New Study Demonstrates Efficacy of Care Navigation in Impacting Healthcare Costs

HealthJoy, a care navigation platform that amplifies employer benefit strategies, today released the results from a claims-based study analyzing the impact of its care navigation platform on high-cost claimants. The study found that high-cost claimants who activated HealthJoy experienced 21 percent lower medical spend than non-activated peers.

To conduct the study, HealthJoy analyzed calendar year 2022 claims data from one of its third-party administrator partners. Additionally, only employers who utilized the HealthJoy product were included in the analysis. Consistent with industry averages and HealthJoy’s book of business, 60.5 percent of the population’s $65.1 million medical spend was concentrated among claimants accounting for the top five percent of total spend.

Claims data was matched to HealthJoy eligibility data, and eligible individuals were categorized as either “non-activated” or “activated” within the dataset. Within the top five percent spend cohort, the mean paid amount for activated users was $57,790, with a median paid amount of $39,758. Mean paid claims amounts were 21 percent lower, and median paid claims amounts were 12 percent lower, for activated HealthJoy members compared to non-activated peers.

Additional findings from the study include:

• 100 percent of high-cost claimants who activated HealthJoy had a primary care office visit, compared to 91 percent of the non-activated population
• 12 percent fewer activated members utilized emergency room services 
• 18 percent lower costs for activated high-cost claimants who had five or more HealthJoy interactions

The study’s findings come at a time when many employers are attempting to protect their health plan from inflation and rising healthcare costs without transferring cost share to their employees.

“Despite employers’ desire to meaningfully manage costs through plan design, wellness initiatives, and condition-specific point solutions, most consumers lack the ability to successfully navigate the complexities of the healthcare system,” said Justin Holland, CEO and co-founder, HealthJoy. “Healthcare navigation supports individuals by making timely connections between patients and high-quality, cost-effective services. Through data-driven member profiling and a consumer-focused user experience, the data shows HealthJoy’s navigation services improve access to care while reducing overall healthcare spend.”

HealthJoy influences employee behavior to improve health outcomes and reduce long-term healthcare spend. This allows employees to engage with their benefits in a healthy way, improve their health, and achieve significant cost savings. HealthJoy clients experience an average return on investment between 2.7x and 3.5x.

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ABOUT HEALTHJOY

HealthJoy provides in-depth care navigation to more than 1,000 U.S. employers, supporting the management and delivery of a premier healthcare and benefits experience to nearly half a million employees and dependents. Its mobile-first platform and human concierge team bring benefits together to surface the best providers, virtual care, and savings. To learn more, visit healthjoy.com.