Why healthcare navigation is a broken system

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Healthcare navigation was supposed to be the ultimate guide—a GPS for the healthcare maze. Instead it’s more like an old paper map with half the roads missing. What was meant to simplify care has become just another layer of complexity, dressed up as concierge support but too often steering people based on cost, not quality.

At a time when AI, telehealth, and integrated care models are merging and transforming how people experience healthcare, navigation as we know it is becoming obsolete.

The rise—and fall—of Navigation 1.0

Navigation started with a clear, patient-first mission: Remove barriers to care. The concept was pioneered by doctors to improve cancer outcomes for underserved patients who struggled with delays in diagnosis and treatment. The original vision was simple: Get people to high-quality care, faster.

But then the industry lost the plot.

As digital health took off, the market became flooded with big vision “front doors”—slick apps that promised convenience but ultimately led nowhere. These platforms were entryways without hallways—flashy introductions to healthcare that failed to connect people to integrated clinical expertise or personalized support. Instead of providing a pathway to better health, they left people stranded.

Then insurers stepped in.

They highjacked “navigation,” repackaging it as a cost-control tool rather than an independent, patient-first service. The incentives—and the experience—were not the same. Instead of guiding people to the best possible care, insurer-led navigation steered them toward lower-cost providers with little regard for quality or fit. What should have been an unbiased clinical advocate became just another mechanism for network steering.

The result? People aren’t just underserved; some are actively led away from quality care, facing more barriers, more frustration, and worse outcomes. Navigation was supposed to help people get to and through the system, but instead, it became a roadblock.

Let’s not forget, we’ve seen this before. Like with the first wave of telehealth, Navigation 1.0 has become an add-on to a fragmented system rather than a real solution. And just like Telehealth 1.0, too many navigation services are now commodity, or more specifically low-value check-the-box offerings—utilization management in disguise.

What comes next: A more integrated, person-centric model

If Navigation 1.0 is dying, what replaces it?

A smarter, all-in-one healthcare model—one that doesn’t just point people in a direction, but actually gets them the right care at the right time—proactively, ongoing, and when called upon. Navigation was always meant to simplify healthcare, but that only happens when clinical expertise, advocacy, and technology work together and are deeply integrated to eliminate friction, improve access, and drive better health outcomes. Here’s what that looks like:

Advocacy, not just guidance

People don’t need another app—they need someone in their corner. True advocacy means:

Fighting billing errors and helping people understand and resolve insurance denials.

Connecting people with high-quality doctors, not just network-preferred ones.

Helping people navigate treatment decisions and medication costs. It’s not about pointing people in the right direction; it’s about walking beside them.

AI + EQ: Smarter, more empathetic care

AI assistants and guides are hot topics, but technology alone isn’t enough. What people want is AI + EQ = the efficiency of AI-driven experiences combined with real human expertise and empathy.

In healthcare, AI should either free up humans to focus on tasks that only humans can accomplish, or provide guidance to humans to help them perform uniquely human roles more effectively. If a system isn’t human-centered, it’s just another version of the problem.

At this point in the game, integration can’t be vision

Navigation without deep clinical expertise, system-wide connectivity, and personalized visibility into an individual’s benefits, history, and preferences is about as useful as a tour guide who’s never been to the city—helpful on the surface, but not when you drill down for trusted, known, and proven guidance.

For navigation to be effective, it must provide direct access to clinical expertise as part of an integrated team—not just for finding a doctor. It should go even further to holistically support people across mental and physical health, administrative, financial, and social needs. It must include addressing the unexpected too, such as medication support, in-home care, and a broad range of social determinants of health issues.

Smarter, cost-conscious care (not just the latest trend)

The GLP-1 drug boom (Ozempic, Wegovy) is a case study in why smarter healthcare decision making matters.

These drugs are breakthrough treatments for diabetes and weight loss—but they’re also so expensive that if prescribed indiscriminately, they could bankrupt the system and individuals too.

That’s why Navigation 2.0 must be evidence-based, guiding people toward treatments that work, are clinically appropriate, and are informed by a person’s benefits and based on what a person can afford short term and ongoing.

Better healthcare isn’t just about access; it’s about making smart, data-driven decisions with and for people.

The future: Personalized all-in-one healthcare

Navigation 1.0 was about helping people wayfind. The next era is about creating a fully connected, advocacy-driven experience that actually improves health, lowers costs, and removes complexity.

At Included Health, we call this personalized, all-in-one healthcare. It’s not just a replacement for navigation—it’s a new category altogether, one that finally delivers on the original promise of making healthcare simpler, better, and more human.

Healthcare navigation, as it exists today, is dying. RIP.

Owen Tripp is cofounder and CEO of Included Health.

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