October 16, 2024

Healthcare Navigation is the right medicine to address barriers

By Dr. Miles Varn, Chief Medical Officer, Sun Life U.S., Head of PinnacleCare

Healthcare continues to be complex and fragmented, causing those trying to access care stress and frustration, often leading them to give up. With no straightforward way to solve the issues of complexity, and increasing pressures to curb costs, streamline processes, and improve outcomes, the idea of health care navigation offers a compelling solution to ongoing challenges. 

The concept of healthcare navigation is believed to have materialized in the U.S. in 1990,  based on findings from the American Cancer Society National Hearings on Cancer in the Poor, which illustrated that people living at or below the poverty line were less likely to access appropriate care for the treatment of cancer. As a result of the findings, patient navigation programs were created to eliminate barriers for financially disadvantaged. However, the concept of care navigation took off and many insurers, hospital systems, providers, private companies, and even the government, have created and implemented tools and resources to help guide people throughout all points of their healthcare journeys.

As a former Emergency Room physician, I am keenly aware of the challenges people face when it comes to unexpected healthcare problems. Emergency care is highly skilled and is equitable in many ways but not comfortable or efficient, particularly for chronic problems. Also, I’ve seen the downside of lack of healthcare knowledge that can often lead to seeking care at later stages. In 2005, when I left the hospital setting, I was working as the Chief Medical Officer at PinnacleCare, a leading health advocacy and navigation company, intrigued by the possibilities of engaging with people and being able to truly impact health outcomes by being involved across the entire spectrum of care.

In 2021, Sun Life, a leading international financial services organization providing insurance, wealth, and asset management solutions, acquired PinnacleCare to help  Sun Life clients access the intelligence, access, and navigation that PinnacleCare provided its 3 million clients. With the right resources in place, the  Health Navigator product was initially introduced to stop-loss customers but has since expanded to Group customers. Utilizing extensive relationships with leading experts and Centers of Excellence throughout the country helps us find the best care and treatment options for people in need. With the personalized, unbiased guidance and support, members are able to ask health-related questions, talk through treatment options, find providers, and obtain expert second opinions. For us, it’s always about the patient. But the data proves definitely that better outcomes also leads to cost savings for the employer.

According to Employee Benefit News 2024 State of Healthcare report, only 44% of employees that responded to the survey felt confident they understand the cost of care will be using their insurance. This shows areas of are opportunities for employers to provide more clarity, education, and guidance to help their employees support and drive healthcare engagement.

While care navigation platforms may vary, the overall theme is the same -- to improve the healthcare experience and outcomes through better intelligence and coordination of care. While challenges and exorbitant health-related costs still exist, I believe that as care navigation platforms, technologies, and digital tools evolve, and as people take more advantage of these type of offerings, patients will have better experiences, earlier intentions, and most importantly for everyone, better outcomes.