For consumers and injured workers, navigating and accessing health care can be a challenging journey. It begins with selecting the best route to the best providers among multiple providers, sites of care, and types of healthcare services. This can lead to confusion and dissatisfaction, delays in getting care, network leakage, unaffordable treatment, and higher costs overall. Health Plans and Workers’ Compensation organizations are in a unique position to ensure a smooth care navigation journey by taking a holistic approach to provider data management.
A provider data management program designed with care navigation in mind can orchestrate a better experience, lead to more intelligent healthcare decisions, help curb healthcare costs, and ensure access to high-value primary and specialty care.
When a provider data process is not designed for care navigation, members and beneficiaries can become so frustrated and confused that it might seem the only way to choose a provider is to use the children’s counting rhyme, “Eeny, meeny miny, moe.” Clearly this is NOT the way to ensure high quality, cost-effective care that is in network and accessible. Care navigation should be seamlessly engineered within the provider data process to help simplify provider search and selection, support referral management, and demonstrate cost transparency by highlighting providers with the best outcomes, displaying provider and treatment costs, enabling provider comparison, and showing provider proximity to member or beneficiary. To be successful in the art of care navigation, it is important to focus on these six areas to support better engagement and experience. accessing care.