Navigation Solutions Bring a Human Touch to a Technology-Infused World

By Christine Tang Wilson

It’s a bit of an understatement to say we are surrounded by technology. On a given day, I could ask Google Home what the traffic condition is for my commute, glance at my Fitbit to see calories burned, check alerts from Amazon on where my children’s soccer gear is on the delivery route, and tap my phone to make reservations via OpenTable.

Yet when it comes to navigating the complex world of healthcare, we often still want a human touch despite the technology. We need a personal adviser, or advocate, at times. This is especially true when facing challenges such as an unfamiliar health condition, a bill with incomprehensible codes, or having to choose a specialist.

Over the last five years, so-called navigation platform operators have gained an increasing role in helping employers and health plans provide that necessary human-based support. These companies are using a combination of sophisticated technology – such as artificial intelligence and machine learning algorithms – along with human decision-making to help patients better sort through and figure out their best health plan options for care. The navigation operators can integrate their technology with the vast data sets of health insurance networks and employee health plans to help achieve better outcomes and lower costs.

These navigation operators are addressing a real market need. The average cost of employer-provided health insurance will rise 6% to almost $15,000 per employee in 2019, assuming no benefit changes, according to the Society of Human Resource Management. With employers covering roughly 70% of those costs, that leaves employees to incur on average $4,400 in terms of premiums and out-of-pocket expenses.

This problem is being met head on with a blend of technology and human interaction. One provider, Accolade, uses a mix of advisers, clinical experts and health advisers to help to have a single point of contact for members. Another one – Grand Rounds – helps members navigate health coverage, ask medical questions, and connect with high-quality doctors. A third, Amino, helps consumers navigate their health plans to get the best benefits available to them at the lowest cost options.

Navigation providers are not new – but are now increasingly able to show how their services can reduce costs. The cost per employee per year for one Accolade client was $782 less than that of a control group, a 6.5% difference, according to a study by Aon, commissioned by Accolade. For another client, the cost was 4.7% less, or $527 per employee per year. Similarly, Amino estimates employers can save as much as $540 per engaged employee with a 40% participation rate.

In a sense, it’s not a surprise that a small dose of human touch can go a long way, given the knowledge gaps many may have about what’s available in health care. For instance, 28% of people admit to not knowing where to find a qualified medical specialist for a specific illness or disease, as Grand Rounds notes on its website.

Navigation platform operators can tap into the data sets of employers and health plans – following strict privacy and data compliance guidelines – to help steer employees the right way. While mobile is one option, they communicate often with a chat function, with a very familiar look and feel to what you may use on an iPhone or Android phone.

Also, sophisticated, quality algorithms are playing a role in measuring medical-provider quality and pairing us with the best options available to us in network. With time, navigation operators will become more predictive, with a greater ability to read and decipher patient data, then recommend best actions via personal contact or potentially through integration with home assistants such as Google or Alexa. Lines will also blur between support with healthcare benefits versus other employer-offered financial or Employee Assistance Program types of benefits – so that the navigation providers may become true “hubs” for an employee’s overall benefit utilization and advocacy.

As personal navigation and advocacy evolve, the challenge will be to find a balance on just the “right amount of touch,” to avoid alienating customers with too many interactions or recommendations while respecting their privacy and anticipating needs. Technology will still need to be tempered by human decision-making and interaction, as healthcare is innately personal and one answer rarely “fits all.”

Christine Tang Wilson currently leads Strategy, Strategic Planning and Performance for Employer Markets at Blue Shield of California. She enjoys exploring new ideas that intersect multiple domains as well as leveraging nearly 14 years of experience in business strategy and analysis each day.