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Independent Health Care Navigation: The Path to Value-Based Care Preparedness
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By Eric M. Parmenter, Ph.D., CEBS | Quantum Health
The healthcare industry can be slow to embrace change. The lagging pace of adopting value-based care (VBC) is a prime example. VBC was intended to transform health care, but the term alone continues to evoke mixed responses. These range from unbridled optimism for what VBC can achieve to continued skepticism over its mixed results.
Self-insured employers are among those that have watched the evolution of VBC mostly from the sidelines — and with good reason. Benefits leaders weighing employe health plans and programs still have fundamental questions, such as: How would I implement VBC? Where would I begin? Can VBC deliver both cost savings and better outcomes while preserving employee choice and experience?
VBC: Definitions, Objectives and Drivers
The Institute for Health Improvement (IHI) defines value in health care as “the optimization of the Triple Aim.”1
The triple aim is to improve population health and the patient experience as well as reduce per capita cost. The triple aim has now become the quintuple aim to include improving health equity and supporting the well-being of the heath care workforce.2
What Is Value-Based Care?
VBC represents a revolutionary change from a health care system where providers work independently from one another and are reimburse regardless of the quality of care they provide to a system where teams of providers coordinate care and take ownership for managing the health, cost and outcomes of their patient populations.
AT A GLANCE
In a value-based care (VBC) system, teams of health care providers coordinate care and take ownership for managing the health, cost and outcomes of their patient population.
- Accountable care organizations (ACOs) are one of the most well-known types of VBC arrangements.
- Essential elements of an employer-based ACO include rightly incentivized providers, comprehensive and well-designed benefits, integrated drug cost controls and easy employee access.
- Independent health care navigation platforms can help employers achieve VBC by steering them to care that is the most appropriate and delivers the highest value.
Accountable Care Organizations
The description of VBC hints at one of the most well-known types of VBC arrangements: the accountable care organization (ACO). Authorized by the Affordable Care Act (ACA), ACOs first took shape through the Centers for Medicare and Medicaid Services (CMS) Medicare Shared Savings Program (MSSP) and have since expanded to include every kind of patient population.
Essential elements of an employer-based ACO include the following.3
- Rightly incentivized providers who are organized in centers of excellence (COEs) and high performing networks (HPNs). While these terms may sound complex, their definitions are easy to understand: Groups of providers who are committed to delivering high-quality, efficient care and are responsible and incentivized for doing so more affordably and with lower overall costs.
- Comprehensive and well-designed benefits. These include health and pharmacy benefit plans with wrapround mental and behavioral health support.4
- Drug cost controls that integrate clinical prescription drug management with effective clinical programs while delivering low net cost purchasing power. Tactics include the use of biosimilars and other evidence-based equivalents as well as aligned formularies with appropriate clinical protocols.
- Employee access via simple means of communication (e.g. a single phone number, app or portal) but multiple means of care delivery. Methods of care delivery range from traditional, in-person treatment and in-home care to telemedicine and other digital options that help providers coordinate and offer coaching and support between visits.5
ACOs include other elements to be described later (e.g. data management and alternative payment models (APMs)). They are also not the only type of VBC arrangement. To keep it simple, however, ACOs are a good example of the hallmarks of effective, employer-driven VBC.
As this article will discuss later, independent health care navigation platforms can aid this multilevel integration. They may help to deliver VBC that is more effective, efficient, equitable, safe, timely and patient-centered. Such platforms can also help reduce waste.
VBC: Aligning Incentives with Outcomes
The lack of VBC and inefficiencies in healthcare delivery often lead to high costs and unnecessary spending in the U.S. health care system. A study in JAMA estimates that waste accounts for $760 billion to $935 billion per year or — 25% — of total health care spend.6
Although the U.S. spends the most on health care, health outcomes don’t compare favorably with other industrialized countries. In February 2025, the Millbank Memorial Fund reported that “life expectancy in the United States is lower than in most developed nations that spend much less on health care, and rates of uncontrolled chronic diseases are rising.”7
Our health care system rewards such care with payments that are often described as misaligned. VBC seeks to upend and replace these kinds of incentives through APMs, including bundled payments, global capitalization or episodes of care. In one way or another, these models cap payment for either a defined group of services (e.g. maternity care, joint replacement) or for the total cost of care.8
The following are key elements of APMs:
- Payments depart from traditional fee-for-service reimbursement.
