The types of navigation solutions (and how to know which your company actually needs)
This post is authored by Nicole Fink, VP of Product Management.
Healthcare costs are rising faster than they have in 15 years. At the same time, 85% of employees are confused about their benefits package. Employers are investing more and getting less utilization in return.
Navigation is often the proposed fix. But “navigation” has become a loaded word in benefits. A carrier portal, a concierge nurse line, a steerage app, and a full benefits navigation platform are all called “navigation”. But they are not all created equal and choosing the wrong one has real consequences for your budget, your employees and your ability to evolve your benefits strategy over time.
This guide breaks down the four types of navigation solutions, who each one is built for, and where each one hits its ceiling.
Looking for a quick summary? Skip ahead to our comparison chart.
Jump to a section
- No dedicated navigation: the status quo
- Bundled carrier navigation: the “included” app
- Digital steerage and overlay tools
- Full navigation and care delivery solutions
- How to choose
What is a healthcare navigation solution?
A healthcare navigation solution is a tool or service that helps employees make better decisions about their healthcare. This could include: finding the right providers, understanding their benefits, accessing the right programs at the right time, and avoiding unnecessary costs.
Navigation has evolved well beyond provider directories. Today’s solutions span advocacy, concierge support, care coordinations, engagement platforms, and AI-driven personalization. The question is less whether you have navigation and more of whether the navigation you have is doing meaningful work.
Tier 1: No dedicated navigation
What it looks like
This is the default state for many small businesses. Employees who have questions call HR directly, wait on hold with carrier customer service, or try to piece together information from scattered plan documents and point solution portals. Open enrollment is the main touchpoint, after that employees are largely on their own.
Who it tends to work for
Organizations with simple benefits structures, a single carrier, and a workforce that is generally health and benefits savvy. At smaller companies where HR knows employees by name, informal navigation can work reasonably well.
Where it falls short
At scale the model breaks down quickly. Benefits questions become one of the biggest time drains on the HR team. Only 36% of employees say they have a very clear understanding of the benefits available to them, which means a significant portion of your workforce is left feeling confused.
The ceiling
Navigation by HR is not scalable, and navigation by carrier customer service line is built for claims and administrative questions, not helping people make proactive cost-effective care decisions. As your benefits strategy grows more sophisticated, the absence of a navigation layer becomes more expensive.
Tier 2: Bundled carrier navigation
What it looks like
Most major health plans offer some form of digital navigation as part of their member experience: a member app, an online portal, sometimes a nurse line or concierge service. These tools help members with plan-specific tasks like finding in-network providers, checking on claims statuses, understanding deductables, and access carrier sponsored programs.
For many employers this is the first “navigation” they adopt because it comes included with the health plan relationship.
Who it tends to work for
Employers with a single carrier, a workforce that is primarily concentrated in the same region or network, and a benefit strategy that does not extend significantly beyond the carrier’s own ecosystem.
Where it falls short
Bundled apps are built around the carrier’s architecture, not an employer’s strategy. Carrier networks are designed and maintained across multiple employers. No single employer’s priorities drive how the network is configured.
If your benefits portfolio includes point solutions, Centers of Excellence, virtual care vendors, or wellness solutions that live outside of the carrier’s ecosystem, those vendors are unlikely to be surfaced prominently in a carrier app. The tool is designed to maximize engagement with the carrier’s offerings, not yours.
There is also the continuity issue worth mentioning. When your member experience is embedded into a specific carrier’s platform, changing carriers becomes complicated. You are not just switching plan design, you are disrupting the experience your employees have built habits around.
The ceiling
Bundled navigation works within the carrier’s walls. For employers who have a strategy that extends beyond a single carrier ecosystem or value flexibility as your benefits program evolves, will face limitations.
Tier 3: Digital steerage and overlay tools
What it looks like
This category sits between the carrier app and full navigation. These tools are typically added on top of existing carrier relationships and tend to focus on specific types of navigation problems: helping employees find higher-quality, lower cost providers; directing members to Centers of Excellence; and offering cost transparency so employees can compare options before booking the appointment.
Some of these tools offer a digital solution only, others offer a human element for more complex situations.
Who it tends to work for
Employers who have identified a very specific cost driver they want to address. Particularly out-of-network leakage or underutilization of high-quality providers, and want a solution without overhauling the entire member experience.
Where it falls short
The scope is narrow by design. These tools are built to solve one specific well-defined problem. They are generally not designed for longitudinal engagement with members across the full care journey. An employee who uses a steerage platform to find a specialist does not necessarily get support in scheduling, preparing for the visit, or following up on referrals, or connecting to a behavioral health resource when the situation may call for it.
The Business Group on Health navigation framework describes this tier as an “overlay” navigation: useful for directing members to specific resources but reliant on the member to follow through. Integration with other benefits programs is usually limited, and the employer still bears the coordination burden across vendors.
The ceiling
Steerage tools reduce specific costs and improve specific decisions. But they do not orchestrate the broader benefits ecosystem, and they may not sustain engagement over time. For employers maintaining a large, complex portfolio of programs, they address a symptom rather than the underlying navigation gap.
