In the best of times, care is extremely challenging to manage. Six in ten U.S. adults have a chronic disease, while one in five are managing a behavioral health condition. This represents millions of people managing complex conditions. On top of this, there have been millions of cases of COVID-19 in the U.S., with the pandemic only adding more anxiety, confusion, and postponed care in already complicated care paths for patients.
We recently hosted Dr. Mohannad Kusti, a global physician executive, regional medical director at Pivot Health and former chief medical officer of U.S. Steel, for a discussion on navigating complex care—and what that means for employers. Below are some key takeaways:
Healthcare is complex and the system is convoluted. It is getting harder for people to navigate their health on their own.
There are plenty of challenges to accessing appropriate care. Many people have complex care needs and comorbidities. A convoluted healthcare system creates barriers, from managing the financial burden to finding the right provider. Plus, consumer preferences are particularly relevant right now as many individuals seek virtual care as in-person care is deferred.
When we look at a patient journey, there are so many opportunities for missed care.
- Find a provider: Evaluating which provider is high-quality, what type of doctor, are they in-network, and what is the out-of-pocket cost can all cause confusion and barriers from the very first step.
- Properly address a condition and comorbidities: Individuals may need to learn how to manage various medications, seek multiple specialists, and get proper labs and tests.
- Seek behavioral health support: On top of everything else, they need to be aware enough to recognize mental health symptoms, as chronic conditions and mental health are correlated. For example, 75 percent of individuals with heart disease either have or are at-risk for mental health conditions. Once they are aware of their symptoms, they then need to find what resources are accessible and which are appropriate. For example, is this something that can be appropriately helped with a mindfulness tool, a digital CBT, or teletherapy.
There are too many steps where someone can miss care, from either misunderstanding needs to seeking inappropriate care.
What does this mean for employers?
We simply cannot expect everyone to be medical experts. Your employees need help navigating the convoluted health system and managing complex conditions. And they particularly need help as COVID-19 has made managing one’s health even more challenging to navigate.
For individuals, this means benefit confusion, uncertainty of clinical next steps, and unexpected costs. But what does this mean to employers?
- Programs go underutilized as employees do not know how to find them or when they should use them
- Employee health is at risk which has an impact on employee productivity and absenteeism that can cost employers $2 billion nationally
- Medical costs continue to rise, with unnecessary ER visits from individuals with chronic conditions accounting for costs of $8.3 billion
How can employers help? We must recognize that people need support. This means not only digital resources, but live, empathetic support that employees can lean on during their care journey to help them navigate to available resources and benefits.
Care Guides offer highly personalized guidance to navigate to the right care and employer-sponsored programs.
In order to serve those members who have a need beyond a digital platform, Castlight’s Care Guides are there for support. Care Guides are highly experienced health concierges that pair with Castlight’s world-class digital platform to provide expert support to your employees and their families.
Care Guides knock down barriers to engaging with a digital platform by offering personalized care journeys, navigation expertise, and years of experience.
Personalization is the key to arming Care Guides with what they need to connect members to the right solution. We get rich data—including eligibility file data, medical and pharmacy claims, health assessment input and more—and apply AI predictive modeling to identify unique insights about the person and identify the right next step in their health journey.
Our Care Guides have a 360 degree view of the individual, from their self-stated health goals, to their in-app activities, to their eligibility for employer-sponsored benefits. Our Genius Personalization Engine serves up the recommended next steps in the individual’s care journey. Care Guides can view specific claims, enabling them to drive claims advocacy or fully explain a bill. Finally, asynchronous messaging enables our Care Guides to have a longitudinal digital relationship with that person.
Our team has cross-functional expertise and brings an average of more than 15 years of clinical experience to the table. From behavioral health, to billing questions, to medication management and more, Care Guides have specialized experience to meet your populations various needs.
Employees need support to effectively manage their health and wellbeing. Digital resources combined with live, empathetic support from a Care Guide can help employees own the next step in their care journey and use available resources and programs offered by their employer. For employers, this means a healthy, productive population, utilization of resources, and less unnecessary medical spend.