Unifying Care Navigation: How AI and Human Support Are Transforming the Health Plan Experience
The healthcare system is notoriously fragmented, especially when it comes to navigating care, benefits, and wellness programs. For many members, finding the right provider, understanding their benefits, or accessing behavioral health support feels like a maze of outdated directories, static PDFs, and impersonal portals.
The result? Delayed care, mounting frustration, and missed opportunities for both members and health plans to simultaneously improve care and lower costs.
Pager Health℠ Navigator is changing that by unifying the four essential areas of care navigation (Clinical, Provider, Benefits, and Solutions Navigation) into one seamless, intelligent, and personalized experience. According to a new survey of nearly 2,000 insured Americans, that’s exactly what members want.
The Fragmentation Problem: What Members Are Facing Today
Members consistently cite difficulty understanding their health plan offerings, with pain points ranging from finding an in-network provider to understanding co-pay responsibilities. In fact:
74% say they want health and wellbeing recommendations from their plan immediately after a related appointment.
79% say 24/7 access to a nurse would improve their peace of mind and sense of wellbeing.
77% want their health plan’s wellness apps to also help them with follow-up actions like scheduling care.
This reflects a deeper issue: traditional payer experiences often stop at awareness, without enabling true access or personalization. Members aren’t just looking for information; they’re looking for actionable, relevant, and timely support.
The Solution: Unified, AI-Powered Navigation Across the Entire Care Journey
Navigator solves the fragmentation problem by integrating intelligent navigation capabilities across the four key dimensions of care. It creates a unified experience where members can access whatever they need in one place, whether it’s finding the right provider through an Augmented Provider Finder to checking their benefits or connecting with a specialty program tailored to their condition, all on one platform. For plans that already offer some of these capabilities, Pager Health can seamlessly integrate these services into this existing ecosystem, creating a frictionless experience that meets members where they are and guides them to the care they need.
Clinical Navigation
With 24/7 access to an AI-powered, nurse-supported triage system, Navigator ensures members get clinically sound advice anytime. For example, the Call-to-Chat feature reduces wait times and enables continuous support, even after hours, by shifting members from phone calls to real-time chat with clinical staff or virtual agents.
Augmented Provider Finder
Navigator’s Augmented Provider Finder reimagines the provider search with AI-powered, personalized results…fast and frustration-free. Whether members search on their own or with an AI agent, they’re seamlessly guided to the right care. With integrated scheduling, care teams book appointments directly and follow up with smart alerts, proactive nudges, and incentives…delivering the right care, at the right time, in the right place.
Benefits Navigation
Understanding deductibles, co-pays, and coverage details shouldn’t require digging through PDFs. Navigator simplifies the process by connecting members to a conversational AI agent that provides clear, personalized answers that reduce friction and enable smarter healthcare decisions.
Solutions Navigation
Health plans offer valuable virtual-first specialty programs, but members often don’t know they exist. With Solutions Navigation, Navigator uses AI to recommend relevant programs and guide members through next steps, increasing program engagement and reducing overuse of high-cost care.
What the Survey Tells Us: Members Are Ready for AI If It’s Personalized
While AI used to be met with skepticism in healthcare, today’s members are increasingly open to intelligent, digital-first solutions:
67% would trust an AI copilot to inform them about their available benefits.
75% trust AI to find in-network doctors and book appointments.
76% believe AI can deliver real-time, personalized healthcare experiences.
Personalization is the key and 45% say they’re more likely to follow health recommendations when tailored to their care needs and delivered at the right moment. 34% say contextual alerts based on activity or claims data would encourage them to use their plan’s wellness programs more often.
The Bottom Line: Smarter Navigation, Better Outcomes
Navigator represents a new generation of care navigation: Smarter, faster, and more connected. It blends advanced AI with clinical human support to guide members across the entire care continuum, from benefits discovery to digital solution access, provider search, and beyond.
For payers, this means lower costs, stronger employer partnerships, and higher member satisfaction. For members, it means healthcare that finally feels simple, personal, and empowering.
Want to learn more about how Navigator can transform your health plan experience? Let’s talk.
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