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Network Steerage for Payers & Health Plans

Your Members Need Care.
They’re Getting It Out of Network.

Every out-of-network visit is excess cost and a member one step closer to leaving your plan entirely. We guide members to in-network providers at the moment of need — before the decision is made.
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The Challenge

The Network Steerage Problem

Members aren’t intentionally going out of network. They’re going wherever is easiest — because nobody guided them to the right in-network option at the right time.

Members leave your network because nobody guided them to an in-network option

When a member needs care and can’t quickly identify an in-network provider, they default to the most convenient option — which is often out of network. That’s a permanent reduction in the value of that attributed life.

Out-of-network utilization inflates your total cost of care

Every out-of-network visit, procedure, or specialist encounter costs more than the in-network equivalent. For plans managing total cost of care, network leakage is a direct hit to your bottom line.

Provider directories don’t solve the navigation problem

A searchable directory assumes members will self-serve their way to the right provider. In practice, members are confused by plan terms, overwhelmed by options, and uncertain which provider is appropriate for their need.
Root Cause

As Healthcare Experts, We See the Deeper Problem

Network steerage isn’t a directory problem. It’s a navigation problem that requires human guidance at the moment of decision — before the member has already chosen an out-of-network path.
DECISION COMPLEXITY

Members don’t understand their network well enough to navigate it

Primary care vs. specialist, in-network vs. out-of-network, referral required vs. self-referral — the complexity of modern health plan design creates decision paralysis that defaults to the path of least resistance.
TIMING

Network steerage must happen at the moment of need, not after

A member experiencing symptoms calls their plan or searches online. If an in-network option isn’t presented within that decision window, the member has already made their choice. Steerage after the fact is too late.
RELATIONSHIP

Members with existing out-of-network relationships are hard to redirect

A member who has been seeing an out-of-network specialist for years won’t switch because of a directory listing. Steerage requires a conversation about why the transition matters and how to make it seamless.
HIGH-COST SERVICES

The highest-cost services have the highest out-of-network rates

Surgical procedures, imaging, and specialist encounters — the services that cost the most are where network leakage is most expensive. These are also the services where members feel most uncertain about where to go.
Our Approach

Activation-Driven Network Steerage

We guide members to in-network providers through live agent engagement — matching them to the right provider, scheduling the appointment, and following up to confirm completion.

  • Real-time steerage during symptom and scheduling calls

    When members call about symptoms or need help scheduling, our agents guide them to in-network providers in real time — not after the visit has already happened.

  • Activation-driven provider matching

    We don’t just give members a list. We match them to specific in-network providers based on location, availability, specialty, and the member’s specific needs — then schedule the appointment during the call.

  • High-cost service steerage

    For surgical, imaging, and specialist referrals, we proactively guide members to high-value in-network providers, reducing out-of-network utilization where it matters most.

  • Transition support for members with OON relationships

    For members who have been seeing out-of-network providers, we facilitate the transition with empathy, education, and practical scheduling support.

  • Closed-loop confirmation

    We follow up to confirm the member completed the in-network visit. Steerage without follow-through is just a suggestion.

PROVEN AT SCALE

Keeping Members In Network, In Care

When members are guided to in-network providers at the moment of need, utilization costs drop and member satisfaction rises.
30%
Readmission reduction
5×
Activation rate increase
99.4%
QA pass rate
9
Behavioral science techniques

Ready to keep your members in network?

Schedule a consultation and see how activation-driven steerage can reduce out-of-network utilization and total cost of care.

Schedule a Consultation