Navigation ROI: How guided care lowers healthcare costs

Authored by Marla McLaughlin, MD, Chief Medical Officer

An employee’s knee is bothering them. 

Again. 

It’s not an immediate injury, but it’s been like this for a while and is now impacting their ability to move comfortably. They’re unsure where to go: urgent care? An orthopedic specialist? How do you just see a regular doctor if you don’t have a set primary care provider (PCP)? 

Their benefits offer options, but which is the right one?

Without guidance, this member may head straight to urgent care, the ER, or listen to their neighbor that they should see an orthopedic specialist who can book a costly MRI, since that was the neighbor’s experience. Or, they may delay care entirely, risking further injury, which in turn would likely increase their future healthcare costs. 

This employee’s care journey could go in a completely different direction though if they have healthcare navigation support. With guided navigation, they’re quickly directed to find a new PCP or an in-network physical therapist to start to figure out the next best step in their care journey. Maybe they will end up needing that MRI in the end, but maybe they just need to rest and work on strengthening their knee’s supporting muscles—avoiding unnecessary imaging, improving recovery time, and lowering total cost of care.

This is the power of guided care, and it’s why health navigation has become more than just a member experience tool. Today, it’s a core strategy for employers looking to reduce unnecessary medical spending across their population.

The real cost of healthcare confusion

Healthcare is complex. A patient always knows what they want (to feel better or get answers quickly and without financial burden) but they don’t always know what they need (like a physical therapist instead of an orthopedic surgeon).

Members often don’t know where to start, what’s covered, or how much services will cost. That confusion leads to costly decisions: ER overuse, unnecessary or redundant tests, or delayed preventive care that snowballs into chronic conditions that could have been mitigated.

Every misstep in the system has a financial impact—for both members and employers.

All members benefit from navigation, but the impact can be unique across different risk levels. High-risk members with chronic conditions often generate the highest savings when guided to appropriate, coordinated care since they’re regularly having more appointments and seeing more specialists than members without chronic conditions. Meanwhile, rising-risk individuals, who may consider themselves healthy but actually just avoid dealing with their health and skip preventive care, need proactive support to avoid future complications. Even low-risk members benefit; many seek care infrequently and inconsistently, making navigation key to helping them know where to go when they need to.

Guided navigation helps prevent those missteps by actively steering members towards more appropriate, higher-value, lower-cost care at the moment they need it.

Smarter decisions = reduced medical spend

At Castlight, guided care means connecting members with:

• High-value, in-network providers
• Primary care options before premature specialty services
• Relevant point solutions based on their needs
• Proactive reminders to close gaps in care
• Cost transparency tools that support better choices

We use data-driven personalization and intelligent design to make these connections seamless and stretch primary care options as far as possible until members actually need to see a specialist. 

Registered Castlight members are:

• 67% more likely to close a cancer screening gap in care
• 28% less likely to have an avoidable ED visit across all members
• 56% less likely to have an avoidable ED per month when interacting with live Care Guides

Members who use our Care Guides also see a $33.83 decrease in monthly spending over six months following their first interaction with the guide. It may not sound like much at first, but it adds up over time—especially for families!

For employers, these smarter decisions translate into measurable savings by helping members get the right care the first time and, in turn, reducing unnecessary medical spending across the board.

Amplifying existing investments

Most employers already offer a suite of benefits, from chronic condition management to mental health support. But without strong navigation, these programs are often underused. It’s not enough to have programs available; programs need to match members’ actual needs. Members also need to be able to easily discover what’s relevant to them at the moment they need it most.

Castlight boosts engagement by putting those resources front and center, at the moment they’re most relevant. This means:

• Higher participation rates
• Earlier intervention
• Better outcomes
• Greater return on existing investments

In short, guided navigation doesn’t compete with your point solution, it amplifies them while also lowering unnecessary care costs by connecting members to the right care at the right time.

How employers can measure ROI

Evaluating health navigation’s value and ROI looks different for every organization. It’s essential to look beyond surface-level engagement and focus on meaningful clinical and financial outcomes. For example, employers with high rates of breast cancer or diabetes spend should track impact in those areas specifically. The goal isn’t just to lower costs; it’s to deliver high-quality care that translates into cost savings. 

One of the clearest signs of a strong navigation program is the ability to bend the cost trend while maintaining or even improving care quality. If the national overall medical trend is increasing at 6%, and your organization is seeing 4%, that’s a sign your programs are working—without reducing access or over-managing care.

Key metrics to watch include:

• Fewer avoidable ER and urgent care visits
• Shifts toward high-quality, cost-effective providers
• Increased engagement with targeted point solutions
• More care gaps closed, earlier
• Overall reductions in total cost of care

These aren’t just soft engagement metrics. They’re real indicators of improved performance, better population health, and reducing unnecessary medical spending at scale.

What sets Castlight Health apart

At Castlight, we’ve guided intelligent care decisions for more than a decade. Our platform combines clinical expertise, behavioral data, and machine learning to support each member’s journey without compromising privacy or trust. Employers gain valuable insights through aggregated, de-identified data, while members retain full control over their personal health information. This dual commitment to outcomes and ethics is why employers across industries trust Castlight to help them manage costs, improve care, and build happier, healthier workforces.

Navigation isn’t just a perk—it’s a performance driver. When done right, it enhances everything else in your benefits portfolio and improves both the member experience and the bottom line. 

In a healthcare system where the cost of doing nothing is too high, guided care offers a smarter, healthier, more affordable path forward.