Rising healthcare costs are often the most visible challenge for employers. But beneath premium increases sits a more fundamental issue: navigating the system itself.
Today, even insured employees struggle to use their coverage effectively. 58% of insured adults report experiencing problems using their health plan in a given year, and about half say they don’t fully understand key aspects of their benefits.¹
The consequences are significant. More than one in three adults say they’ve delayed or skipped needed care due to cost or uncertainty—decisions that can lead to worse outcomes and higher downstream expenses.²
In practice, employees aren’t just accessing care. They’re expected to navigate a complex system—often without enough context to make confident decisions.
What is healthcare navigation?
Healthcare navigation refers to the guidance and support that helps people understand their benefits, access appropriate care, coordinate services across providers, and make informed decisions.
This goes far beyond finding an in-network doctor. It includes:
- Interpreting coverage rules
- Understanding cost tradeoffs
- Coordinating across providers
- Resolving billing questions
- Supporting follow-through during complex or stressful health situations
In practice, navigation is what connects access to action. It helps move people move from “I have coverage” to “I know what to do next.”
The reality of healthcare navigation today
The U.S. healthcare system is not built as a single, coordinated experience. Patients routinely move between providers, facilities, and systems—often without a consistent point of guidance.
Even with widespread adoption of electronic health records, coordination gaps persist. One national study found that 34% of primary care physicians do not reliably receive useful clinical information from specialists, making coordinated decision-making difficult by default.⁴
This fragmentation has measurable consequences. Poor coordination is associated with unnecessary testing, avoidable hospitalizations, and higher total cost of care.⁵
And complexity is not limited to vulnerable populations. Even individuals with strong health literacy can face challenges when diagnoses are unfamiliar, billing is unclear, or treatment decisions involve tradeoffs across providers and settings.
Why insurance coverage doesn’t equal confidence or understanding
Having coverage does not mean people know how to use it effectively.
Many Americans struggle to understand deductibles, coinsurance, and network rules.³ As a result, decisions are often made with incomplete information—or delayed altogether.
Those decisions rarely happen in controlled settings. They happen when someone is:
- Managing a new diagnosis
- Interpreting conflicting recommendations
- Reviewing a bill they don’t understand
- Deciding whether care can wait
In those moments, information alone is often not enough. People need help interpreting what applies to them, what matters now, and what to do next.
The hidden cost of confusion for employers
When employees navigate care without clear understanding or support, patterns emerge.
- Increased emergency department utilization
- Lower engagement with primary and preventive care
- Greater likelihood of avoidable inpatient admissions
- Reduced trust in benefits
Over time, these patterns don’t reduce utilization, they change it. Care is delayed, often redirected to higher-cost settings, or accessed too late.
Employers often respond by adding digital tools or point solutions. But without guidance, more tools can increase fragmentation, requiring employees to connect systems that were never designed to work together.
What research shows about human support in navigation
Across public and private settings, research suggests that access to human support can improve how people navigate care.
Improved coordination and follow-through
Patient navigation programs are associated with:
- Better coordination across providers
- Improved access to appropriate care
- Higher rates of follow-through on recommended treatment⁶
Trained navigators and community health workers are often effective because they interpret information in context—helping individuals understand their options in plain language and move forward with confidence.⁷ ⁸
Impact on utilization and cost
Employer and public-sector analyses link navigation support to reductions in avoidable utilization, often driven by better decision-making earlier in the care journey—when individuals can choose the right setting, avoid unnecessary care, or follow through on treatment.5
Why technology alone isn’t enough
Digital tools have made healthcare information more accessible than ever. They can surface benefits details, explain plan design, and help people compare options more efficiently.
But access does not guarantee understanding—and understanding does not guarantee action.
In real situations, people often need context, judgment, and reassurance as much as they need data. They need help answering questions like:
- What matters most right now?
- What can wait?
- Which option is actually better in my situation?
These are moments where human support plays a distinct role helping people translate information into decisions.
What employers and brokers should look for in healthcare navigation support
For organizations evaluating healthcare navigation solutions, a few factors matter most:
1. Human accessibility
Are trained professionals available when decisions become complex or time-sensitive?
2. Integration across the experience
Is support connected across benefits, providers, and care journeys—or limited to a single tool or use case?
3. Decision support (not just direction)
Does the solution help employees understand tradeoffs and implications—or simply point them to lower-cost options?
4. Continuity of support
Can employees engage with a consistent team that builds context over time, rather than starting over with each interaction?
Effective navigation doesn’t replace benefit strategy. It helps employees make better use of the benefits already in place.
Why this matters now
Healthcare is not getting simpler. And while digital tools have expanded access to information, they haven’t changed how decisions are actually made.
When someone is facing a diagnosis, a confusing bill, or competing recommendations, the key question isn’t whether information exists—it’s whether they can make sense of it in the moment.
Research shows that navigation and care coordination programs can improve engagement and follow-through—particularly when human support is part of the model.⁶ ⁸
Because healthcare decisions don’t happen in isolation. They happen in moments that are personal, uncertain, and often time-sensitive.
And in those moments, people don’t need more information.
They need support that helps them move forward.
Sources:
1. KFF. Survey Shows Complexity, Red Tape, Denials, and Confusion Rival Affordability as a Problem for Insured Consumers. June 15, 2023.
2. KFF. Americans’ Challenges with Health Care Costs. April 30, 2026.
3. Employee Benefit News (Arizent). State of Healthcare 2024 Report. April 2024.
4. JAMA Internal Medicine. Care Fragmentation, Care Continuity, and Care Coordination—How They Differ and Why It Matters.2024.
5. Mathematica. Fragmented Care and Healthcare Utilization. February 2023.
6. U.S. Department of Health & Human Services (ASPE). Patient Navigation Models and Outcomes.
7. Centers for Disease Control and Prevention (CDC). Community Health Workers and Care Navigation. November 2022.
8. American Hospital Association (AHA). Care Coordination and Navigation Insights. https://www.aha.org
This article is for informational purposes only and does not constitute medical or benefits advice.
