At a moment when everyone’s feeling the squeeze of rising health care costs, and most Americans have expressed growing fear and frustration over the affordability crisis, care navigation offers a promising step forward. By improving the health care consumer experience, care navigators help drive better health outcomes and generate significant cost-savings.  

When it comes to health care, most of us are relatively inexperienced users of the system. We all need health care at some point, but unless you’re a frequent health care consumer, it’s hard to feel completely comfortable knowing where to go and what to do. Anytime someone faces complex health needs, their journey through the system is going to get even more complicated.  

Care navigators can help patients with complex needs who feel lost and confused stay on the right track. Navigational support can take many different forms: helping members find the right level of care; making sure patients and providers are aligned on their understanding of the steps ahead; ensuring patients have access to all the resources they need to continue healing; and more. 

By helping patients avoid easily preventable complications, care navigation doesn’t just support individuals when they need it most – it also relieves some of the stress on the system, bringing down costs for everyone in the long run.  

Recognizing how care navigation promotes better health outcomes and affordability, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has been steadily growing our work in this area, improving health and health care in many ways.

In high-volume health care facilities, clinicians and staff can find themselves pushed beyond the max. Care navigators can help relieve some of that burden. 

Currently, Blue Cross NC has stationed onsite care navigators in nine hospitals across the state, and more are on the way. In addition, our Behavioral Health team has care navigators stationed at two high volume behavioral health facilities in the state. 

Because these care navigators are onsite, they’re ready to serve as liaisons who can coordinate with provider teams. This cooperation facilitates appropriate discharge planning and helps close care gaps. They can also act as a bridge between hospital teams and the external resources their patients need. This work helps ensure our members experience seamlessly coordinated care and face no barriers getting essential services after they’re discharged. Onsite care navigators help members understand their health plan benefits and find in-network providers who can deliver post-discharge care.  

The emotional and psychological impact on our members who receive face-to-face support can’t be overstated, especially for those with acute needs.  

Our support doesn’t stop when the member is discharged. Care navigators connect members with our case management programs to provide continued support. This includes promoting primary care provider follow-up, medication adherence, and other services. 

Care navigation is a significant investment, but it keeps the member on track toward healing and recovery and reduces the risk of unplanned hospital readmissions. 

What’s the impact of that face-to-face work? 

To put it simply, when the member experience is better, health outcomes improve. 

• Over the past year, our onsite nurse care navigators alone have helped more than 7,000 members. This engagement has achieved an estimated associated savings of more than $32 million through raised awareness of benefits, increased adherence to recovery protocols, and improved discharge planning. 
• Our onsite behavioral health team has engaged more than 570 members since launching in 2024 and has saved an average of $4,000 in post-discharge expenses per member engaged. 
• A separate telephonic behavioral health care navigation team has engaged than 16,000 members since Spring 2023. Of those, 60% have attended their appointments within 60 days of engagement. Our members are clearly responding, and that’s a strong indicator of the need for this kind of work. 

These are impressive numbers – and they reflect the work of only a subset of Blue Cross NC’s care navigators. We have many more, working in different teams and in different capacities. 

The reach of our care navigation extends well beyond those hospitals served by our onsite teams. For example, our Transitional Needs Team nurses telephonically support members in any hospital in or out of state. 

Across the board, whether our care navigators are supporting members in-person or remotely, their work doesn’t just focus on clinical needs. They help coordinate any other planning needs, such as transportation, home health, and durable medical equipment. 

Blue Cross NC care navigators include registered nurses and licensed clinical social workers, ready to help members with unmet drivers of health needs, including access to nutritious foods, transportation to follow-up appointments, social connectivity, and other non-clinical resources essential for continued healing.  

It’s important that our approach to care navigation includes a team dedicated to supporting members on their mental health journey. Americans are still in the process of getting over the stigma associated mental health care. The great news is that more and more people feel comfortable seeking out support. Unfortunately, because this is completely new terrain for many, a lot of people simply don’t know where to begin to get the right kind of care. The shortage of mental health care professionals in almost every county in North Carolin (PDF) makes matters even more complicated. 

Our Behavioral Health Care Navigation service helps members as they’re getting started in mental health care. This team simplifies the process of finding care and works to match each member with an outpatient in-network behavioral health provider who will meet their needs. They also follow up with members to make sure the initial referral was a success. If not, the care navigator can help find a different provider who’s a better fit. In some cases, they can refer cases to our care management team for help coordinating other levels of care.   

Helping members get the care they need to achieve their best health possible is priority number one for us. And when we achieve priority number one, everyone feels the positive effects through savings that get passed on to all North Carolinians. 

In just about everybody’s book, that’s the perfect illustration of a win-win.