Healthcare navigation is changing the way both employers and their employees manage and save on healthcare expenses. Particularly for self-funded plans, the savings are two-fold: when an employee cuts down on healthcare costs, the employer benefits as well. Yet, people typically don’t think about their health benefits until the moment they need them. And when they need to seek care, they’re not thinking about the cost. In fact, plan members will choose low-cost care options less than 30% of the time. That’s why medical debt is the leading cause of bankruptcy in the U.S—and likely why nearly 90% of employers believe providing health benefits to employees will be unaffordable by 2030.
But healthcare navigation can help employers—and their people save on healthcare.
With just a quick phone call or email, healthcare navigators direct employees to high-quality, cost-effective care options—yielding multiple avenues of savings for both the individual and their employer before care decisions have been made. They also meticulously examine post-treatment bills, and astonishingly find that up to 80% of these invoices have discrepancies. Some healthcare navigation services, like Emry Health, go the extra mile, walking employees through hospital financial assistance processes, ensuring they consider all available savings opportunities. Now, let’s explore the different types of savings generated by healthcare navigation.
Type 1: Refunded
Refunded savings refer to reimbursements made to members for payments they’ve already made. These situations arise when a member has paid for a service, in full or partially, but has been either overbilled or the claim wasn’t processed accurately by the insurer. In such cases, the member is entitled to a refund for the overpaid amount.
Type 2: Avoided
This is the amount an employee (and many times an employer) would have been responsible for based on a recommended care path. But with the intervention of healthcare navigators like Emry, more cost-effective alternatives are suggested. For example, when a member experienced chronic side pain and her primary care physician (PCP) advised a CT-Scan at a hospital imaging center. With a high-deductible plan, the anticipated cost at the referred hospital was $1,900. After consulting with Emry, the patient was directed to an alternative location where the CT-Scan would only cost $630, resulting in a remarkable savings of $1,270. If the deductible had been met, this cost would have directly impacted the self-funded employer’s bottom line.
Type 3: Direct Member Savings
This indicates the dollar amount by which a patient’s identified bill or financial liability is reduced. For instance, a member faced an unaffordable $77,000 hospital bill and substantial medical debt. Based on the federal poverty guidelines, the member qualified for hospital financial assistance. Emry directed the member to their Financial Assistance Portal and walked them through the eligibility and application process. The hospital subsequently approved and covered 100% of the member’s $77,000 bill through financial assistance.
Type 4: Productivity Savings
Time is money. The hours an employee would typically spend untangling healthcare-related issues can now be saved, thanks to healthcare navigators. It’s estimated that for every hour an employee invests in healthcare matters, navigation services like Emry save them three.
Type 5: Total Saved
This is a comprehensive figure that combines avoided, direct, refunded, and productivity savings. A case in point is the largest private insurance exchange in the US. Aiming to enhance their health benefits, they engaged Emry to steer employees towards the best quality care at the most affordable rates. Over a span of three years, Emry’s comprehensive navigation services, from pretreatment to bill reviews post-care, resulted in a whopping total savings of $5 million across 80,000 employees.
Healthcare navigation is not just a service. It’s an indispensable ally to employers and employees in the complex and costly world of healthcare. With an easy, multi-avenue savings approach, it promises a healthier, more affordable healthcare future for all stakeholders involved.