Duncan Sibson, Krish Maypole

At its core, care navigation aims to connect people to the providers and services they need at every step of their healthcare journey, optimizing for cost, quality, experience, and time along the way. 

General navigation is a common solution in benefits ecosystems geared toward helping members face the issues and complexities rampant in the commercial healthcare system.  

These solutions are valuable resources for members with a wide range of healthcare questions, including questions about the benefits ecosystem. Answers to these questions are especially important at a time when benefits are harder-than-ever for both members and employers to understand. 

Members can call their general navigators, who are often Registered Nurses (RNs). In turn, navigators can steer their members toward other benefits solutions when appropriate, make single-point referrals to specialists, and—sometimes—offer health coaching. 

In theory, general navigation covers the whole care continuum for every diagnosis and condition imaginable. In practice, however, there’s too much ground to cover for general navigation alone. Just as orthopedic physicians exist for specialty care beyond what a PCP is trained to offer, specialized navigation is a critical complement to generalized navigation.

More tools are needed to support members at every step of their care journey. Specifically, these tools should provide clinically-focused domain expertise, enable continuous end-to-end member engagement, and bridge the gap between in-person and virtual care with a bricks and clicks approach.

Various care navigation models have popped up, with many of them linked to improved outcomes. Verticalized navigation models have gained significant traction in oncology, including oncofertility, as ways to support people who need complex care. 

Applying verticalized navigation concepts to musculoskeletal (MSK) care, a confusing and specialty care-heavy part of the healthcare system, is especially needed. Within MSK alone, members often have a dizzying array of clinical needs that only specialists can help them address. Getting to the right specialist is hard, and deciding what should really come next is even harder.

We built Icon Health to provide members with timely end-to-end support and specialized knowledge along their care journeys that general navigation can’t supply. Our members have 24/7 access to board-certified MSK experts, who can quickly connect them with the highest-quality, lowest-cost care possible, whether in-person or virtual.

On top of their specialized knowledge, we empower our MSK experts to make data-driven, evidence-based decisions and recommendations. When our members need referrals, we offer condition-specific member-to-provider matching, using robust data sources and comprehensive analytics to power network-optimized referrals.

Member interactions with our MSK experts don’t stop at a referral recommendation: we assist in appointment scheduling, preparation, and follow-up, engaging both members and their providers with clinical oversight at every step of the way. Because MSK conditions can require longer care timelines, we frequently engage with the same member over a span of weeks or months to make sure they receive the sustained support they need until they’re pain free.  

While Icon Health is effective as a standalone MSK solution within a benefits ecosystem, our solution can also fit seamlessly alongside digital physical therapy, Centers of Excellence (COEs), and general navigation.

General navigation solutions can warmly hand off members to Icon Health when they require specialized MSK domain knowledge, reflect care needs that are too complex, or may benefit from ongoing support. Icon Health can then quickly get in touch with these members, devise the best possible care plan, and direct them to specialty care in a timely manner. 

Specialty care can then include, but is not limited to, referrals to existing MSK benefits within the ecosystem when necessary (e.g. digital PT and COEs) and beyond, including providers who practice in-person. 

Looking ahead, employer spending on healthcare is projected to increase. As the pandemic continues, employers will likely feel the increase disproportionately within musculoskeletal care, especially as pent-up demand for in-person MSK services gets released this year and beyond. 

If you represent an employer that wants to make a difference in the lives of its members, implement Icon Health alongside the other solutions in your benefits ecosystem. Your members will thank you. To learn more about Icon Health, visit www.iconhealthco.com.