Understand the episode
Gather the concern and relevant context before presenting destinations.
COMMERCIAL HEALTH PLANS
Care navigation before the emergency department.
Bring clinical context, available destinations, and member choice into the same conversation—before a care decision becomes a claim.
Medical directors · Network strategy · Actuarial teams
NeXtriage / IN MOTION01 / 05
The right next step.
From a concern to a confirmed choice
Structured intake brings the member’s concern into the conversation.
ILLUSTRATED WORKFLOW
An escalation path remains distinct from the illustrated navigation journey.
Read the complete process
- A concern becomes context. Structured intake brings the member’s concern into the conversation.
- Clinical judgment stays central. Decision support is reviewed; urgent concerns need an escalation path.
- Options become understandable. Available, clinically appropriate destinations can be considered.
- The member makes a choice. A recommendation and a confirmed selection are different events.
- Follow-through closes the story. Completed care must be distinguished from a recommendation.
PRE-HOSPITAL DECISION SUPPORT + IN-FACILITY WORKFLOWSClinical review. Member choice. Clear evidence.
THE ESSENTIAL QUESTION
What should health plans look for in care navigation software?
Look for a traceable path from the presenting concern to a clinically reviewed recommendation, a usable in-network option, member confirmation, and an observed outcome. A referral alone does not establish completed care or avoided spending.
A WORKFLOW TO EVALUATE
Connect the decision to what happens next.
Check the available path
Evaluate network and eligibility information alongside clinically appropriate care options.
Close the loop
Separate the offered recommendation, member choice, completed encounter, and financial result.
GO DEEPER
Useful before your first demo.
BUYER GUIDE
A buyer’s guide to health plan care navigation
Questions, implementation considerations, and a pilot readiness checklist for health plans.
↗INTERACTIVE PLANNERModel the completion funnel
See how reach, eligibility, and acceptance affect completed navigation episodes. Use your own assumptions; this is a planning model, not a forecast.
↗Questions worth asking.
Does NeXtriage guarantee lower medical spend?
No. A savings hypothesis needs observed utilization, comparable claims, program costs, and clinical outcomes. Design targets are not measured results.
Is the microsite a member symptom checker?
No. This resource is for organizational buyers. Request a demonstration of the configured product and its clinical review workflow.