remote employees can’t come into an HR leader’s office with questions, or request a recommendation for a nearby dentist from a colleague. 

        Though they’re physically isolated, they may have an even greater need for tools like virtual primary care and on-demand chat support in order to work within your healthcare plan’s network. 

        Remote workers have increased mental healthcare needs. 

        While remote work might give us more time to focus on taking care of ourselves, it can also lead to isolation, loneliness, and stress. At the same time, a lack of 1:1, in-person contact can make it more difficult for managers and co-workers to spot signs of these and other issues, like mental health concerns and burnout. 

        A healthcare navigation tool that surfaces resources like your company’s Employee Assistance Program (EAP) or virtual behavioral health can lower barriers to care and help you reach employees, regardless of their physical location.

        Remote workers need different support during open enrollment.

        Managing open enrollment was difficult when you were in an office, and while you’ve adapted since going remote, it remains a challenge. That challenge is multiplied if you’re rolling out any plan design changes, attempting to promote a new benefit, or looking to re-engage employees in their benefits broadly. 

        A healthcare navigation platform shouldn’t offer only the tools employees need to find healthcare. A robust platform that offers custom communications and a centralized experience can smooth the process of plan design changes, drive adoption and utilization of new benefits, and offer a way for remote employees to find the support they need to make the most of all their benefits. 

        4. You're Self-Funded

        In a self-funded insurance plan, an employer assumes substantially more risk than they would on a fully-insured plan. 

        This makes it even more important that employees know how to access care that meets their needs and their budgets. In short, it makes the case for a healthcare navigation solution.

        Self-funded employers normally work with a third party administrator (TPA) to process and adjudicate their employee benefits claims. TPA’s have access to a wealth of information that, when paired with the right healthcare navigation solution, can help benefits leaders proactively combat high claims and improve employee health outcomes. 

        A healthcare navigation solution that can work directly with your TPA, like HealthJoy TPA+, allows for greater collaboration between companies, their TPAs, and their employees. 

        Using pre-certification and claims data accessible only through a TPA partnership, HealthJoy TPA+ can get ahead of costly healthcare decisions that lead to increased claims and high costs for self-funded employers. 

        5. You Have a Reference-Based Pricing Plan

        According to Mercer, reference-based pricing (RBP) can result in up to 40% savings on overall medical spending, as well as a reduction in fraud, waste, abuse claims, and stop-loss premiums and claims. Reference-based pricing works because it creates transparency. Understanding the costs and profits in healthcare services allows employers to identify lower-cost facilities and more accurately project their healthcare spending trends. While reference-based pricing can reduce costs for both employer and employee, it can also place an unacceptable burden on employees.

        Typically, a health plan provides a list of services, pricing structure, and providers who will accept the reference price for each service. But employees must be willing to do the research. When they aren’t well-educated on their specific plan or guided to appropriate providers, the employee is left to pay the difference between the reimbursement maximum and the provider’s charge. This is called balance-billing.

        Even successful RBP plans can leave employees with more cost-sharing. 

        Of course, companies on RBP don’t want to sacrifice quality for cost. For any health plan to work, employees will need to be able to locate high-quality providers. The good news is that cost and quality don’t seem to be correlated. The bad news is that finding a provider who balances the two can prove tricky.

        The vast majority of employees won’t need a procedure in the week after their enrollment meeting. They’re far more likely to need high-cost care months after their initial meeting when they’ve forgotten about RBP completely. Without the tools to find high-value care, this is a recipe for disaster.

        To maximize success and minimize problems associated with RBP, you need a technology solution that will consistently educate, engage, and help employees make decisions.

        It Might Be Time To Roll Out a Healthcare Navigation Solution

        If your company is dealing with any of these scenarios, it might be time to investigate a healthcare navigation solution. With the right live support and tools, you can empower employees to make the most of their healthcare benefits without sacrificing time or quality.

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