Consultants & Brokers
 

A New Approach to Health Plan Management
Numerous benefits consultants and brokers around the country have identified Quantum Health's  Coordinated Health/Care™ program as an important new approach to health plan management that is appropriate for many employer groups.  We find that Coordinated Health/Care fits best with more sophisticated clients who typically have a consultant or broker as their advisor.  For that reason, the majority of our new client sales today are through a consultant/broker.

Plan Analysis and Consultation
While the consultant/broker is the "benefits expert," we believe our job is to be your partner as the "healthcare expert."  We work directly with the patients and providers, and have extensive grass-roots data on what is actually driving the client's healthcare cost.  Many of our key managers have backgrounds as strategic consultants, and we conduct regular analysis on healthcare utilization, group health factors, and claims cost details, and prepare a quarterly performance report that we submit to the consultant/broker for review and collaboration.  When combined with analyses done by the consultant/broker and TPA, we find that our clients achieve a much deeper understanding of their health plan, along with action plans for recommended changes so they can actually manage their healthcare costs.

Beyond Cost Shifting
Why Coordinated Health/Care?  Our partner consultants and brokers tell us that better PPO discounts, cost shifting through increased deductibles, OOP limits, and premiums, and reduced benefits are virtually tapped out as strategies they can recommend to their clients.  Coordinated Health/Care offers a new, hands-on approach to making the process of healthcare more efficient at the grass roots level -- with patients and their physicians. 

Proven Results
Coordinated Health/Care has held annual claims trend to less than 6% for six consecutive years, through the period when trend has been 10-17%.  While recent surveys have listed trend at single digits, a deeper look reveals that these numbers are being achieved AFTER significant cost-shifting to employees.  Actual healthcare cost trend remains in the 10-12% range, compared to Coordinated Health/Care's six year track record of 5-6% trend.  

No Reduction in Benefits
To our clients, cost control is a requirement.  But even better, Coordinated Health/Care has achieved its results with no reduction in benefits.  In fact, most of our client plans enhance benefits by creating an enhanced benefit level for certain efficient healthcare behaviors.  These targeted plan incentives are based on Quantum Health's proprietary consumer behavior research on healthcare, which revealed specific steps in the healthcare process that trigger duplication, delays and confusion.   

Rather than reduce benefits or withhold care,
Coordinated Health/Care actually provides an enhanced
benefit level for following a coordinated process of care.

Better Employee Guidance and Support
Just as important, Coordinated Health/Care provides an enhanced level of guidance and support to employees and their families, through a staff of Care Coordinators.  Typically, the plan utilizes a single toll-free number, through which all customer service calls are routed to the Care Coordinators − replacing the fragmented calls previously made to the TPA, PPO, medical management nurses, HR department, and PBM.  By understanding the full scope of an employee's healthcare activities, the Care Coordinators can go beyond simply answering their questions to actually guiding them through the healthcare process − including gentle re-direction when they are unnecessarily duplicating services or causing delay.

In customer satisfaction surveys, more than 92% of Coordinated Health/Care members report being "Extremely Satisfied" or "Very Satisfied."   See Patient/Member comments.

Single-Point Customer Service
Coordinated Health/Care will provide all customer service support on the Plan. Following are the specific services that will be provided for your clients:

• A dedicated phone line - this allows our Care Coordinators to answer the phone in the client's name, direction of the phone line to specific individuals during the enrollment process who will service on an on-going basis as your dedicated Account Coordinator, and enables our care coordinators to immediately have accessible all information on your Plan when taking that call;
  
• Phone access to care coordinators 8:30am to 8:30 pm ET weekdays;
  
• Single website enabling look-up of:

  - Provider directories
  - Referral and pre-certification information;
  - Health information
  - Schedule of benefits and plan document
  - Claims information and
  - Enrollment updates