The US healthcare system is renowned for its complexity. 

With a myriad of insurance options, providers, and regulations, no wonder employees and their families struggle to navigate their healthcare benefits.

According to a Bend Financial survey, 56% of participants feel “completely lost” in terms of their health insurance.

What does this mean to your business?

Poor employee benefits navigation can lead to increased healthcare spending and dissatisfaction with your leadership.

It’s a developing crisis in the US, and many have tried to come up with various healthcare navigation solutions to combat this.

But here’s the thing…

Not all benefits navigation tools are created equal.

So, how do you know which solution is the best for your company?

Keep reading because, in this post, you’ll learn:

• What exactly are health navigation solutions?
• How these tools help your workforce.
• The different navigation solutions available.
• How to choose the perfect fit for your company.

And we’ll delve into a game-changing healthcare navigation platform that uses AI to provide ultra-personalized, end-to-end care for each user. It’s called Healthee, and it happens to be our product 😉

Let’s jump in.

What are health navigation solutions?

Healthcare navigation solutions, often referred to as benefits navigation tools, are specialized resources designed to simplify the complexities of the US healthcare system. 

These tools guide employees and their beneficiaries to ensure they make informed and cost-effective decisions.

These tools are designed to:

Provide personalized guidance

These solutions offer employees personalized assistance in understanding their healthcare options. They help individuals navigate insurance plans, identify in-network providers, and make informed decisions.

Promote cost transparency

Benefits navigation tools provide clarity on healthcare costs. Employees can compare prices, estimate out-of-pocket expenses, and make financially sound choices when seeking medical care.

Grant access to expert support

These tools can connect employees with healthcare experts, such as benefits advisors or licensed clinicians. These healthcare providers answer your employees’ questions, offer guidance, and provide support throughout the healthcare journey.

Health benefits navigation tools are vital for every business because they empower your workforce to maximize their healthcare benefits.

What are the benefits of using a benefits navigation solution?

Now that you know what these navigation tools are…

What do they bring to the table?

Choosing the right healthcare navigation solution will allow you to enjoy the following perks:

Cost control

Cost control is arguably the biggest reason companies implement navigation tools for their employees.

These navigation solutions help employees make informed choices regarding their healthcare. It allows them to:

• Select cost-effective insurance plans
• Choose in-network providers
• And opt for preventive care measures

All of which reduce long-term healthcare costs for both the company and the employees.

This is done through the price transparency features of apps like Healthee.

These tools provide clarity on healthcare costs, enabling employees to seek in-network providers, compare prices, know the out-of-pocket expenses, and make financially sound decisions.

Time savings

Saving money is definitely on top of the list of the benefits of these tools. But don’t forget the most precious resource of all – time. 

Imagine how much time your HR team could save as a health navigation solution such as Healthee handles employee communication, resulting in streamlined administrative processes and simplified benefits-related tasks, thereby freeing your team to focus on more significant challenges. 

Your HR staff can now devote their time to more strategic initiatives and focus on the things that will make the most significant impact.

Employee satisfaction

The complexity of the healthcare system can leave a bad taste in employees’ mouths. 

A healthcare navigation solution like Healthee can simplify the process through quick, personalized responses. This not only minimizes frustration and confusion but can potentially help maximize health outcomes. 

When employees feel supported and informed, their satisfaction and engagement with your leadership and culture skyrocket.

Enhanced employee recruitment

Robust health benefits navigation services will not only help you retain top talents. They can also make your company more enticing for jobseekers.

Potential hires are more likely to choose an employer offering clear and accessible healthcare resources, strengthening the company’s ability to attract top talent.

What are the different benefits navigation tools available?

When considering benefits navigation solutions, it’s best to be aware of the various options at your disposal. 

The four types of healthcare navigation solutions are: 

• Traditional methods
• Technological solutions
• Hybrid models
• And specialized navigation instruments

Let’s dig deeper into each type.

1. Traditional methods

Traditional methods involve human or in-person assistance in navigating healthcare benefits. 

These methods have been relied upon for years and provide a personal touch to guide individuals through the complexities of healthcare.

Here are a few examples of traditional solutions:

• Health insurance brokers: Professionals who can help you understand, compare, and select a health insurance plan based on your specific needs.
• Employer HR departments: Many employers have HR employees designated to assist in understanding and enrolling in their benefits offerings.
• Healthcare customer service representatives: Employees often contact the customer service departments of insurance companies to ask questions about benefits, coverage, and claims.
• Workshops and seminars: Events arranged by insurance firms or healthcare professionals to educate businesses or individuals about various possibilities.
• Employer-sponsored wellness programs: These programs offer one-on-one support to employees, connecting them with dedicated advocates who assist in understanding and maximizing their healthcare benefits. This personalized approach is ideal for those who require hands-on guidance.

