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90% of Execs Say Providing Employee Health Benefits Will Be Unsustainable By 2030 — Here's One Solution Businesses Need to Consider Healthcare navigation is something that employers and employees can't afford to go without. Here's why.

By Michael Waterbury

Key Takeaways

  • Employers are increasingly adopting cost-saving measures such as self-funding healthcare and implementing high deductible health plans. However, these strategies come with risks, including potential spiraling costs for self-funded employers and increased medical debt for employees.
  • Healthcare navigators play a crucial role in mitigating healthcare costs for both employers and employees.
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Healthcare appears to be headed for a breaking point as the cost for employers threatens to become unsustainable. According to a Kaiser Family Foundation survey, 9 out of 10 executives say it will be impossible to continue providing employee health benefits by 2030.

Rising healthcare costs are a challenge, but not an impossible one. Employers today have options. More and more, companies of all sizes are self-funding their employee healthcare to control costs, while fully funded and self-funded employers alike are adopting high deductible health plans (HDHP) that require lower premiums.

There are risks with these approaches, though. Self-funded employers who do not take care to contain healthcare costs can see their own expenses spiral. High deductibles, meanwhile, can saddle employees with greater medical debt.

However, these cost-saving measures do not need to result in an outsized risk for the employer or medical debt for the employee. Low-cost enhancements to health benefits can provide substantial support to employees in any workplace, regardless of whether their health plans are fully insured or self-funded.

For self-funded employers in particular, these improvements are especially advantageous, as their expenses are directly linked to the healthcare costs incurred by their employees.

The most effective enhancement available to employers is the healthcare navigator. With a single phone call, employees who work for businesses that offer a navigator with their healthcare plans can save in numerous ways, lowering overall medical costs for the self-funded employer and helping covered workers avoid medical debt.

Related: There's A New Trend In Healthcare That's Saving Money For Small Businesses

Price comparison

People aren't usually aware of what their health plan covers until they need to use their insurance. That can be a stressful time to find out how much a necessary procedure costs. And it's unlikely that someone in need of medical care is going to shop around and compare prices.

This is where healthcare navigators come in: They can do the comparisons for the plan participant and often find a care path that costs significantly less than the one recommended by an insurance plan or primary care provider. In this way, navigators help employees avoid certain costs that could otherwise have a devastating effect on their personal bottom lines, as well as the financial health of self-funded employers.

Bill review

By now, many people are aware that billing errors are shockingly common in the healthcare industry. When a patient pays a bill they aren't actually responsible for, the patient is due a refund of the overpaid amount.

However, the average employee might not be aware that they've overpaid or might not have time to investigate whether they were billed in error. Likewise, a self-funded employer may not have the internal resources to do this kind of investigative work. A healthcare navigator knows how to quickly spot this type of error and can help the employee (and the self-funded employer) get the refund they are owed.

Financial assistance

Often, people don't know that they qualify for hospital financial assistance. Employees might assume they're not eligible for such programs based on their income, so they don't apply, when in fact financial assistance could save them (and the self-funded employer) thousands of dollars.

Healthcare navigation can guide people through the process of applying through a hospital's financial assistance portal, potentially leading to significant direct savings.

Related: How to Protect Your Money from Getting Eaten by Health-Care Costs

Time saved

For the average person who isn't well-versed in the complex language and structure of the health insurance universe, trying to figure out and deal with health care costs is extremely time-consuming.

Frustrating health insurance issues that would have taken a plan participant four hours to solve take only one hour with a navigator. Those lost hours of problem-solving don't just cost the employee; they can cost the employer as well by cutting into work hours and tying up HR resources.

Not just for low-cost plans

While employees on HDHPs and businesses that self-insure stand to benefit the most from healthcare navigators, there are advantages to this kind of policy enhancement for any company offering their employees health insurance.

No matter how the care is funded or what type of plan an employee is signed up for, healthcare can be intimidating. Any employer who provides workers with an ally in the fight to get the best care with the lowest personal cost is likely to build goodwill among staff and burnish its reputation as a people-first enterprise.

Combining all these types of cost savings, from pre-treatment to bill review, it's possible to establish a comprehensive figure that accounts for the total savings realized by using a healthcare navigation service. Depending on the size of the company, this can add up to millions of dollars.

Making sense of the complex and expensive world of healthcare requires dedicated expertise. Healthcare navigation is something that employers and employees can't afford to go without.

Related: 6 Ways Entrepreneurs Can Solve the Problem of Medical Debt

Michael Waterbury

Entrepreneur Leadership Network® Contributor

CEO of Goodroot

Michael Waterbury is founder and CEO of Goodroot, a community of companies reinventing healthcare one system at a time. After a 20-year career as a health plan executive, he became an entrepreneur on a mission to increase access and affordability to quality healthcare through innovation.

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