Care Navigation to Meet & Exceed Your Plan’s Care Gap Closure Goals

Using care navigators for your health plan’s member outreach is an effective way of reaching members who would normally fall through the cracks of the healthcare system.

Sometimes, health plans retain their own team of care navigators. As a senior member of ReferWell’s care navigation team, I can say that for many payers, a cost- and time-effective solution is to contract an external vendor like ReferWell that specializes in hiring and training a unique and diverse care navigation team.

ReferWell partners with health insurance providers to assist with scheduling members who are overdue for preventative screenings such as colonoscopies, mammograms, or annual wellness visits with their primary care physicians. ReferWell care navigators can also administer patient-reported health surveys and make connections to SDoH agencies to address health equity issues.

Whatever the ultimate health outcome your plan is trying to achieve or financial metric you’re hoping to impact, care navigators help. At ReferWell, we maximize our technology platform to connect the member to a provider of their choice, who is conveniently located and accepts his or her insurance plan, and schedule an appointment on their behalf. This allows ReferWell to leverage the referable moment, reach more members and connect them to more services, making a larger impact than traditional care gap closure programs.

Which plan members do care navigators help?

Care navigation most often serves populations who have the greatest needs.

For example, your plan may want to reach members who are elderly, those with economic barriers or those who have conditions that limit their health, such as diabetes, heart disease and other chronic conditions that make it difficult to access care.

Often times, when we connect with these members, we find out that they either did not know they were due for preventive appointments, or they did not have the ability to coordinate their own care easily because of one of the barriers mentioned above. We then can eliminate these barriers allowing for a smoother connection, and gap closure that would otherwise be missed.

What skills should you look for in a care navigation team?

Our care navigators offer a unique mix of skills and experience that allows them to offer more than just customer service communication. We have backgrounds in nursing, healthcare administration, social work and case management.

We use these skills daily to impact each member in a more meaningful and compassionate way. We have the member experience in mind in each interaction. With this level of skill, we can engage members where they are.

We support them in making a meaningful connection to a community provider meeting their specifications and ensure their scheduling is seamless.

Here’s what a care navigator reported after calling a beneficiary who had an open care gap for breast cancer screening:

"I talked to a woman who said she knew she was due for a mammogram but had been putting it off because she has a family history and it scared her. When I said I could schedule her an appointment for her and that was covered by [her insurer] she was incredibly enthusiastic and scheduled right away. She chose to go the next week to just get it done and over with. She was very appreciative."

How does care navigation improve the member experience?

The barriers faced by the members we serve can be immense; they may have physical limitations, language barriers, financial issues or other concerns. They may not be aware why the tests for which they are overdue matter or the potential negative impact of avoiding these preventative screenings. There can also be barriers related to access to care, such as transportation or technology.

ReferWell care navigators meet people where they are and provide them with support to eliminate any barriers they have, while ALSO being empathetic to their needs.

For the members we speak to every day, it is a huge relief to know they can get their healthcare needs met without the burdens typically associated with finding a doctor and scheduling an appointment.

But it’s not just about all the feel-good feedback we get from members—though we do love to hear when we’ve made a member’s day! The data also shows that care navigation gets more people to close care gaps and follow through with their care.

Recently, a Medicare Advantage plan asked us to contact 5,000 members with open care gaps in the first 90 days of our contract. Well, not only did our team of care navigators make the calls in 30 days (three times faster), but we also scheduled 10 times more care gap appointments than the plan expected from this population!

We also blew other expectations out of the water. The insurer asked us to get 25% of members to make a decision on whether to have a preventive screening. We got 66% to decide. You can find more about our success on that project in the case study linked below.

I have to give a shout out to ReferWell’s development team too. By creating and maintaining efficient tools within the ReferWell platform, they allow care navigators to serve members each day quickly and effectively. This combination of technology and service creates a seamless and smooth experience for health plan members who are often left without these crucial resources.