AI FAQs: How Quantum Health Turns Artificial Intelligence into Real Results

Employers, consultants and HR leaders are asking smarter, more strategic questions about AI: Can it actually help employees? What kind of results should we expect? How does it affect benefits teams? Below are 10 of the most common questions we hear and answers you can put to use right away. 

Q1: How is AI used in healthcare beyond chatbots and search tools? 

They’re a common starting point, but there’s really much more. Yes, organizations use AI for surface-level support, such as answering FAQs, triaging calls or directing members to web pages. But that’s not the ceiling for what AI can do. In fact, when it’s limited to search-based functions, it often adds to member confusion rather than reducing it. 

Here’s what Shannon Skaggs, Quantum Health’s Chief AI Officer had to say: “It’s here and it’s accelerating. And if you’re not accelerating, if you’re still talking about proofs of concept, you’ve missed the opportunity already.” 

This is backed up by the data, which shows that 94% of healthcare organizations view AI as core to their operations, and 86% are using it extensively now. 

The real power of AI in healthcare navigation is when it becomes agentic, meaning it acts on behalf of members. At Quantum Health, that includes: 

• Early engagement: Detects signals from provider eligibility checks, pre-authorizations, and claims, then initiates outreach to guide members proactively. 
• Action-to-Impact™ reporting: Goes beyond action by tying each intervention to a measurable outcome, including savings, adherence and avoided complications. 
• Member AI Assistant: Provides guided, proactive support for members, anticipating needs (like confirming coverage or steering provider selection) and escalating seamlessly to a Care Coordinator when human expertise is required.  

Q2: What makes Quantum Health’s AI different in healthcare navigation? 

Quantum Health’s AI is built on 26 years of real-world healthcare navigation, not generic data sets or simulated journeys. Unlike other solutions, this AI is trained on millions of actual interactions from both members and providers, with a deep understanding of how people engage with care in real life. That means our AI recognizes complex patterns and opportunities others might miss. 

Because we own the full experience from first interaction through care coordination and claims support, our AI sees the entire journey. It knows when a provider is calling about an MRI pre-auth and triggers outreach before the member even knows what’s next. That’s more than automation. It’s intelligence in action, grounded in behavioral science and human insight. 

Q3: How does AI reduce costs in healthcare? 

The technology powering our early engagement capabilities uses AI to scan millions of signals from both providers and members, including eligibility checks, pre-authorization requests and early claims activity. The AI analyzes these signals to spot risk or opportunity and predict where intervention will have the most impact. 

Once identified, this triggers proactive engagement (like routing to an in-network provider or coordinating care) before a claim is filed, sometimes months in advance. That allows our teams to guide members to in-network providers, coordinate complex care plans and avoid unnecessary ER visits or readmissions. 

Early intervention powered by AI doesn’t just improve clinical outcomes; it also drives measurable cost savings. For example, redirecting a high-cost surgery to a preferred facility can save thousands per episode. More importantly, it spares members from fragmented experiences and HR teams from hours of follow-up and escalation. 

Q4: How can AI help prove the impact of healthcare navigation? 

It’s not enough to say that AI helped us engage a member. We need to understand the impact. That’s where our AI-powered Action-to-Impact™ technology comes in. It’s our proprietary framework that evaluates millions of interactions to tie each action to a concrete outcome, whether it’s cost savings, improved adherence or avoided complications. 

“Our enhanced reporting pinpoints the most complex journeys, identifies where the greatest value is created, and outlines next steps to maximize results,” said Chris Reed, Director of Value Creation at Quantum Health. “As our dataset matures, insights become even more predictive, helping clients stay ahead of emerging challenges." 

This system ensures accountability. It allows our clients to see not just how many members interacted with us, but what changed because of it. It’s a smarter way to track ROI, especially when healthcare is full of noise and false positives. As one client put it, “You didn’t just engage them. You changed their outcome.” 

Q5: Is it secure and trustworthy? 

Absolutely. Quantum Health’s AI is built in a closed-loop, HIPAA-compliant environment. We don’t scrape public data or rely on unverified sources. There are no “hallucinations” or speculative outputs, only curated, member-specific information used with strict controls. 

We also never outsource this intelligence to third parties who lack the clinical or privacy frameworks needed for responsible care coordination. Because trust is table stakes in healthcare, everything runs through systems designed for security, transparency and member protection. 

Q6: What is the human role? 

While AI can efficiently sift through millions of data points, it is humans who deliver empathy, judgment and trust. That’s why AI-driven signals are followed up by a Quantum Health Care Coordinator or nurse. It’s not about replacing people; it’s about empowering them. 

“It’s really hard to recreate and synthetically create empathy, compassion and trust,” said Skaggs. “Bringing AI-powered strategy with human-powered care, you don’t have to pick one or the other. You should have both.” 

That’s especially true during high-stakes moments like a new cancer diagnosis or post-surgical discharge. AI makes the experience faster and smarter. Meanwhile, our people make it compassionate and personal. 

Q7: What about outcomes that don’t happen? 

Some of the most powerful proof points in healthcare are the “non-events” — the hospital stay that didn’t happen, the duplicate scan that was avoided, the ER visit that was never needed. These are the moments where AI quietly changes the trajectory of care without the member even realizing it. 

For example, if our AI sees a provider call for a pre-authorization, and we intervene to redirect the member to a more appropriate site of care, that’s a non-event. But, it’s still a win. It saved money, reduced risk and protected the members’ time and energy. These are the hidden impacts that matter most in long-term employee retention and satisfaction. 

Q8: Is this just for large employers? 

Not at all. The best AI models are scalable across industries and employer sizes. Whether you have 500 employees or 50,000, many challenges are similar: healthcare is too complex, costs continue to rise, and HR teams are stretched thin. Our AI and care coordination model flexes to meet the needs of each client and population. 

With flexible integration options and modular solutions, Quantum Health fits seamlessly into existing benefits ecosystems. It’s not one-size-fits-all and it doesn’t require a tech overhaul. That’s key for midsize employers looking to drive meaningful change without adding complexity. 

Q9: What ROI does healthcare navigation deliver? 

Our clients typically see a 5x ROI by Year 3, along with 10% average savings vs. expected claims and 89% engagement among members with a claim. It’s all based on independent actuarial validation across our book of business. 

But the ROI isn’t just financial. It shows up in reduced HR workload, higher employee satisfaction, and improved retention. If HR teams aren’t spending hours untangling care issues, they can focus on strategy, not stress. When employees feel supported during their most vulnerable moments, they remember. You can hear real examples in the first episode of our Beyond the Benefits podcast. 

Q10: What’s the bottom line? 

AI is already reshaping how organizations navigate healthcare. The winning approach is one that combines intelligence with human touch. Quantum Health’s model isn’t about using tech like AI just so we can say we do. It’s about using AI to identify the right moment and the right action to guide each member through a better journey. 

For employers, this means fewer surprises, stronger outcomes and a navigation partner that brings action, empathy and accountability to the table. Because in healthcare, it’s not what you know: It’s what you do with it that counts. 

Ready to see what AI-powered healthcare navigation can do for your organization? 

Let one of our experts show you.