Quantum Health's management team includes experts in consumer behavior analysis and consumer marketing.  They bring lessons developed in other industry sectors, such as retailing and consumer goods marketing, to the world of healthcare.

In fact, the Coordinated Health/Care™ program was developed in the late-1990s based on research that was spearheaded by company founder Kara Trott and involved other company principals.  They interviewed more than 3,000 "consumers" who were recent users of healthcare, asking exactly how they navigated from one service to another, why they made certain choices and who influenced these choices.

The conclusion was that there are critical gaps in the process of healthcare.  The technical aspects of healthcare - medical diagnosis and treatment - can be perfect, but the process can still be full of delays, duplication and unnecessary services.  This is caused by the fragmented nature of the healthcare industry, and the historic lack of a central "coach" who coordinates all the information, decisions and actions.

Coordinated Health/Care™ was created to bridge gaps that were specifically identified by this healthcare behavior research.  

Patient self-navigation is often ineffective
One of the key findings of our research was that:

• 41% of all referrals to specialists were made by the patient themselves, and

• 60% of these self-referrals were to the wrong specialist.

Unfortunately, when you visit the wrong specialist they must run diagnostic tests to "rule out" their body system, due largely to defensive medicine.  Even if a neurologist to whom you self-refer for a common headache is 98% sure that you don't have a brain tumor, they cannot afford to send you away without a confirmation.  Guess what:  you're headed for the MRI machine, with a $2,000 claim soon on its way to your health plan.

Simply put, patients are poor self-navigators of the healthcare system.  For that reason,  Coordinated Health/Care places a high premium on getting patients to use primary care physicians to do initial assessment and referrals to the appropriate specialist.  This is accomplished through patient education and targeted benefit incentives.

Complex product, complex decision
One of the key features of healthcare is that is often incredibly complex.  Normal consumers are not equipped to understand many healthcare processes, and therefore may not be able to make effective and efficient healthcare decisions.

One study showed that as much as 50% of patients leaving a physician office said they did not fully understand what their physician had told them and what they were now supposed to do to manage or maintain their health.  Fewer than 15% said they were able to ask all their questions during the office visit.

A common example of how this complexity leads to unnecessary services duplication of diagnostics.  When they are referred to a new specialist, many patients are told "The first thing I want to get is an MRI (or some other expensive diagnostic)."  The patient may well have had the same MRI last week, ordered by a different specialist.  Due to the complexity of medicine, most patients are intimated and will not tell the physician, "I just had an MRI last week, so let's get the results from that one to you and save $2,000."  

In Coordinated Health/Care, the Care Coordinators review all requests for MRIs and find several each week that can be eliminated by arranging for previous results to be sent to the new physician.  It's not that the MRI wasn't medically necessary, but that it was being duplicated due to lack of coordination between physicians

Healthcare is a service expenditure
Decisions are made, money is spent.  Healthcare is a service expenditure.  But like all services and intangibles that are bought and "consumed," healthcare has unique features that often make rational consumer decision making difficult or impossible¹:

• The service is created at the very same time that it is being "consumed" or used.  Since a service cannot be pre-produced and put on a shelf, clear information on scope and price of the service are often not known in advance.  This makes consideration of options and rational decision making impossible in some cases.

• The consumer, or patient, is often part of the product delivery itself.  When you carry your lab results from one physician to another, you are part of the "healthcare product" that is being created even as it is being consumed.

• The service provided and consumed for two similar medical conditions may be very different, making it difficult to compare quality and price.  

The consumer is not necessarily the decision maker
Another result of healthcare's complexity is that the consumer is not always the primary decision maker.  Patients and their physicians form a "joint decision team" that can sometimes be a two-headed monster lacking clear direction.

Therefore, encouraging and facilitating efficient decisions is a complicated process that requires interaction with both the patient and physician, and their frequent surrogates, family members and office staff. 

In one case, our Care Coordinators noticed a surgery being pre-certified at a non-network hospital, which would cause $15,000 in unnecessary expense.  The patient said "the doctor ordered that I do it as this hospital."  The physician said "no, the patient asked to do it there."  After a third call, the patient admitted that her elderly father planned on visiting her, and she didn't want him driving in a major city so she wanted the surgery done at the small town non-network facility.  The Care Coordinators made arrangements for the employer to pay for a taxi to drive the father to the hospital, and the surgery was re-scheduled at an in-network facility.

In other cases, several doctors mis-communicate and order unnecessary services.  For example, we received a pre-cert for both an MRI and CT Scan of a neck tumor.  Upon inquiry, the oncologist said he only wanted the much cheaper CT Scan, and didn't know who had ordered the MRI.  Further inquiry showed that the patient's PCP, who had discussed the case with the oncologist, misunderstood the specialist's needs and ordered both tests.  The Care Coordinators got this MRI cancelled.

Quantum Health developed Coordinated Health/Care™in response to what we have learned is the biggest source of inefficiency:
            lack of coordination in a complex system.

By understanding the sources of patient confusion and mis-direction, we have developed  "coordinated healthcare programs" that are focused on coordinating information and activities between patients, families, physicians, and their office staffs.  Patients receive better guidance and information, and health plans using this approach have seen significant savings by reducing unnecessary duplication and delays.