What health systems lose when employees go out-of-system and how benefits navigation can help stop it

Health system benefits leaders are running one of the most structurally complex employer benefit programs and doing it with the same tools and pressure every large self-insured employer faces: rising healthcare costs, point solution sprawl, utilization you can’t fully see, and a workforce that’s too stretched to engage with benefits until they actually need care.

But health systems face one challenge (and one opportunity) that most employers don’t.  Your own facilities, employed physicians, and value-based programs are right there. And yet a significant share of your employees are seeking care somewhere else.

That’s both a benefits spend problem and a network revenue problem. This piece is about solving both at once.

This blog will answer the question: How does healthcare navigation reduce leakage?

1. Employee searches for care
2. Preferred in-network options surface first
3. Employee receives guidance and support
4. Care stays within the health system ecosystem

The leakage problem is bigger than most systems realize

Healthcare leakage happens when employees receive care outside a health system’s preferred network, leading to higher claims costs and lost downstream revenue opportunities. Data from FAIR Health helps show the scale of the issue: about 10% of claims are serviced out-of-network with a higher percentage of emergency claims (~17%) being out-of-network.  For a self-insured employer spending millions on claims each year, even modest reductions in out-of-network utilization  can have a major impact. 

When an employee goes out of system, you don’t just lose the claim. You lose the follow-up, the imaging, the specialist referral, and the relationship. The compounding effect is what makes this a strategic problem, not just an administrative one.

The underlying driver isn’t employee preference. Typically, employees aren’t choosing out-of-network care because they want to. They’re often defaulting to the provider or care option that’s easiest to find in the moment of need. That’s a navigation gap, and it’s one that’s solvable.

What benefits navigation with Castlight can do for health systems that it can’t do for anyone else?

Most employers use benefits navigation platforms for one purpose: help employees find the right care, at the right cost, at the right time. That’s valuable. But for a health system employer, navigation can do something more.

When Castlight is configured for a health system, it promotes that system’s own facilities, employed physicians, and value-based programs directly in search and steerage results. So when an employee opens the app looking for a primary care physician or a specialist, their own employer’s network surfaces first, not because of a paid placement, but because Castlight has the ability to configure a network that has the preferred pathway.

For health systems, that creates a unique double sided return on investment:

• Lower benefits trend: employees are directed toward high-quality, cost-efficient, in-network care, reducing unnecessary out-of-network utilization and avoidable high-cost events
• Network revenue recovery: the same steerage that reduces claims cost also drives volume into the system’s own facilities, capturing contribution margin that would otherwise leave

Castlight is the only benefits platform that works on both sides of a health system’s profit and loss statement at once.

The data behind the model

Castlight’s published outcomes data across employer clients shows what shifts when navigation is working:

• 9.1% YoY reduction in medical spend vs matched control group
• 56% lower ER utilization for Care Guide users
• 63 NPS score 
• 3.25 higher engagement with employers point solutions

For health system employers specifically, the steerage and provider quality numbers matter most. Every encounter directed toward your preferred network is a claim that stays in-system and a piece of the downstream care journey you retain.

Reaching a workforce that doesn’t stop moving

The engagement challenge in a health system is different from most employers and you know it better than anyone. A communication strategy built around desktop email and open enrollment windows doesn’t reach a clinical workforce. The intervention has to happen at the moment care is needed or targeted to an employee based on identification from personalized data.

That’s where Castlight’s model is built to work. Rather than competing for attention during open enrollment, it meets employees where the care decision is actually happening – in the app, at the moment of search. That’s when guidance changes behavior, not when a benefits guide lands in a mailbox.

The platform is built for this kind of workforce:

• AI-powered personalization that routes each employee to the right resource based on their specific situation and plan design (without requiring them to know which of your point solutions to call).
• RN Care Guides for high-complexity cases, helping employees navigate care decisions that often drive the highest cost claims  the employees whose navigation failures tend to drive the highest claims
• Mobile-first experience designed for people who aren’t at a desk, with a 58% registration rate and a 76% annual return rate.
• 40+ deep integrations so your existing point solution investments actually get used

The strategy is already there. The infrastructure is what’s missing.

The case for in-system care doesn’t need to be made internally; you know your system delivers the best care. The investment in building that network reflects a belief in its quality.

The gap is operational: without a navigation layer, that network strategy doesn’t translate into employee behavior at scale. Castlight closes that gap. We don’t change your strategy. We help operationalize it at the individual employee level, at the moment the care decisions are being made.

The implementation lift is lower than most organizations anticipate. Castlight works with your existing plan design, network configuration, and point solution stack. It doesn’t require replacing vendors or rebuilding infrastructure. It sits above what’s already in place as the engagement and navigation layer that connects employees to what you’ve already built.

Why now

Health system operating margins hit a 12-month low in January 2026 according to Strata. Labor costs remain elevated. Medicaid policy uncertainty is creating revenue exposure that’s hard to plan around. In that environment, there’s real pressure to find levers that move the needle on cost and revenue without a major capital commitment.

Benefits navigation is one of those levers. It’s deployable in months, the ROI is measurable in a format that holds up with finance leadership, and it addresses a problem that compounds annually. Every plan year that employees continue defaulting out-of-network is another year of leakage in claims cost and in network revenue. That doesn’t have to happen.

Acting ahead of the next renewal cycle means having a platform in place before next open enrollment and baseline data before the end of the plan year. That’s a realistic timeline for an organization that wants to show impact this year.

For health systems, benefits navigation isn’t just about helping employees find care. It’s about helping employees stay connected to the care ecosystem you’ve already invested in building. 

See how one health system of 50,000 employees achieved $4.3M in savings through smarter steerage.