What Consultants Are Saying About Independent Healthcare Navigation

Research by Quantum Health shows that most benefits consultants see independent navigation as a valuable solution to the complexity of healthcare and health benefits — for employers and employees alike.

Today’s employers are focused on healthcare and benefits navigation solutions as never before.

• A survey of more than 600 employers by consulting and insurance firm Willis Towers Watson found that 69% planned to upgrade navigation and advocacy support for their employees in 2021.
• A Business Group on Health survey of large employers found that, in 2021, 90% would offer their employees some type of navigation support.
• Last year Quantum Health surveyed benefits decision-makers who work for self-insured employers. Of the more than 250 decision-makers surveyed, 97% said offering professional healthcare navigation services is important or very important if the goal is to provide employees the best benefits possible.

Given this clear focus on navigation as a healthcare and benefits administration strategy, many HR teams and benefits advisors are having conversations about how to enhance navigation support for their health plan members.

To help you prepare for those discussions, we’ve compiled findings from more than 150 benefits consultants surveyed in the Quantum Health study mentioned above. All the respondents work with at least some self-insured employers. Nearly two-thirds said that half or more of their clients are self-funded for health benefits. The survey was blinded, so respondents didn’t know who was asking for their perspectives on the employee healthcare and benefits experience.

Solving for Healthcare and Benefits Complexity

Consultants rated navigating the healthcare system more complex for consumers than planning for retirement or buying a home. More than half said they expect navigating healthcare and using health benefits will only grow more complex.

The survey asked which types of organizations were best at helping consumers understand and use health benefits. Three in four consultants said an independent company that specializes in healthcare and benefits navigation is best at providing those services. That 75% was considerably higher than the 15% who rated health insurance carriers or third-party administrators (TPAs) best at providing members with navigation services.

In fact, familiarity with independent navigation solutions led to even greater confidence among consultants. The more times they had an independent navigation vendor adopted by one of their clients, the survey found, the more likely consultants were to say that a navigation specialist is best at providing navigation assistance.

“Interestingly, consultants who’ve worked with a navigation vendor even once see a clear difference in which type of partner is best at helping consumers understand and use healthcare and benefits,” said Missy Jaeger, Quantum Health’s vice president of consultant relationships. “This is an important insight for employers, since it can be easy to assume that a TPA or insurance carrier already provides a sufficient level of navigation support to members.”

Improving the Employee Benefits Experience

The survey asked consultants to share their clients’ most important needs when it comes to designing health benefits that will support employees. The top five needs were that employees:

• Fully understand their health benefits and coverage.
• Obtain assistance with health insurance claims issues and appeals.
• Receive help managing chronic conditions or developing a care plan for more complex health issues.
• Can easily find provider cost and quality information.
• Are enabled to take advantage of all the health-related benefits and programs available to them.

Each of the above is something a fully capable independent navigation partner can help HR teams address. In fact, 73% or more of consultants said offering a professional navigation service:

• Makes employees’ healthcare and benefits experience less frustrating and stressful.
• Increases employees’ confidence in using their health benefits.
• Helps employees achieve improved health outcomes and lower out-of-pocket costs.

Meanwhile, two-thirds or more of consultants said HR and benefits teams also stand to gain from an independent navigation partnership, through:

• Lower healthcare claims costs.
• Reduced benefits-related workload.
• Simplified administration of point solutions.
• Fewer privacy concerns related to handling colleagues’ protected health information.

Evaluating Navigation Solutions

Finally, the survey asked consultants which factors they consider most important when they and their clients evaluate navigation service vendors. The consultants with the most experience in recommending navigation solutions to their clients considered the following their top criteria:

• Demonstrates savings on claims costs for self-insured employers
• Shows evidence of decreased healthcare costs over multiple years
• Offers a single point of benefits contact for both health plan members and providers serving those members
• Provides clinical specialists to assist employees
• Demonstrates experience partnering with employers in similar industries

“Today’s benefits consultants are extremely knowledgeable about helping HR teams ask the right questions before making any important vendor decision,” Jaeger said. “This research, and the results from other surveys within the consulting community, provide excellent input for HR and benefits leaders considering whether and how to enhance navigation support for members.”