Care Navigation Value
AI-powered care navigation helps members find the right provider, understand their benefits, and navigate the healthcare system. Navigation reduces: (1) unnecessary specialist visits (by ensuring members see the right specialist); (2) ER use (by directing members to urgent care or telehealth for non-emergency conditions); (3) low-value care (by identifying evidence-based alternatives to expensive procedures); and (4) out-of-network use (by directing members to in-network providers).
Navigation Platform Capabilities
- Provider matching: Match members to high-quality, in-network providers based on condition, location, and quality metrics
- Benefits navigation: Help members understand their benefits and cost-sharing
- Care coordination: Coordinate care across multiple providers and settings
- Second opinion facilitation: Connect members with expert second opinions for complex diagnoses
- Claims advocacy: Help members resolve billing disputes and claims denials
- Mental health navigation: Connect members with mental health providers quickly
Member Engagement
IQ Insight
Member engagement is the critical success factor for care navigation. A navigation platform that members don't use delivers no value. High-performing navigation programs achieve 40–60% member engagement through: proactive outreach, easy access (phone, app, chat), trusted relationships with dedicated navigators, and demonstrated value (members who use navigation save money and get better care).