- Providers are rewarded for delivering better outcomes.
- Providers must absorb financial losses for poor results.
Many VBC arrangements, such as the aforementioned ACOs, include these payment models. Such financial safeguards can help contain health care costs.
Interest in VBC
Rising health care costs are impacting every stakeholder — self-insured employers in particular. The Business Group on Health (BGH) 2025 Employer Health Care Strategy Survey projects a nearly 8% surge in 2025.9
- Traditional high-cost conditions (cancer, cardiovascular disease, diabetes, musculoskeletal disorders)
- Specialty drugs (employers’ fastest growing cost center and 27% of total health care spend)
- GLP-1s, whose growing use for weight loss has created a $133 billion market, according to PwC10
As BGH stated in its Trends to Watch in 2025 report, preferred provider organization (PPO) strategies and “quick fixes” likely won’t be enough to solve this challenge.11 Employers may want to consider playing the long game by investing in VBC and its potential for improving efficiency, effectiveness and cost across every patient, condition and setting.
VBC Progress
Despite its sclerotic pace, VBC has seen meaningful progress in results, adoption and resources and support for implementation.
More than 40% of health care payments are now value-based per a report from the Health Care Payment Learning & Action Network.12 In addition, CMS reports that in 2023, the MSSP generated more than $2.1 billion in net savings, the largest in the program’s 13-year history.13
And while only 46% of large employers implemented VBC models according to the BGH 2024 Large Employer Health Care Strategy Survey, the 2025 BGH survey notes that a growing percentage are adopting the building blocks for VBC.14 15
These building blocks include the previously described COEs, used by 82% of companies, and HPNs, used by 46%. These provider groups help employers build three key VBC capabilities:
- Integration of diverse clinical teams, the care they provide (primary, specialty) and the settings where they provide it (hospitals, outpatient clinics)
- Alignment of incentives that drive employees to choose these gold-standard providers
- Access via a single point of contact and engagement that expands where employees receive care, how they access it and how they leverage their plan benefits.16
Health care Navigation as a Tool for Achieving VBC
One resource that plan sponsors can consider to help them deliver VBC is independent health care navigation , delivered via an integrated platform. This combination can deliver a high-touch, high-value experience as employees embark on their often complex and challenging patient journeys. Understanding how this is achieved requires understanding the individual components of an independent health care navigation platform.
What is Health Care Navigation?
Health care navigation involves guiding employees to the best care by:
- Helping them understand insurance complexities
- Clarifying treatment options
- Facilitating clear communication with health care providers.
Through health care navigation, employees receive personalized support, empowering them to make informed decisions and access care with confidence.
What Is Independent Navigation and Why Is It Important?
Independent Navigation means that care recommendations are health plan agnostic and thus less prone to bias. These recommendations align with an employee’s benefits but, within that framework, are person-centered and evidence-based versus purely utilization management driven.
What Is an Integrated Platform, and How Does It Facilitate Independent Health Care Navigation?
Even the best health care navigation will fail if employees cannot access the help they need in one place and employers cannot track the return on investment (ROI). Digital “point solutions” often address single problems but these distinct apps may not impact broader savings and outcomes and can lead to fragmented care. As such, they likely cannot support a full transition to VBC.
In contrast, integrated platforms provide a single point of contact and engagement for employees. Easy to use, these platforms deliver a comprehensive yet streamlined experience that helps address every health care question, need and concern, making it easier for employees to:
- Understand manage and use their health care benefits
- Search for and make appointments with affordable, high-quality providers
- Access both traditional and digital care options (e.g. in office visits, telehealth, smartphone apps, remote monitoring)
- Receive ongoing, updated guidance as benefits, providers and costs change
- Receive help from care coordinators to navigate all of the above.
