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Clinical Navigation

After we run your claims data through our reporting platform, we can better understand the health of your population and their utilization habits. When an unusually large claim hits, we’ll take a look at the data and see what procedures led to the diagnosis and how the condition is being treated. Hopefully, we can confirm that best medical practices were used and that the billing appears to be in order. If not, we’ll let you know.

While diving in and looking at past claims can be helpful, clinical navigation’s real strength is in enabling prevention. It’s kind of like having your own crystal ball. After your employees complete their annual biometric screenings, we identify risk levels. With those who are high-risk, we can implement wellness consulting and suggest other clinical measures to prevent large claims before they occur.

We can also use the data to determine possible wellness initiatives and education. For example, maybe the data shows that a significant number of your members are being treated for high blood pressure. Our Medical Director will work with our wellness team to recommend that you institute an initiative to educate employees on how to prevent and reduce high blood pressure. With GBS Benefits, you have a team behind you to improve health and lower future costs.

Clinical Navigation FAQs

Some of our most frequently asked Clinical Navigation questions:

Why is clinical navigation important?

The most notable aspect of clinical navigation is its ability to predict future claims spend and enable prevention. This is important because you’ll save healthcare dollars, and maybe even a life, as our findings could prevent a more serious medical condition before it happens.

How is the data kept confidential?

At GBS Benefits, we believe it is our responsibility to secure and protect the HIPAA data entrusted to us by our clients. We are responsible for transmitting this HIPAA data between GBS Benefits and our clients and the insurance carriers. We take strict care to transfer this data securely. We also enter into Business Associate Agreements with all of our clients, committing to act in compliance with HIPAA Privacy and security rules to protect our clients and the Protected Health Information (PHI) of their employees.

Will my medical carrier cooperate?

At GBS Benefits, we capitalize on our strong carrier relationships to negotiate claims and extract agreements with all the major carriers. Once we get the claims feed from the carrier, we are able to run it through our reporting platform and our team can perform a comprehensive analysis.

Do I have to have a self-funded medical plan to benefit from clinical navigation?

Clinical navigation is a powerful strategy for both self-funded and fully-insured medical plans. Understanding current claims and working to prevent future claims gives us strong leverage in stop-loss and renewal negotiations. Keep in mind that for fully-insured medical plans, claims data is available for groups with 100 or more enrolled.

A fresh approach to improving health and cutting costs

Together, Advanced Analytics and Clinical Navigation provide powerful information to inform your decisions and reduce future medical expense.

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