Who is this for?

Traditional methods are suitable for individuals and employees who prefer direct human interaction and guidance when navigating healthcare benefits. 

They work well for those who value personal support and assistance in understanding and managing their healthcare options. 

This category is particularly beneficial for employees who require hands-on guidance, personalized advice, and a deeper level of engagement with their healthcare benefits.

Traditional solutions are the most time-intensive and are subject to human errors.

2. Digital solutions

Technological solutions leverage digital tools and platforms to simplify the process of understanding and managing healthcare benefits.

Some examples of technological solutions include

• Health insurance apps are offered by some insurance providers to help members navigate their benefits and improve the member experience. These tools can be useful for leveraging the resources of one’s existing insurance carrier.
• Health insurance exchanges are online platforms and marketplaces (e.g., healthcare.gov) where you can explore, compare, and purchase health insurance plans. Navigational tools and assistance are often available.
• Online benefit calculators, like the one provided by the Social Security Administration, can help individuals estimate healthcare costs, compare insurance plans, and understand out-of-pocket expenses.
• AI-driven benefits platforms can handle employee health-related queries for hundreds or thousands of employees 24/7 without a large support team.
• Employee benefits portals are offered by some employers so employees can access information about their benefits, including health insurance plans, and wellness programs.

It’s worth noting that there are options available that include the benefits of more than one of the above. Healthee, for example, is an AI-driven benefits platform that employers provide as an employee benefits portal. It also performs all of the benefit calculations for users.

Who is this for?

Technological solutions are suitable for users who prefer self-service, convenience, and digital access when managing healthcare benefits. 

These tools are particularly beneficial for companies and tech-savvy individuals who value the flexibility of accessing their benefits and healthcare information online at their convenience.

3. Hybrid models

Hybrid methods combine the advantages of technology with human expertise to offer a comprehensive approach to healthcare benefits navigation. 

These solutions provide the convenience of digital tools while ensuring access to human support when necessary.

Here are a couple of examples of hybrid model navigation solutions:

• Telehealth benefit advisers are professionals who provide personalized guidance on utilizing telehealth services included in health insurance plans. They can help individuals understand how to access telehealth, find suitable providers, and make the most of virtual healthcare options. Combining human expertise with technology aims to provide a more hands-on approach to telehealth navigation.
• AI-enhanced health insurance navigators use artificial intelligence to streamline the enrollment process and provide quick answers to common questions. However, these services also offer the option for users to connect with a human navigator when they require more detailed assistance or have complex inquiries, making it possible to transition between technology and human support.

Who is this for?

Hybrid methods are suitable for individuals who value the convenience and accessibility of technology but may also require personalized assistance in specific aspects of healthcare benefits. 

They offer a balanced approach for employees who seek both the efficiency of technology and the assurance of human expertise.

4. Specialized navigation instruments

Specialized navigation instruments are tailored to meet the unique healthcare needs of specific groups, providing targeted support and information for individuals facing distinctive healthcare challenges.

Real-life specialized navigation methods include:

• Pediatric health benefits navigator: helps parents and caregivers navigate health benefits for children. It provides information on pediatric healthcare services, preventive care schedules, and ways to maximize benefits for their children, including coverage for check-ups, vaccinations, and child-specific treatments. Examples of this are the eHealthInsurance website and Every Child Pediatrics’ “Care Navigators” : eHealthInsurance website helps families find child-only health plans. You can filter the results by setting the primary member as the child and exploring plans tailored to their medical requirements. Every Child Pediatrics offers trained professionals to assist families in obtaining health insurance.
• The Veteran’s health-benefits portal: tailored to the unique needs of veterans, including those covered by the Veterans Health Administration (VA). It offers comprehensive information on VA health benefits, including eligibility criteria, services available, and assistance in coordinating primary care between VA benefits and private health insurance when applicable.
• Senior health benefits aggregator: designed for seniors, especially those eligible for Medicare. It provides information on Medicare health plans, supplemental insurance options, prescription drug coverage, senior wellness programs, and retirement-related healthcare options. For example, Australian company Brevity has a feature specifically designed to help Aged Care Providers serve their HCP and CHSP clients effectively.
• Disease-specific platforms: built for specific disorders (for example, diabetes or mental health) that assist patients through therapies, providers, and insurance alternatives that are targeted to their individual needs. An example is The American Diabetes Association which offers resources to help people with diabetes navigate their insurance choices, understand their options, and learn how to obtain prior authorizations and file exceptions and appeals. And they also offer information about resources that may help with medical expenses for Diabetes patients.

