Member Engagement & Navigation
Guiding members to high-quality, cost-effective care
What Is Member Engagement & Navigation?
Innovative Care Management’s Member Engagement and Navigation services help plans ensure that members access the right care, in the right setting, at the right cost.
Health benefits are often complex, with multiple pathways for care. Navigation support helps members align coverage, provider networks, and care options promoting informed choices, reducing avoidable costs, and supporting a smoother care experience.
ICM’s navigation services provide members with clear guidance on their benefits and care options while helping plans promote high-quality, cost-effective healthcare utilization. By connecting members with preferred providers, identifying lower-cost sites of care, and coordinating with vendors and providers, ICM helps plans protect plan assets while improving the overall member experience.
How We Do It
ICM’s Member Engagement and Navigation services combine benefit guidance, clinical insight, and operational coordination across the healthcare ecosystem. Our team works directly with members, providers, vendors, and plan administrators to ensure care decisions align with plan design and cost-containment strategies.
Our approach emphasizes early engagement, vendor collaboration, and clear member guidance, helping plans reduce unnecessary costs while ensuring members receive appropriate care.
Available Services
Integration Support
External Vendor Coordination
Member Navigation
Concierge
Integration Support
ICM aligns pre-certification workflows, member support processes, and vendor coordination with your plan design. Customized integrations help streamline operations and ensure that member navigation supports plan cost-management strategies.
External Vendor Coordination
Many healthcare services involve multiple vendors. ICM coordinates communication between providers, vendors, and the plan to ensure consistent information and smooth processes. During precertification and care planning, opportunities for redirection or cost optimization can be identified and coordinated across vendors to ensure accurate and timely communication.
Member Navigation
ICM’s navigation team guides members toward high-quality, cost-effective providers and care settings. Nurse navigators support complex clinical cases, while tools and quality data help identify providers and facilities that deliver strong outcomes at lower cost.
Concierge
Plans seeking a higher-touch member experience can offer a single point of contact for member questions regarding benefits, preauthorizations, provider searches, and claims. This concierge model helps reduce confusion while ensuring that members are guided toward appropriate and cost-effective care options.
Member Engagement in Action
Case Study1
Guiding a Member to a Preferred Provider
A member required a surgical procedure and initially planned to schedule the surgery with a provider outside of the plan’s preferred network, which would have resulted in significant out-of-pocket costs and higher plan spend.
Through ICM’s navigation services, the member was guided to a preferred provider within the network who specialized in the same procedure. The navigation team helped coordinate the transition and ensured the member understood the coverage and provider options available.
As a result, the member was able to receive the surgery from a preferred provider with zero out-of-pocket costs, while the plan benefited from network-aligned pricing and avoided unnecessary expenses.
Case Study2
Redirecting Infusion Therapy to a Lower-Cost Site of Care
A member receiving infusion therapy was scheduled to receive treatment at a hospital-based infusion center, a setting associated with significantly higher costs.
During the navigation process, ICM identified the opportunity to redirect the treatment to a home infusion provider. The team coordinated with the prescribing physician, infusion vendor, and the member to transition care safely to the home setting.
The member was able to receive treatment from the comfort of home without the need for hospital visits, improving satisfaction and convenience. At the same time, the shift in site of care generated substantial cost savings for the plan while maintaining appropriate clinical oversight.
Additional Services to Consider
Member-Facing AI Assistant
Members can text questions about benefits, networks, coverage, and ID cards and receive quick responses from a multilingual AI assistant, reducing wait times for simple inquiries.
Comprehensive Wellness Programs
Whole-person wellness services may include employee education, incentives, health risk assessments, behavioral and biometric programs, and condition management coaching.
Cost/Quality Data
With access to robust cost and quality data, we can help members find high-quality and cost-effective providers and identify providers who are known for working with innovative and non-traditional plan designs. The insights empower smarter decision-making that help plans improve outcomes and manage costs.