New data reinforces how Quantum Health’s unique model works to control costs across entire member populations, leveraging real-time member intercept capability, care coordination and proven digital health solutions. Analysis found while many employers experienced annual healthcare cost increases of 6% or more, the cumulative cost impact from better navigation and utilization was held to less than 1%.

Healthcare Navigation Platform Empowers Employers to Combat Rising Costs

DUBLIN, Ohio, Dec. 14, 2022 — Quantum Health, the leading independent navigation and care coordination company, today released results of an analysis that shows how the company’s solution helps employers improve cost effectiveness on medical care received by their health plan members. The study found that navigation demonstrates cost-control impact across the entire member population and helps to counter increases in provider prices, which are expected to rise significantly in 2023 and beyond.

The study examined medical claims data for all Quantum Health clients active during 2016-2019, prior to the COVID-19 pandemic that produced a historically distorting effect on U.S. healthcare consumption. Provider prices were factored out of claims costs during the study period. Instead, the study focused on how the company’s navigation model works to control two other primary cost drivers: utilization (the volume of services consumed) and mix of services (the type of services used.)

By acting as the single point of contact for members seeking benefits guidance and providers looking to confirm benefits eligibility prior to providing services, Quantum Health is uniquely positioned to intervene early in members’ healthcare journeys, through Real-Time Intercept®  capabilities, to guide and inform utilization and mix of service decisions. The analysis found that, over the study period, while many employers were seeing healthcare costs increase by 6% or more annually, the cumulative cost impact from utilization and mix of services was held to less than 1%. This can translate into millions of dollars in savings for midsize and large employers.

“Higher inflation is showing up in prices negotiated for and charged by providers, and that’s expected to continue for some time – something both HR and finance professionals are grappling with across industries,” said Scott Doolittle, Quantum Health’s chief financial officer. “It’s important for employers and benefits advisors to recognize that price is just one factor applying upward pressure on cost trend. We did this analysis to look more closely at how navigation helps employers manage and control utilization and mix of services.”

Other findings include:

  • In-network care steadily increased year over year, helping employers take greater advantage of negotiated rates with providers.
  • Clients’ members had fewer avoidable ER visits, while use of urgent care grew at four times the rate of ER use.
  • Inpatient admissions, length of hospital stays, and readmissions within 30 days of a hospital discharge all declined.
  • Surgeries performed in more cost-effective outpatient settings grew, while surgeries done in more costly inpatient settings declined.
  • For the most prescribed specialty drug, treatments administered in home and office settings increased, while those performed in more expensive outpatient hospital settings declined.

Along with identifying cost-control impacts, the study found that Quantum Health clients’ members outperformed healthcare industry benchmarks for receiving recommended preventive services and achieving chronic-condition treatment quality metrics.

“Many people still think of navigation as a tool to help members find providers and reduce the HR team’s benefits workload, and navigation does that, absolutely,” said Doolittle. “But the true art and science of independent navigation is to ensure all members get the clinically appropriate care they need, when they need it, at an appropriate cost, within a highly simplified and satisfying experience,” Doolittle said. “Provider prices show no signs of going down. Employers have an opportunity to adopt a real-time, always-on strategy for managing the other major cost drivers: utilization and mix of services.”

On Dec. 15, at 1 p.m. ET, Quantum Health executives will share results from the study in a webinar, Pushing Back Against Healthcare Inflation. To register for the webinar, click here or download the full healthcare navigation cost control study here.