When it comes to getting (and staying) healthy, there’s no one-size-fits-all solution. That’s why Castlight takes a high-tech and high-touch approach — so we can meet the needs of all Castlight members, helping each individual navigate his or her unique healthcare experience.
Each member’s digital platform is a personalized home for health that provides all their benefits, programs, and healthcare navigation tools in one simple, secure location. Rounding out this experience is our team of highly experienced and trained clinical and benefits experts, who we call Castlight Care Guides.
Care Guides support the health and wellbeing of every Castlight member with proactive, expert engagement via phone, chat, or email. Here are six of the many ways Care Guides can help Castlight members better navigate their personal health and wellbeing journeys.
1. Finding Quality Healthcare Providers
Identifying the best-fit healthcare provider can be difficult, especially since quality can vary greatly among providers. And quality care matters — a lot. For example, choosing a high-quality provider can double the chances of receiving effective care,* cut in half the chances of receiving inappropriate care such as an avoidable C-section, and reduce the risk of postoperative care by 60%.
Care Guides can help members find and connect with high-quality, in-network providers who align with the member’s preferences (i.e., provider gender or physical office location) and clinical history (i.e., diagnosed diabetes or depression). In addition, Care Guides can schedule member appointments and offer appointment reminders if requested.
Our Care Guides have deep insights into which providers would be a good fit for each employee based on Castlight’s proprietary analysis of provider clinical practices and employer-preferred sites of care.
Connecting members to the right level of high-quality care is integral to driving improved health outcomes and reducing overall healthcare spend. On average, members who went to a PCP recommended by Castlight experienced 15% fewer inpatient days per year and an 8% reduction in total annual healthcare spend.
2. Explaining Billing Details and Helping Resolve Any Errors
Healthcare billing errors — such as incorrect medical codes and missing claims details — are unfortunately quite common. For the patient, these types of mistakes can be distressing and lead to distrust in the healthcare system. And oftentimes, without resolution, it can result in increased costs for the patient and their employer.
Castlight Care Guides can help demystify a confusing medical bill by explaining all the details, such as: what the member’s deductible is, how much insurance covers, and why there are out-of-pocket costs, if any. When needed, and only if the member consents, the Care Guide will reach out to the provider, pharmacy benefit manager, or health insurance plan on the member’s behalf in order to figure out and rectify an inaccurate bill.
With Care Guides available to help navigate billing concerns and issues, members can focus more of their energy on improving their health and wellbeing.
3. Improving Health Literacy
Members’ ability to understand basic health information and make well-informed healthcare decisions varies. Low health literacy has been associated with less healthy choices, riskier health behavior, poorer health status, less self-management, inappropriate use of health services, and higher costs.
In addition to providing members with much-needed information about their specific healthcare coverage, Care Guides help members understand the best way to achieve their health and wellbeing goals. From the very first conversation, Care Guides take special care to ensure they build a trust-filled relationship with the member.
Through motivational interviewing, Care Guides can uncover a member’s intrinsic motivators and potential barriers to care. They’ll then take whatever amount of time is necessary to comprehensively educate the member about their condition(s) and explain why a specific behavior change and treatment plan adherence is so important, aligning the reasoning with the member’s personal motivators in order to increase the chances of staying on track.
Ultimately, improving health literacy enables individuals to develop the skills and confidence needed to make informed health decisions, be active partners in their care, and advocate for themselves and their families.
4. Providing Financial Guidance for Future Care
Many people delay or completely avoid necessary care because they’re concerned about how much it’ll end up costing them. Unfortunately, this type of behavior can lead to worse health outcomes in the long run.
Though Castlight has offered the full spectrum of healthcare navigation services for several years now, the company’s roots are in price transparency. Our Care Guides can supply the member with all the details they need in order to understand the cost of a healthcare service.
Specifically, our Care Guides can outline expected out-of-pocket costs, help the individual understand tracking toward their deductible, and redirect patients to alternative high-quality sites of care that are more cost-effective. In addition, Care Guides have insight into members’ health savings accounts and flexible spending accounts and can tell them how much can be applied against a healthcare bill, which can help minimize the direct financial impact to the member.
Using Castlight’s industry-leading insights into projected cost of care, our Care Guides can provide members with a comprehensive understanding of the financial impact of seeking care, as well as clinical context on the value of connecting to the care they need.
5. Increasing Awareness of Employer-Sponsored Programs
Often, employees are completely unaware of all the benefits available to them, let alone how they can leverage each for their unique personal health journey.
Powered by the data-driven insights of our personalization engine, our Care Guides are able to proactively connect employees with the most appropriate benefits available to them, including employer-sponsored condition management programs. Our Care Guides take the time to explain each benefit, its purpose, and how it can help the employee manage a condition or achieve a health goal.
Care Guide interactions lead to a boost in program engagement, including a 24% increase in health assessment completion, and a participation increase in the following program categories: nutrition (15%), behavioral health (13%), virtual care (10%), and diabetes (5%). Engaging with the right digital condition management program has led to cost savings for diabetes (2.1x), musculoskeletal issues (2x), cardiac health (2x), and more. For diabetes alone, engagement with best-in-class diabetes programs results in average savings per member per year of $5,200.
As a result of the tailored guidance our Care Guides provide, members are better equipped to take control of their health and achieve improved health outcomes.
6. Identifying and Closing Gaps in Care
Leveraging claims data, machine learning, and rules engine technology, Care Guides are able to spot potential gaps in care — for example, screenings for certain types of cancer, labs such as HbA1c for diabetes, and lack of routine preventive care visits — and equip the member with the knowledge and resources needed to fill those gaps.
Our Care Guides explain treatment plan options, provide prescription education, and help remove barriers that may be preventing the member from receiving recommended care or adhering to a treatment plan.
Our data capabilities also allow Care Guides to see if a member is frequently using a specific healthcare service, like the emergency room, in which case the Care Guide would encourage the member to instead engage with an alternative and less costly site of care, such as their primary care physician or an urgent care clinic.
Castlight Care Guides are a powerful complement to our digital home for health. When leveraged, this resource can lead to a more seamless healthcare navigation experience and better health outcomes.