In summary, independent health care navigation can deliver the transparency and self-direction that both employees and employers need to truly understand and manage their health care benefits, costs and outcomes.
The Link Between Health VBC and Independent Health Care Navigation
While not all employers agree on what VBC is, many believe that health care navigation is a key component. Health care navigation was cited as a key strategy by 82% of large employers in the 2024 BGH survey and 37% of small to midsize employers in a 2024 survey by Employee Benefit News.17 18
Independent health care navigation has already been shown to help employers control health care costs through eliminating wasteful practices — specifically by preventing employees from self-referring to inappropriate types and levels of care.
For example, by encouraging employees to see a designated, well-matched primary care physician (PCP), one provider’s research found that navigation:
- Increased PCP visits by 0.5% annually and 2% cumulatively per 1,000 members
- Decreased specialist visits by the same amounts
- Reduced cumulative overall medical claim costs by $0.16 per member per month.19
Independent health care navigation can also deliver savings. Recall the main drivers of health care inflation escalation: high-cost conditions and prescription drugs. In fact, a 2025 AARP Public Policy Institute Spotlight found that 25 drugs accounted for nearly $50 billion in total 2022 Medicare Part D spending; the top five were either specialty drugs or GLP-1s.20 A cohesive care navigation platform can integrate medical and pharmacy point solutions across all conditions, all costs and an entire employee population.
How Employers Can Implement VBC Using Health Care Navigation
Many examples illustrate the benefits of a VBC strategy driven by independent health care navigation.
Take cancer, which is a leading driver of employer health care costs.21 Delayed detection and access to the right treatment means worse outcomes for employees and preventable cost escalation for employers. In contract, a care navigation platform does the following:
- Leverages data – and AI-driven algorithms to identify high-risk employees sooner
- Intercepts low-value care in real time through clinical alerts (also driven by AI) to care coordinators
- Steers employees toward the right care at the right place at the right time by combining human-centered, evidence-based care guidance with tech-enabled decision making.
Another example of the link between navigation and VBC is cancer screenings. Colonoscopies are the gold standard for colon cancer detection, but they are expensive. In addition, research shows that the colonoscopy appointment backlog became so long through 2022 that it could take years to resolve it unless provider prescribe other screening options.22 This is occurring at a time when colon cancer rates are on the rise among younger patients and remain higher and with worse outcomes for Black patients, according to the American Cancer Society Cancer Facts & Figures 2025.23
A health care navigation platform powered by data-driven, AI-powered clinical insights; expert empathetic care coordination; and a seamless digital application could address those challenges in the following ways:
- Identifying employees at low risk for colon cancer but who meet screening age guidelines
- Directing low-risk employees away from expensive, unnecessary colonoscopies and toward less expensive and more convenient home-based screening tools
- Ensuring that these tools are prescribed by a physician who is accountable and rewarded for recommending high-value care
This scenario illustrates that VBC doesn’t have to be complex and that health care navigation can simplify care while generating employer savings and a better employee experience.
Health Care Navigation Can Help Encourage the Right Incentives
Charlie Munger — the former vice chairman of Warren Buffet’s Berkshire Hathaway — once quipped, “Show me the incentive and I’ll show you the outcome.”24
The most comprehensive VBC models not only reward providers that deliver better outcomes but also require them to assume graduated financial risk for such outcomes. A health care navigation platform can help employers find providers who are willing to be rewarded with higher reimbursements for quality care and absorb losses for lower quality care.
The most innovative benefits strategies can only achieve so much. Benefits leaders are well-versed in how difficult it is to balance quality and cost-savings while protecting member choice and experience. Broad PPO plans deliver on choice. However, Oliver Wyman reports in The Next Wave of Value Generation in Commercial ACOs that annual PPO costs often rise 4-6% because these plans don’t combine care coordination, APMs with provider risk sharing and incentives, and other VBC mechanisms.25
In contract, ACOs can deliver 1-5% cost savings and slower cost growth over PPOs.26 Employers may be able to save even more by using an integrated platform powered by independent health care navigation.