Tier 4: Full navigation and care delivery
What it looks like
This is the most comprehensive category. A full navigation solution is a personalized, modern high-touch platform that optimizes your benefit and care delivery investments across the entire employee population. It functions as a carrier agnostic front door to the employer’s entire benefits ecosystem: health plans, point solutions, pharmacy benefits, virtual care, and specialized care vendors. It uses data across the full ecosystem to surface next best actions, connect employees to the right resources at the right time, and sustain engagement across the care journey. Not just at the moment of a care decision.
At its best, this tier combines digital navigation with human support for complex needs. Real human care coordinators or advocates are available to members to act as a guide through the full care journey. That means helping someone manage a chronic condition and reduce unnecessary ER visits, closing gaps in preventive care before they become bigger problems, and facilitating billing issues so members don’t have to fight that battle alone. For more complex situations, clinical advocates can serve as a quarterback to a member’s care, for example handling nurse triage over the phone before deciding if you need that trip to urgent care.
However, it is worth noting that not all Tier 4 navigation platforms are built the same. It is worth asking any vendors a few questions:
- Does the vendor own care delivery?
- Does it measure programs and point solutions across your entire benefits ecosystem?
- Does it activate the entire population or only members already in a health event?
Who is it built for
Employers with complex benefits ecosystems: multiple carriers, portfolio of point solutions, specialized programs, and an interest in measuring whether those investments are working. For organizations where healthcare is a major cost center and major driver of workforce health and productivity, this tier is built to move the needle on both.
What makes it different
The difference is not just features, it is alignment. A full navigation platform answers to the employer’s strategy, not a carrier;s operational model. It surfaces your programs, integrates with your vendors, persists across carrier changes, and gives you the data to understand what is working.
According to Mercer’s research, employers estimated that their healthcare costs would rise about 8% if they did not take any action to lower them. A navigation platform that meaningfully shifts care to lower-cost, higher-value settings, reduces out-of-network utilization, and increases engagement with preventive care and condition specific programs is one lever available.
Where Castlight fits in
Castlight operates in this tier. As a carrier-agnostic platform, Castlight offers more than 200 integrations (including over 40+ deep bi-directional point solutions integrations) and connects employees to the right resource based on their individual health profile, plan design, and benefits available to them. Resulting in:
- 3.25 more point solution engagement
- 65% whole-population activation
Real human RN Care Guides support employees through complex, high-cost care journeys. Castlight is also the only navigation platform with owned onsite and near-site primary care through our Vera Whole Health brand. And because Castlight sits outside any carrier’s ecosystem, it works across carrier relationships and persists through plan changes, keeping the employee’s member experience consistent year after year.
How to know which tier fits your company
A few questions worth considering to help you decide.
- How many carriers and point solutions are in your current ecosystem? If the answer is more than one of each, bundled carrier navigation is probably not sufficient.
- What percent of your benefits investments are people actually using? If you do not have a confident answer to this question, you are missing visibility into what programs are actually working.
- How much HR time is going toward fielding benefits questions? Even smaller teams are spending several hours per week on benefits questions. That is time that could be redirected if employees had a place to get answers on their own.
- What happens to the member experience if you change carriers? If the answer is significant disruption, your navigation is more tightly coupled with your carrier than it should be.
- Are you able to measure the ROI of your point solutions? A navigation solution that integrates with your vendor ecosystem should be able to tell you which programs employees are finding, engaging with, and benefiting from.
| No Dedicated Navigation | Bundled Carrier App | Dedicated Steerage / overlay | Full Navigation and Care Delivery | |
|---|---|---|---|---|
| What it does | HR fields questions; employers navigate on their own | Helps members use one carrier’s plan and programs | Directs employees to low-cost high-quality providers |  Connects employees across all benefits with personalized guidance |
| Who it’s built for | Small teams with simple benefits packages | Single carrier employers with limited point solutions | Employers targeting a specific cost or quality problem | Employers managing complex, multi-vendor ecosystems |
| Carrier agnostic | N/A | No | Varies | Yes |
| Human support and advocacy | HR only | Carrier customer service line | Limited, mostly digital | Dedicated guides across full care journey |
| Employer strategy alignment | Dependent on HR capacity | Aligned to carrier priorities | Aligned to one specific objective | Aligned to your full benefits strategy and goals |
The bottom line
The right navigation solution depends on the complexity of your benefits and what you are trying to accomplish with it. For small employers managing a straightforward, single carrier set-up, foundational tools may be adequate. For employers who have built a sophisticated benefits ecosystem and want to actually maximize its value, a navigation layer that reflects your strategy rather than a carrier’s is worth the investment.
Healthcare costs will keep rising. And 77% of employers report rising medical costs as a primary source of stress. The employers who manage costs most effectively over the next few years will be the ones who help their employees make better decisions, not the ones who spend the most on vendors and hope utilization follows.
Navigation is the lever. The question is whether yours is pulling in the right direction.
