Health Plan Solutions


The Last Healthcare Program You Will Ever Need

Navigation Health provides a revolutionary, fully integrated, turnkey, self-funded health care program that delivers better benefits at lower costs while improving member experience.  We have done all the heavy lifting to vet and integrate proven cost-containment strategies, industry leading care coordination, innovative technology solutions with best-in-class healthcare vendors into our self-funded and level funded healthcare offering. If you are looking to save your small (25+), mid-size, and large client’s 15% to 30% in just the first year while increasing benefits and having a better member experience, we have the program for you.

There are multiple health plan strategies and cost containment solutions.  Based on size and geography of the group, available services, and what’s going on with the group and their appetite for cost containment will determine the appropriate strategies/solutions to be implemented and which vendors are the best fit. 

Integrated health plans strategies, cost containment solutions, and vendor partners include:

As a member, navigating the health care world can be complicated, frustrating and overwhelming.  Navigation Health’s Care Navigator makes it easy by providing members their own personal health care concierge to help guide the way.  With just one phone number to call for all needs,  the Care Navigator will explain benefits, answer questions, research and schedule procedures with high quality, fair priced contracted providers in the area.  The Care Navigator is the members advocate for all pre-service and any post service support and guidance.

Not all providers of healthcare are the same. Some providers have consistently better results, and some charge substantially more for the same services.  Higher costs and higher quality of care are not synonymous.  Our custom high-performance provider networks focus on direct contracting high-quality providers with fair and reasonable charges.  We replace the “one size fits all” leased network model with a cost-effective custom network created around the specific needs of our clients and their employees.   Our high-performance direct contracting model provides unmatched flexibility to deliver the most efficient, cost-effective coverage attainable.

An unbelievable 25 cents of every healthcare dollar are consumed by administrative waste.  Claims, billing, and collection activities do nothing to improve quality and clinical outcomes, but they do destroy the consumer experience and make price transparency virtually impossible.  What would happen to healthcare costs if employers and health plans replaced claims with immediate cash payment?  Our real-time cash payment platform vendor connects employers and providers with direct, immediate cash payment.  The result is lower healthcare costs (20% to 50%) and a dramatically improved healthcare payment experience for consumers, employers, and providers.  All this without losing any essential data for plan administration, reporting and analytics.

VBP aka Referenced Based Pricing (RBP) is a significant cost containment strategy – but because there is no contract, providers can balance bill the member which can be very disruptive to the plan.   VBP Direct does not leave balance billing to chance.  Through navigation to direct contracts or through claim negotiation (pre- and post-service) we have nearly eliminated balance billing issues while still securing the absolute best facility pricing.  However, when balance bills do occur dedicated Care Navigators take the lead in settling the dispute which includes legal services.  Certain balance bill indemnification programs may be available that cover both the plan and member of any financial responsibility should a settlement over plan limits be required.

We have access to Centers of Excellence and other quality surgical facilities and the best surgeons that offer all-inclusive, low-cost bundled, transparent prices for more than 400 inpatient and outpatient procedures.  These arrangements offer high quality providers, better outcomes, massively reduced costs, better member experience and often come with a re-admission warranty.  They are a win-win, both to the self-insured employer paying just one much lower transparent payment and to the member not having any out-of-pocket costs.

– Navigation Health only works with top tier benefit administrators that deliver innovative technology and administration solutions to control rising health care cost.  Services include – claims administration, COBRA, FSA & HRA.

Data warehousing allows in-depth reports to be developed to identify trends in health care spend (a macro view) as well as opportunities for specific, member level care improvement/cost avoidance (a micro view).  Our reporting services provide guidance for evaluating health plan performance, benefit planning, and areas of costs avoidance and clinical intervention opportunities

It is no secret that pharmacy costs especially specialty drugs have skyrocketed over the last several years.  It is also no secret that there’s a lot of “fluff” built into PBM contracts.  That is why Navigation Health works with   the top transparent PBM in the industry that retains zero revenue from manufactures or pharmacies passing 100% of savings including rebates directly to clients.  To combat the high-cost specialty drugs, our PBM takes advantage of the total manufacture’s coupon/copay on hundreds of drugs passing the savings on to the client and also utilizes the Tele340B program.  We also engage sourcing of Patient Assistance Programs, international procurement, and healthcare tourism.  Through our various programs, we can save clients 30% to 80% on specialty drugs.

We offer a full suite of URAC-accredited services (Utilization Management, Case Management, Disease Management) to improve access and target the most appropriate levels of care before services are rendered, resulting in dramatic savings for the plan and member.  We have the data and tools to move from reactive care to proactive population health management.

Studies show that more than one-third of medical diagnoses are misdiagnosed.  A recent Mayo Clinic study found that 88% of the patients who came to the clinic for a second opinion learned that their diagnosis had been changed or moderately altered.   Second opinions can play an important part in a self-funded health plan, both for patient peace of mind and savings to the plan.   Second opinions are provided free to the member on certain diagnosed procedures that meet the criteria for a higher potential of misdiagnosis and higher risk to the member.

Utilized by our Care Navigators to provide purchasers of healthcare a clear picture of how reliably hospitals and physicians are delivering the best outcomes and appropriate care across the continuum at the greatest value.

Virtual medicine has been accepted and is being utilized more than ever. All our plans include virtual medicine at $0 copay with a top vendor in the industry.

Making decisions for one’s health is not just an administrative function; it is a personal experience.  That is why we offer a best-in-class platform that not just saves clients’ time, stress, and money – it supports every step towards better health benefits usage and engagement.  This all-in-one benefits app unifies member experience by having everything in one place: ID cards, Plan Summaries, Virtual Care, Care Navigation, Provider Lookup, Provider Comparison /Transparency Tools, Pharma, Claims Data & Instant Payments Options.  Also includes a member communications tool that sends secure, HIPAA-compliant messaging to groups and individual members to ensure the right message at the right time.

Navigation Health has preferred Stop-Loss Carriers / MGUs that have analyzed our high-performance networks/direct contracts along with our other cost-containment strategies previously mentioned and are giving maximum credit to their rates and factors.  In addition to traditional experience underwriting, we have carriers that use Curv (formerly GRx) and/or Verikai underwriting for groups with 25 or more enrolled employees without needing health questionnaires or experience.  Great for groups wanting to move from fully insured or coming out of association or PEO plans etc. with no experience.  We have unique captive options as well.

For questions, or a more complete overview of our integrated health plan strategies and cost containment solutions and the vendors that provide them please contact Chad Olson at chad@navigationhealthllc.com or 602.692.1109.