Healthcare Management Administrators Launches Care Navigator Plus

New navigation solution actively identifies and engages at-risk members to improve population health in areas driving considerable plan spend

BELLEVUE, Wash., June 14, 2023 /PRNewswire/ -- Healthcare Management Administrators (HMA), a pioneer in self-funded health benefit programs and one of the nation's largest third-party administrators, is launching its own in-house, data-driven navigation and advocacy product that takes a proactive approach to avoiding intensive care: Care Navigator Plus.

Featuring a proprietary analytics solution that leverages claims data and a health questionnaire, among other data sources, Care Navigator Plus expands on HMA's foundational Care Navigator product — which has an NPS of 91 — to proactively identify and engage members who could benefit the most from direction to high-quality, high-value care.

The legacy Care Navigator product brings clarity and emotional support to the member experience through benefits education, ER diversion and out-of-network steerage, improved adherence to care plans via pre- and post-procedure calls, coordination with providers as well as internal care teams, and more. Care Navigators have shifted sites of care and found savings opportunities in the thousands.

Seeing an opportunity to expand on the meaningful relationships that Care Navigator forms with members today, HMA designed Care Navigator Plus to help members make educated decisions about their care without burdening them with the responsibility to use disparate consumer-driven tools.

"Our healthcare system expects members to be their own advocates, which can result in missed opportunities to get the highest quality care," said Lindsay Harris, President and CEO of HMA. "Care Navigator Plus is an answer to that problem. Our Care Navigators engage members, do so as early as possible in their care journey, and provide clear care options so members feel knowledgeable, confident, and supported in finding high quality, high value care."

HMA's in-house design posits several advantages over other navigation and advocacy solutions. First, access to and analysis of both quantitative and qualitative insights gives Care Navigators a comprehensive and detailed look into what's driving healthcare risks and needs. Second, integration of a health questionnaire into the start of members' healthcare journey organically engages members while also giving members a voice in their care. Third, Care Navigators can collaborate with Care Management, Case Management, Specialty Medication, and other teams to deliver the highest quality of care possible and realize cost savings opportunities.

Once engaged in the Care Navigator Plus program, members may be guided to sites of care for neurosurgical, orthopedic, cardiac, and other top surgical drivers of spend as well as for advanced imaging, to include non-urgent MRIs and CT scans. Building on HMA's in-force partnership with Healthcare Bluebook, Care Navigators will leverage Quantros data to identify sites of care, and in some cases, will find specialty care centers recognized for their quality health outcomes.

Care Navigators will also identify members without a primary care provider to connect them with one; refer members with multiple chronic conditions to Lyn Health, HMA's partner for polychronic condition management; and educate members on other available vendors on the plan. Care Navigator Plus additionally features all of the same benefits of Care Navigator.

Care Navigator Plus will go live January 1, 2024.

ABOUT HMA

HMA is Proving What's Possible in Healthcare^®. Our team of caring experts design and deliver high-quality, innovative, and affordable health plans for self-funded employers. We are the service-oriented partner employers trust to protect two of their most important assets, their people and their health plan dollars. With over 30 years of industry experience and a team of proactive, highly skilled professionals, we help employers improve their bottom-line. We call this "Winning Together" because we're on the same side and share the same goals – healthier outcomes for members at the best possible value. To learn more, visit www.accesshma.com or follow us on LinkedIn. 

SOURCE Healthcare Management Administrators, Inc.