Improve Your Employees’ Healthcare Experience: Better Navigation Reduces Fragmentation

Understanding healthcare fragmentation: Key challenges and solutions

The U.S. healthcare system is a labyrinth that is difficult to discern and navigate, and it poses a litany of challenges for employers and their employees. Navigating this multifaceted landscape often leads to wasted resources, such as time and money, as employees move between providers seeking solutions to their healthcare needs. This disjointed—and often redundant—process not only disrupts the continuity of care but also drives up costs for employers and their workforce, resulting in a cycle of uncertainty and inefficiency.

Understanding and simplifying the fragmented healthcare system can lead to more informed healthcare choices for employees and measurable cost savings for employers. 

 

Healthcare Fragmentation

Identifying effective healthcare solutions is paramount to establishing a healthcare system that is accessible and affordable. Healthcare navigation fragmentation is caused by a number of factors, including: 
 

• Specialty Care Needs: Many people require specialty care, but with more than 120 medical specialties and subspecialties, it is difficult for employees to know the right type of physician to see for answers and treatment. Primary care providers can be helpful, but not everyone has one, and many primary care physicians are not linked to specialty networks. What’s more, upon finally arriving at an appointment, many specialists focus on symptoms and diagnoses that align with their area of expertise, however, they will not comment on the holistic needs of the employee. 

 

• Proliferation of Point Solutions: Human resources or HR leaders want the best for their workforce. Point solutions present a unique way to build robust benefits offerings for employees, but the sheer volume of options has created confusion for employees who don’t know what benefit to use and when. With multiple entry points to care, these point solutions further complicate employees’ understanding of where to initiate their healthcare journey. With thousands of narrowly focused solutions available—seemingly one for every body part, condition, and demographic—the assumption is that the employee understands exactly what they need and how to find it. In reality, these benefits go unused. 

 

• Geographical Barriers: In rural and remote areas, access to healthcare resources is limited—nearly 80% of the rural US is medically underserved. The scarcity of specialists in any community limits the choice of physicians, so patients are left with few options, many of which require extensive travel and lengthy wait times exceeding a month or more for appointments. Exacerbating the issue is the fact that approximately 29 million people have to drive more than 30 minutes to reach the nearest hospital. Consequently, employees who live and work in rural areas often resort to physicians who are nearby and have availability, not necessarily those who can best address their healthcare needs. 

 

• Low Health Literacy: The healthcare system on its own is complicated. Confusion is compounded by low health literacy, which affects nearly 36% of adults in the US. Employees with low health literacy struggle to understand medical jargon and other health information, from what type of specialist to see and how to take medication properly to understand the next steps for care. 

Effective Navigation Through Virtual Health

Simpler navigation can ease fragmentation and establish a patient-centered approach to healthcare, leading to lower costs and improved health outcomes. Advanced virtual healthcare technology combined with clinical expertise improves access to care and empowers employees navigating this multifaceted maze to take charge of their health. When employers invest in clinician-provided navigation and virtual health, employees benefit from:
 

• Accelerated Access to the Right Care—from the Start: When employees are connected with the right doctor for their needs, the time from diagnosis to treatment is reduced, obviating the need for visiting multiple providers, repeating tests, and experiencing a number of false starts. Instead, the right diagnosis is often achieved during the first visit, alleviating undue stress and anxiety and putting employees on a quick path to better health outcomes.

 

• A Single-Entry Point to Access Healthcare: Virtual health solutions that address the spectrum of health concerns offer a single starting point to access medical support and education that maps a path forward in care. This single-entry point eliminates employee confusion about what benefits to use, and when to use it. What’s more, the virtual environment delivers fast and convenient access from a place of an employee’s choosing.

 

• Frictionless Access from Anywhere: Virtual health dismantles geographical barriers, making healthcare accessible to all, regardless of location. Employees who live or work in rural or remote areas can engage in consultations, follow-up appointments, and specialized care without the need to travel long distances. Additionally, family members and caregivers can join virtually, allowing for improved communication, decreased administrative burden, and increased compliance with care. This enhances the efficiency of healthcare delivery and ensures that individuals receive timely, high-quality care.

 

• Education that Instills Confidence: Knowledge builds employee confidence, empowering them to take control of their health. Clinical expertise not only aids in triaging employees to the most appropriate setting and specialist for their needs but also helps them understand their health concerns by answering their questions with depth and nuance. The combination results in better outcomes and decreased costs.

Whether it's trying to find the right specialist in a certain region or trying to understand a health condition, the intersection of clinical navigation and virtual care serves as the linchpin for a seamless employee-centric healthcare journey. Navigation from clinicians ensures that employees receive the right care at the right time, while virtual care platforms bring that care to the comfort of their homes.

A Unified Vision for Healthcare 

As we navigate the ever-evolving landscape of healthcare, it is imperative to recognize the transformative power of navigation, clinical expertise, and virtual health. Taken together, these aspects of healthcare not only simplify the employee experience but pave the way forward toward a more accessible and affordable healthcare ecosystem that drives better outcomes for everyone.

Mary Mulcare, MD, FACEP, is the Chief Medical Officer at Summus and oversees all clinical aspects of operations. Mary also serves as a Clinical Assistant Professor of Emergency Medicine at NewYork-Presbyterian/Weill Cornell Medicine and has held several leadership roles at Weill Cornell, including Director of Undergraduate Medical Education in the Department of Emergency Medicine and Assistant Director of the Margaret and Ian Smith Clinical Skills Center. She continues to make significant academic contributions to the fields of medical education and Geriatric Emergency Medicine.