There are many care coordination models out there. So how does Quantum Health stand apart from our competition? Two critical differentiators are Real-Time Intercept™ (RTI) and our relationship with providers.
RTI is Quantum Health's unique ability to identify members earlier in their unchosen healthcare journey by leveraging both member AND provider interactions—well before traditional predictive tools that rely solely on claims or other data. Our Care Coordinators look for opportunities to provide guidance and support that positively impact the cost and quality of care by addressing a member's financial, clinical and humanistic needs. In fact, we engage with members more than 100 days earlier than other models that rely on post-care data.
But, how do we recognize these opportunities for intervention? One key way is through provider interactions. Every time a provider calls to verify patient eligibility status, benefits or answer questions related to an upcoming procedure, it's not simply a transaction—it's a window shedding light onto the member's upcoming healthcare journey.
A recent example of a RTI/provider interaction involved one of our members, Charles. After Charles underwent a routine colorectal screening, he received the devastating news that he had cancer. Any member facing this sort of life-threatening situation is in need of holistic support. How did we know that he and his family needed our support? His provider's office called us and asked a seemingly transactional question, "I need benefits for an upcoming surgery." Trained to probe deeper, our Care Coordinator uncovered the reason for the upcoming procedure. And, within 24 hours of diagnosis, we were guiding Charles through his unchosen healthcare journey at a time when it was real, relevant and life-changing decisions were being made.
Talking with providers does more than help identify opportunities for member support, it also allows us to build a roadmap of our members' health and care. Every provider call is a rich data point alerting us to not what we predict a member will do, but what they are actually doing in real time. This allows us to guide our members with the empathy, expertise and care they have come to know and trust.