The Missing Link for Employers in Value-Based Care: Healthcare Navigation

Value-based care is ______. Every healthcare stakeholder will likely finish that statement differently.  

Value-based care (VBC) has been around for more than a decade yet feels somehow like it hasn’t arrived. Yes, there has been meaningful progress. More than 40% of healthcare payments are value-based — and by 2030, CMS wants 100% of Medicare beneficiaries to be in value-based arrangements. But skepticism abounds and may be merited, given all the healthcare complexities that VBC must address. 

Understandably, commercial self-insured employers have been among the slowest to adopt value-based care: 13% of small to midsize companies and 46% of large ones have implemented various value-based care models, according to the Business Group on Health 2024 Large Employer Health Care Strategy Survey. But multiple forces— from unprecedented cost spikes to new fiduciary requirements — now converge to make it not only smart but imperative that employers take a fresh look.  

Navigation Insider® sourced Eric Parmenter, Quantum Health’s vice president of Health Systems, to dissect why independent healthcare navigation — combined with the unique cost and quality levers employers already deploy — is the missing link in the next stage of VBC progress. 

Why employer VBC adoption lags — and why that must change

Despite much-heralded promise, value-based care and its alternative payment models have yet to yield the savings many policy experts predicted. The Center for Medicare & Medicaid Innovation (CMMI) found that, since 2011, only six among more than 50 of these models created statistically significant savings for Medicare. The results are similar on the commercial side, and for the same reason: It is notoriously difficult to improve cost and quality simultaneously and nearly impossible to do so with our current reimbursement system. 

Fee-for-service (FFS) payment is one of value-based care’s fiercest headwinds. No model can perform against these misaligned provider financial incentives. Commercial employer plans have been the slowest to embrace the shift from FFS and face their own unique headwinds: 

• Managing rising healthcare costs. Projections for 2025 show an 8% surge in cost trend to record levels of costs for employers and employees (2025 BGH Survey). 
• Offering personalized, competitive benefits in a challenging environment. This goal cannot be achieved with employee cost-shifting, which does nothing to control overall spend. 
• Ensuring benefits deliver value for the price. The new Consolidated Appropriations Act (CAA) holds employers financially liable for delivering healthcare coverage that is essentially aligned with value-based principles. 

If employers needed a reason to take a fresh look at value-based care, they have it now. The only thing they’re missing is an approach that turns these challenges into VBC opportunities. 

Healthcare navigation amplifies VBC capabilities

Self-insured employers possess levers that other healthcare stakeholders don’t: the ability to steer members toward the providers, plan designs and payment structures that improve cost and quality. Employers are already adopting the mechanisms that make these levers work: 

• Centers of excellence (COEs): 92% 
• High-performing networks (HPNs): 46% 
• Virtual-first solutions: 37% 
• Value-based primary care: 32% 
• Accountable care organizations (ACOs): 31%  

In addition, 82% of large employers already cite healthcare navigation as a key to VBC strategy, per the 2024 BGH Survey. The last piece of the puzzle is bringing these components — employers’ unique levers and independent care navigation — together. With this combination available to employers, the only truly “risky bet” is continuing to rely on broad PPO plans’ FFS reimbursement model to deliver results. 

Healthcare navigation unites care and payment dynamics

Healthcare navigation isn’t a strategy for big, well-resourced companies alone. Employers of all sizes can implement it to connect members to high-value care and connect providers to value-based payments. But how does it work? 

1. Alignment of medical, mental health and pharmacy benefits that engages and incentivizes members to use providers from accountable care organizations, high-performance networks and centers of excellence. 

Result: smart decisions at point of care, dollar conservation through account-based plans.  

2. Integration across providers — primary, specialty and facilities — to form a coordinated care team.  

Result: improved cost and quality for complex, chronic conditions.  

3. Access to these providers via traditional and digital visits (e.g., telehealth, smartphone apps, remote monitoring).  

Result: member education, coaching and support between visits and across diverse, patient-friendly settings. 

4. Payment that rewards all stakeholders for making high-quality care decisions.  

Result: excellent clinical and experiential outcomes, with more capacity for downside risk. 

When powered by data and contained within a single platform, healthcare navigation delivers high-tech, high-touch and high-value support across a member’s entire healthcare journey.

A single point of entry that delivers double-digit savings

Value-based care strategies rely on seamless coordination, timely engagement and meaningful provider relationships. Independent healthcare navigation from Quantum Health enhances these efforts by connecting members to high-quality providers and ensuring informed decisions at critical moments. 

Key to this integration is real-time provider interaction. By leveraging insights from provider engagements — such as precertifications and eligibility inquiries — navigation creates opportunities to guide members toward high-value care while addressing gaps in care coordination. This proactive approach amplifies the impact of VBC initiatives, aligning member behavior with employers’ cost and quality goals. 

By prioritizing both member and provider alignment, navigation helps employers achieve the savings and outcomes that make value-based care a viable path forward. 

For employers, value-based care is more than a healthcare strategy 

The goal of value-based care is to deliver healthcare’s Quintuple Aim: affordability, outcomes, experience, equity and workforce wellbeing. 

Most of us want that kind of healthcare system, and self-insured employers are in a better position than most stakeholders to deliver it. Building a robust and sustained culture of health that focuses on the wellbeing and productivity of employees is a key value-based care capability. 

This perspective is far more empowering and optimistic than the last decade of healthcare headlines suggest. Just as 5G technology has amplified cloud computing and AI capabilities, integrated, independent healthcare navigation can unlock an employer’s VBC potential with greater ease. Why? Because they share the same focus: to deliver the right care at the right place at the right time. 

So, again, value-based care is _____? The time is now for employers to revisit their answers and the solutions.