More than a quarter of all health care dollars are wasted due to failed care delivery, lack of care coordination, or unnecessary treatment. It’s an astounding percentage, exacerbated by rising health care costs. Given corporate focus on cost containment, it is an issue that companies need to address. The wasted money is a symptom of a larger problem, though: how to provide health care solutions to employees that are attractive, useful, and cost effective.

In a From Day One webinar, two executives from the health navigation company Accolade talked about how this kind of service can help achieve cost containment, better outcomes, and stellar appreciation from users. “In a survey by Willis Towers Watson, two out of every three U.S. employers plan to prioritize controlling rising health care benefit costs over the next three years,” said Jen McDonnell, VP of solutions management for Accolade. “You are under ever growing pressure to both contain and even reduce your trend and under pressure to help your organization attract and retain top talent. Many of you are likely experiencing frustration, because the programs you worked so hard to put in place and invest in and to take care of your employees are not necessarily delivering the return on investment that you expected.”

Life has become harder for all of us, McDonnell said. “The pressure of work, the economy, and caring for parents and children all take a toll. Mental health care demand has skyrocketed, and it’s compounded by the shortage of providers. And while the rise of specialty clinical point solutions has brought much needed specialty care to millions, it's also made it more confusing for people to know how and where to get the care they need when they need it.”

“Consumers need someone to help them understand the benefits available to them, to access them, to find high-quality providers, and get appointments with them that aren’t weeks away, and to help make the really hard decisions they often face when dealing with a serious health issue,” McDonnell said. “A lot of HR and benefit leaders are turning to advocacy and navigation partners like Accolade to avoid that wasted spend.”

Erin Hirshorn, RN, senior director of population health at Accolade, said that these services can predict which members will cost more, and that can lead to opportunities for early intervention or providing access to those who may not have it. She pointed to a Robert Wood Johnson study that found 80% of health outcomes are impacted by life circumstances, like access to care, cost or family caregiving responsibilities. Any of these can delay care which can lead to worse outcomes and higher costs.

It’s considered dogma that a strong relationship with your primary care physician leads to cost savings, said McDonnell. But data suggests the majority don’t understand that, with about half the population either lacking a PCP (primary care physician) or a good relationship with one. It could be that they are the victim of the shortage of primary care providers, or they travel so much for work that they can’t easily access a provider in their home area. It could be that their relationship with their doctor is so bad that they avoid care. Maybe they come from a marginalized community and don’t feel seen by their provider. Accolade’s virtual connections allow people to have access 24 hours a day, 7 days a week, 365 days a year. They can treat both physical and mental health needs, and patients can look for a provider that is, for instance, LGBTQ+ friendly.

“In the 15 years that we've been in this business, one truth we’ve learned is that almost no one cares about their benefits until they need to use them,” McDonnell said. “If no one in your family has diabetes, then you don't really know what benefits you have to cover diabetes. People are overwhelmed with their daily lives, and they won’t spend time learning about benefits that they might not need, or no one in their family needs. But when people get sick, they care a lot about those benefits.”

The problem is they lack the foundational knowledge of their benefits, said McDonnell. “They don't know where to start. They're often scared, they're not feeling well, which makes it even harder to be a smart consumer. The goal is to get information and guidance to the to these, in the moment when they're sick, when they're experiencing symptoms, facing a new diagnosis or caring for someone who is. And that's hard. It’s like being a dating site that matches sick people with the benefit or provider who is best and uniquely suited for them right now in this moment. Many people don't have anyone to turn to so they turn to WebMD and crowdsourcing ideas from their friends and family. But companies like Accolade guide people through this entire journey.”

McDonnell said the data Accolade uses to identify when people need or are seeking care spurs them to reach out to them at that moment. “We use a lot of modern technology and behavioral science to capture their attention to let them know we see them and that we're here to help. We identify the steps that they need to take, and we guide them through their entire journey.” In the last 15 years, Accolade has operationalized doing this across the entire population of people from low through high risk. “We created the concept of health care moments that matter the most,” she said. These include when someone is experiencing symptoms, when someone needs to find new providers because they moved, or there is a new diagnosis and a need for a specialist. Chronic conditions can also lead to some of these moments: someone who has well controlled diabetes may be thrown off balance by a life change like divorce or death. “We identify people in those moments, reach out to them, and let them know we can help. We tell them the steps they need to take, the benefits they have, what programs are available to them, and then we help them stay on that path.”

The payoff isn’t always just a great medical outcome or financial savings. Hirshorn told the story of a patient identified through their stratification model. The person had stage four bladder cancer with metastasis to the bone. “It’s a scary diagnosis, not just for the person, but for the family as well,” she said. “This person had been hospitalized, and discharge is a time when a lot of things can go wrong. We had a nurse case manager working with this family, and she found a few errors with prescriptions of pain medication, and a lack of instruction about medical equipment that the patient was sent home with. She was able to work with the hospital and the discharging provider to make sure that the the correction for the pain medication was made, that the patient and family understood the best way to take the medications, that home health care was set up so they could understand the equipment that was sent home, and we even pointed them to a expert medical opinion.” Oftentimes, during a diagnosis like this, a confirmation of the diagnosis is a good idea. Second opinions can also let patients explore other treatment plans. “Even if they recommend the same thing, it builds confidence in the patient and family that they are on the right course.”

The mental toll of such a diagnosis can be brutal, and Hirshorn said they were able to help the wife and daughter connect to some mental health support through their EAP program. “Most importantly, there was somebody hanging in there with them through their entire journey with the family, helping them navigate through a really difficult time.”

None of this obviates the potential financial benefits of having a good navigator program, said McDonnell. “A tremendous amount of health care costs is driven by the overuse, misuse, or lack of use of the health care system. What we do is solve for a lot of those by reacting to symptoms. We triage them and guide them to the best place of care. If they should go see a PCP versus visiting the emergency room, then we're going to help guide them there. A lot of people use the emergency room and urgent care these days because they either don't have a PCP or they can't get an appointment, or they can't find a PCP that’s open when they need them. In managing a chronic illness, we help get people back on track, so they don’t turn into a high-risk patient. For many people, getting them the care they need rather than avoiding it or getting the wrong level of care, can help them remain a lower risk patient, and lower risk patients cost less.”

Editor's note: From Day One thanks our partner, Accolade, for sponsoring this webinar.

Lisa Jaffe is a freelance writer who lives in Seattle with her son and a very needy rescue dog named Ellie Bee. She enjoys reading, long walks on the beach, and trying to get better at ceramics.