Who is this for?

Specialized navigation instruments are designed for individuals with specific healthcare needs, such as parents with children, veterans, or senior citizens. 

These tools provide targeted support and information to help these groups navigate their unique healthcare benefits more effectively.

How do you choose your healthcare navigation solution?

There are so many options available in the market today…

How do you know which one is a perfect fit for your company?

Factors like:

• Budget,
• Company size,
• And technical expertise of employees and employers

Play a vital role in determining the best solution for your organization.

So, let’s take a closer look at these factors and a few other things to consider before selecting a health benefits navigation tool that is right for your company.

Employee needs and demographics

The first step is to understand the unique situations, healthcare needs, and preferences of your employees, such as their: 

• Demographics
• Health concerns
• And preferred communication channels

You can do this by conducting surveys, meetings, or reviewing your employee database.

Your goal here is to know as much as possible about your employees and their healthcare needs. This helps you tailor the benefits navigation solution to your workforce’s specific needs and preferences.

For instance, if your employee population is predominantly young and tech-savvy, consider prioritizing digital solutions like AI-based navigation apps.

Conversely, if your employees are predominantly not tech-savvy and don’t know how to use online platforms, like apps, it might be worth considering specialized solutions catering to those demographics.

Budget and cost-efficiency

The cost of implementing and maintaining your benefits navigation tool is an important consideration. 

Look at the cost-effectiveness of each option. While traditional solutions offer a human-to-human connection, it can be costly to scale. 

Generally speaking, the bigger the company gets, the more technology-driven navigation tools are more cost-effective because maintaining software is usually cheaper than hiring and training more support teams to cater to benefits-related inquiries.

Employee feedback and satisfaction

The effectiveness of your benefits navigation tool depends entirely on your employees’ perception of it.

So, how do you assess if your solution is effective?

Gather employee feedback. Here are a few ways:

• Employee surveys: Regular surveys can provide structured insights into your employees’ preferences. These surveys should cover a range of topics, including benefit utilization, communication effectiveness, and satisfaction with the benefits program.
• Focus groups: Focus groups allow for in-depth discussions, providing qualitative data about what your employees like or dislike about their benefits and how they want to receive information.
• One-on-ones: Personal discussions can uncover unique needs and concerns, especially among employees who may be hesitant to share their opinions in a group setting.

After collecting feedback, analyze the specific health concerns and medical requirements of your employees. 

It’s also important to be agile in implementing improvements based on employee feedback. 

Make sure employees see their suggestions and concerns addressed, which reinforces their belief that their voices matter.

Scalability

Scalability is one of the biggest considerations when choosing a benefits navigation tool.

Your solution should accommodate changes in your workforce’s evolving needs.

For instance, if your business is growing, ask yourself these questions:

• Will it require additional licenses?
• Can this tool handle an increasing number of employees without breaking the budget?
• Can it seamlessly integrate with our HR systems?

Conversely, if you plan to shrink your workforce, you must still assess how the solution can scale down without unnecessary expenses.

A key question is if you can quickly and smoothly reduce the number of features or licenses.

Be prepared to adapt your scalability plan as circumstances change.

Data security and privacy

Safeguarding sensitive employee information is not just a best practice…

it’s a legal and ethical imperative. 

Here are a few questions to ensure your benefits solution keeps your data safe.

• Is it HIPAA (Health Insurance Portability and Accountability Act) compliant?

• Does it use strong encryption methods to protect data both at rest and in transit?
• Does it regularly back up data to prevent loss in case of security incidents?

Non-compliance with data privacy laws can have dire consequences like hefty fines, legal actions, and severe damage to your company’s reputation. 

So, it is imperative to prioritize compliance with these laws to protect your employees and your organization.

Conclusion

The world of healthcare benefits is complex. 

And to make them accessible and user-friendly means having the right solution in place. Otherwise, how will your employees be well-informed and make cost-effective decisions? How will they get the most out of their health benefits? The answer is, they won’t. 

But here’s how you can give them a decidedly “Healthee” option. 

Healthee’s AI-powered platform offers the benefits of technology and personalized user experience. With real-time answers, efficient open enrollment support, and a proactive approach toward health, Healthee promises a transformative experience for both employers and employees. 

Dive into the future of healthcare navigation with Healthee and empower your organization with the best in class. Your employees deserve it.