Health care navigation has already cut employer costs from health care waste — an area with a projected $191 billion to $286 billion savings potential per a JAMA study.27 When paired with other VBC principles, such as fee-for-value reimbursement, risk sharing and incentives, and high-quality provider networks, these savings may increase.
Conclusion
As employers reassess their health care benefits strategies with an eye toward lowering health care costs, they may want to take a fresh look at VBC and the independent health care navigation strategies to help achieve the right care in the right place at the right time for every patient.
Author
Eric M. Parmenter, Ph.D., CEBS, REBC, RHU, SPHR, CLU, ChFC is an organizational psychologist and vice president of health systems at Quantum Health. He has worked in the employee benefits business for more than 30 years as an advisor to midsize, large and health system clients and has deep experience in health plan strategy, design, prevention care, and productivity, and behavioral economics. He leads the hospital industry vertical for Quantum Health.
Endnotes
2. www.ihi.org/insights/quintuple-aim-why-expand-beyond-timple-aim.
3. E. Parmenter (2024). “The Next Era of Value-Based Care for Self-Funded Employers.” Quantum Health internal paper.
4. E. Parmenter, M. Attridge (2021). “Can Robots Improve the Mental Health of the Workforce?” ResearchGate.
5. Ibid.
6. https://pubmed.nbci.nlm.nih.gov/31589283.
7. www.milbank.org/publications/the-heatlh-of-us-primary-care-2025-scorecard-report-the-cost-of-neglect.
8. E. Parmenter (2024). “The Next Era of Value-Based Care for Self-Funded Employers.” Quantum Health internal paper.
9. www.businessgrouphealth.org/resources/2025-employer-health-care-strategy-survey-intro.
10. www.pwc.com/us/en/industries/consumer-markets/library/glp-1-weight-loss.html.
11. www.businessgrouphealth.org/en/resources/trends-to-watch-in-2025.
12. http://hcp-lan.org/workproducts/apm-methodology-2022.pdf.
14. www.businessgrouphealth.org/en/resources/2024-large-employer-health-care-strategy-survey-intro.
15. www.businessgrouphealth.org/resrouces/2025-employer-health-care-strategy-survey-intro.
16. E. Parmenter (2024). “The Next Era of Value-Based Care for Self-Funded Employers.” Quantum Health internal paper.
17. www.businessgrouphealth.org/en/resources/2024-lare-employer-health-care-strategy-survey-intro.
18. www.benefitnews.com/research-report/continuing-care-in-the-face-of-costs-complexity-and-concerns.
19. Based on Quantum Health research.
21. www.businessgrouphealth.org/en/resources/2024-large-employer-health-care-strategy-survey-intro
22. Calculations by Cologuard based on: (1) A. Piscitello, D.K., Edwards (2020). “Estimating the screening-eligible population size, ages 45-74, at average risk to develop colorectal cancer in the United States.” Cancer Prev Res.; (2) American Association of Medical Colleges (AAMC). “Active physicians with a U.S. doctor of medicine (U.S. MD) degree by specialty, 2015.” www.aamc.org/data-reports/workforce/interactive-data/active-physicians-us-doctor-medicine-us-md-degree-specialty-2015.; (3) J.M., Eberth, M.J. Josey, L.R. Mobley et al. (2018). “Who performs colonoscopy? Workforce trends over space and time. J Rural Health.
24. https://fee.org/articles/charlie-mungers-rules-for-life-in-his-own-words.
25. www.oliverwyman.com/our-expertise/perspectives/health/2018/aug/committing_to_value.html
26. www.oliverwyman.com/our-expertise/perspectives/health/2018/aug/committing_to_value.html. Want to reconfirm that data is in source.