Healthcare is an ever-shifting landscape, leaving plan members feeling overwhelmed when it comes to finding the right care. From chronic illnesses and serious injuries to routine checkups, supporting a member's journey towards quality, cost-effective healthcare is more important than ever.
With 2/3 of employees claiming that they expect their employer to help them navigate this complexity, self-funded employers are exploring a variety of tactics to make it easy for their plan members to understand their health plans and benefits programs. Self-service digital health care navigation, like what Amino Health offers, is a powerful solution to this problem. Amino Health, which can be white labeled and configured to meet the demands of third-party administrators, benefits administrators, and health plans, makes it easy for plan members to find high-quality, cost-effective care on their own.
Sometimes, however, employers seek higher-touch options. Care advocacy, which connects employees and their eligible dependents with a qualified care advocate, emerges as a strong option. Though these advocates, sometimes known as care coordinators, might be better versed in navigating the system, their real value is in whether they can reliably recommend patients to high-quality, cost-effective care.
Unfortunately, the increasing complexity of plan designs and benefits programs, as well as the manual workflows typical of the field, have made it historically difficult for care coordinators to deliver on this goal. For care coordinators to be successful, they must be empowered with technology that streamlines their processes, provides insight into a patient’s unique health plan and benefits, and reliably surfaces high-quality, cost-effective care options for a specific need.
The current state of a care coordinators workflow
The primary objective for a care coordinator is to direct plan members to appropriate care. Yet, numerous hurdles either prevent, or dramatically slow, their ability to do so.
Care coordinators often rely on provider directories to find in-network providers and facilities for their patients. Unfortunately, these directories have historically been riddled with flaws, with a 2015 CMS report showing that close to 49% of provider locations had at least one error in them, and “inaccuracies with the highest likelihood of preventing access to care were found in 41.75% of all locations.”
Additionally, common care coordination workflows are manual and inefficient. Let’s consider a common scenario: Imagine a plan member calls into a call center needing to find a new dermatologist and understand what their out-of-pocket costs could be. A typical workflow might look like this:
- The care coordinator asks for, and then opens, the member’s insurance information to see what plan they are on
- The coordinator then opens the insurance carrier’s provider directory to see all in-network dermatologists (fingers crossed the data is accurate)
- The coordinator asks where the members lives, and uses a mapping program to determine how far each in-network dermatologist’s office is from that member
- The coordinator quickly researches a few of the closest dermatologists to read their reviews on sites like Healthgrades and Yelp. These reviews are subjective, but they’re all the coordinator has to attempt to understand the care quality
- The coordinator attempts to find cost estimates as well as real-time accumulators to help the member understand the potential cost of the appointment
- Finally, the coordinator verbally gives the member the phone number and address of the three to five closest, highest-rated dermatologists (and hopes that they’re accepting new patients)
The impact of a broken workflow
This overly manual process is something that coordinators rely on every day—and this is just for one member. When someone else calls in, the entire process begins again.
We’ve heard from healthcare navigation companies that their care coordinators can spend upwards of 2 hours a day researching specialists for members, and are often forced to look everything up manually via search engines. This workflow isn’t scalable and stunts the growth of an otherwise fast growing company.
Consider that more than one third of primary care visits result in a referral to a specialist and that specialty providers account for over 25% of total medical expenses. Poor processes and subjective reviews on these specialists, who account for one fourth of total medical spend, leaves way too much room for excessive spending on the table. While software isn’t trying to replace the humane and empathetic work of a care coordinator, it can help scale those authentic relationships and make them more stable, impactful, enduring, and goal-oriented.
Supporting care coordinator teams with better tools for a streamlined workflow
To drive the most value out of care coordinators – and to provide consistently reliable recommendations to patients – coordinators must be empowered with technology that equips them with fast insight into a patient’s unique health plan and benefits, as well as with validated, objective, insight into the cost and quality of various providers.
Amino Health, powered by 26B claims across 1,800 networks, analyzed against 200+ quality measures, provides this objective insight into the cost and quality of more than 2.75M providers. Care coordinators can quickly access personalized member information like insurance coverage and cost estimates quickly to better inform members about their care. Amino surfaces all this information, including any third-party point solutions relevant to a member’s specific need, in a single, intuitive platform. Not only does this streamline processes and save hours of unnecessarily wasted time, but Amino’s platform also reduces wasteful spending and improves overall patient health outcomes.
Technology has revolutionized how patients interact with the healthcare industry—isn’t it time care coordinators got in on the action too? Talk to the Amino Health team to learn more about how Amino streamlines care coordination workflows to drive down costs and improve patient outcomes.