The US healthcare system is notoriously difficult to navigate. So much so that it is often referred to as an “anti-system.” The key stakeholders — primary care, specialty care, hospitals, rehabilitation centers, pharmacies, insurers, social care services — are not incentivized to communicate and work together. Instead, they operate as isolated systems, leaving patients to bridge the gaps. To navigate successfully, individuals must determine where to enter the system. They must orient themselves within organizations, find the right place for their problems, and communicate across systems.
Difficulties navigating the healthcare system lead to disorientation, futile and stressful searches, uncertainty, and discontinuities in healthcare. Costs balloon as individuals bounce from one provider to the next. Repeating tests and visits, in a fruitless search for answers and treatments. Understanding the causes of navigation challenges, and the keys to successful solutions, can help us create a system that makes care accessible and affordable for everyone.
Specialization leads to increased fragmentation
With more than 120 medical specialties and subspecialties, it’s difficult for anyone to know where to find the answer to their health question. Many specialists focus solely on their area of expertise, overlooking the holistic needs of their patient. We can resolve member issues in days, when previously they may have spent years visiting multiple specialists and searching for answers. We’ve come to expect healthcare to be a struggle, but people simply need someone with the right medical expertise to guide them to the right place for care.
While primary care used to play this role, primary care providers are increasingly difficult to find. Many people use retail or convenient care, delivered by physician assistants or advanced practice nurses, for urgent care needs but lack the ongoing relationship with a primary care provider who can help them navigate the specialty care space. High deductibles mean that even when a primary care doctor is available, many people avoid care due to the unknown costs.
The proliferation of point solutions, or condition-specific employer benefits, has further fragmented healthcare. Instead of waiting for an appointment and guidance from a primary care provider, an individual is now offered multiple options: retail care, telehealth, in-person care with a primary care provider or specialist, virtual care solutions offered by their employer… or an internet search, which can lead to any number of consumer options or questionable resources.
The impact of effective navigation
Efficient navigation of the healthcare system can lower costs and improve health outcomes. Fast access to the right care reduces the time to diagnosis and treatment. This can mean faster diagnosis and more immediate treatment. Instead of visiting multiple providers, repeating tests and imaging, the right diagnosis is achieved with one visit — the first visit. Delayed treatment often leads to increased worry, worsening symptoms, and potentially preventable complications.
Effective healthcare navigation can also alleviate disparities in access to care. Individuals with low health literacy face additional challenges in understanding and using healthcare services. Healthcare navigational challenges exacerbate the issues faced by traditionally underserved communities.
Better navigation can also reduce stress and anxiety. Navigating the healthcare maze can be emotionally draining. The stress of dealing with administrative tasks, understanding medical jargon, and managing financial concerns can contribute to increased anxiety. Appointments with the incorrect specialist lead to frustration and feelings of medical “gaslighting” as specialists struggle to diagnose a problem outside of their area of expertise.
Transforming access through simpler navigation
Effectively guiding people through the healthcare maze requires both clinical expertise and a relationship based on trust. Clinical expertise is critical to helping an individual triage their symptoms or concerns, and identify the most appropriate setting, and specialist, for their needs. Without a knowledgeable physician to guide them, patients experience false starts and delays in treatment.
Trust is a necessary, yet undervalued, component in effective navigation. Trust fosters open and transparent communication between patients and healthcare providers and facilitates informed decision making. When patients trust their healthcare team, they are more likely to share crucial information about their health, lifestyle, and concerns. This information is vital for accurate diagnosis, effective treatment planning, and overall care coordination. Patients that trust their healthcare team will ask questions, actively participate in decisions, and are more likely to adhere to treatment regimens.
Effective navigation emerges as a powerful tool for positive change in the healthcare system. By addressing the challenges of fragmentation, specialization, and health literacy, effective healthcare navigation empowers patients to take control of their health and access the right care, quickly. The transformative impact is not only seen in improved health outcomes, but also in reduced stress, lower costs, enhanced patient satisfaction, and a more equitable distribution of healthcare resources. As we strive for a healthcare system that prioritizes accessibility and patient-centered care, investing in effective navigation becomes not just a choice but a necessity.
Summus physician-led navigation support
Summus puts a leading physician at the center of every healthcare decision. Physician-led navigation means each member has an objective, trusted source of education and guidance for any health concern. Combined with our marketplace model, navigation services allow fast, unparalleled access to top expertise across all aspects of a health journey. Better decisions lead to reduced costs and better outcomes for everyone.