Blog Posts

What Is Care Navigation?

Healthcare can be overwhelming for members. From understanding their diagnoses to coordinating treatments and finding the right providers, members often struggle to navigate the complexities of the system. Care navigation bridges this gap by providing personalized support, guiding members to the best possible care while optimizing costs for both the member and the health plan.

At Boon-Chapman, we believe care navigation is more than just a service—it’s a commitment to ensuring every member receives the right care at the right time. Our dedicated team of professionals offers hands-on assistance, connecting members with quality providers, coordinating care, and addressing potential barriers before they become costly problems.

Proactive Intervention Saves Money and Improves Outcomes

Early intervention is key to improving long-term health outcomes and reducing unnecessary expenses. By identifying risks and engaging members proactively, Boon-Chapman’s Care Navigation team helps avoid costly hospitalizations, prevent complications, and promote better overall health.

Here are a few impressive examples of our care navigation efforts in 2024 alone:

• Surgery Center Utilization: With 1,073 cases guided to cost-effective, high-quality care, we achieved a 52% utilization rate, resulting in $17.1 million in potential savings.
• Advanced Imaging Utilization: Through proactive outreach and education, we facilitated 3,791 scans, with a potential saving of $4.95 million.
• Virtual Physical Therapy: By engaging members in alternative therapy options, we identified $216,612 in savings.

And it’s not only about the numbers. The full impact is clear when we hear positive feedback and stories from our members, like this one: “This was the easiest process I’ve been through for a procedure. The navigation nurses helped with situations I thought I would have to deal with. It was smooth and easy! I wasn’t stressed. I wasn’t worried. They took care of me, and it was greatly appreciated!”

Understanding the Differences: Utilization Management, Case Management, and Disease Management

Care navigation is often confused with other healthcare management programs, but each serves a unique role:

• Utilization Management (UM) ensures that medical services are necessary and cost-effective, reviewing treatments and procedures to prevent unnecessary spending.
• Case Management (CM) focuses on high-risk individuals with complex medical conditions, providing personalized support to coordinate care and prevent hospital readmissions.
• Disease Management (DM) is tailored for chronic conditions like diabetes or heart disease, offering education and interventions to improve self-management and prevent complications.

Boon-Chapman’s Care Navigation integrates elements of all three, offering a holistic approach that not only ensures cost-effective care but also enhances the member experience.

The Boon-Chapman Difference

What sets Boon-Chapman apart? Our hands-on, member-focused approach. We prioritize communication, proactive engagement, and a deep commitment to ensuring every individual receives the care they need.

From guiding members to high-quality providers to reducing financial burdens and improving health outcomes, our Care Navigation team is redefining what it means to support members in their healthcare journey.

When healthcare is complex, guidance matters. At Boon-Chapman, we’re here to make every step of the journey easier, more efficient, and ultimately, more effective for members and health plans alike.