Empowering Patients with AI: The Logic Behind Quantum Health’s Embold Acquisition

Healthcare in the United States is notoriously complex, and advances in medicine and technology are only making the field more complicated for patients to navigate. Quantum Health has long been dedicated to guiding our members through the healthcare maze, ensuring none face the confusing journey alone. The recent acquisition of Embold Health—a physician-led healthcare technology company—is another step in our commitment to empower patients.

Modern Navigation for Modern Healthcare

Traditional healthcare navigation approaches are no longer sufficient in today’s knowledge-concentrated and highly specialized healthcare environment. Historically, medical knowledge was distributed across community physicians. Today, specialized knowledge tends to be concentrated in centers of excellence, while local providers may lack access to the most cutting-edge knowledge and treatment options.

At the same time, healthcare is becoming highly specific. Personalized medicines based on a person’s unique gene makeup are a prime example. There is no longer just one type of breast cancer we treat; there are different types according to gene, such as BRCA1 (BReast CAncer gene 1) and BRCA2 (BReast CAncer gene 2). While such individualized treatments hold great promise, they also create a more confusing journey for patients.

Against this backdrop, the traditional healthcare navigation model—built on the basic premise of getting patients to the care they need—falls flat. Even well-intentioned physicians may not know all a patient’s available options, due to a lack of deep clinical insights about the latest treatment options and knowledge gaps regarding optimal care locations. This can result in uninformed decision-making about potentially life-saving care.

This is where we come into the picture. Quantum Health has helped millions of people on their healthcare journeys, coordinating everything from the routine (like seeing a primary care provider) to the complex (like managing a cancer diagnosis). When employers hire us, their health insurance plan becomes a contracted provider network and medical claims processor, and we become responsible for handling all consumer and provider communication, acting as a single point of human interface, guidance, and comfort.

With our acquisition of Embold Health, we are enhancing this commitment to empower patients

to make informed decisions about their care. With its proprietary physician-level analytics and AI-powered provider recommendation engine, Embold Health simplifies the care-seeking process even further. Additional investment from Quantum Health will allow Embold (which continues to operate independently) to accelerate the advancement of such data-driven innovations.

Empowering Patients with Physician-led Intelligence for Complex Care

A key part of healthcare navigation is helping people understand what’s happening to them —guiding them, comforting them, supporting them. That side of the work is balanced by the clinical side — knowing what a patient is dealing with, where they should go, and who is best positioned to diagnose and treat them.

Quantum Health’s acquisition of Embold Health was rooted in the understanding that it’s really hard for people to even understand their treatment options, let alone where to seek those options. By integrating Embold Health’s physician-led approach, which grounds technological development in real-world clinical expertise, we can guide patients through the healthcare maze with even greater confidence.

By combining data from Quantum Health’s 3+ million members with data from Embold Health’s approximately 5 million members, we can better understand who and where to send patients for diagnosing and treating specific conditions. This means:

● Quantum Health clients will benefit from integrating Embold Health’s capabilities, with new features rolling out in the coming months.

● Embold Health customers will benefit from the added scale, innovation, and support provided by the Quantum Health family.

● Consultants and partners of both brands will benefit from expanded solutions that can generate greater value as the integration deepens.

On Quantum Health’s side, the greater beneficiary is our members—the people we help through the complex healthcare maze.

Technology as an Enabler, Not a Replacement

Integrating AI-powered tools into Quantum Health’s offering does not mean we are shifting away from our human-first approach. Far from it. Our Healthcare Warriors®, those on the front lines communicating with members, grapple daily with the complex nature of modern medicine and the U.S. healthcare system. AI can help make their work easier and more effective, synthesizing data from 700+ vendors and sources to ensure they empower patients by pointing them in the right direction, every time.

AI also allows Quantum Health to enhance its Real-Time Intercept® (RTI) model. This is based on the premise that provider- and consumer-initiated contacts in real time, before a claim occurs, are the best predictors of what will happen in the healthcare journey. RTI uses the opportunity that these points of contact present to connect with patients sooner in their journey, as decisions are being made—not after (as has been the industry norm, where people would be identified for clinical programs using existing data like medical or prescription claims).

AI simplifies such engagement further, giving Warriors access to more sophisticated, streamlined, and comprehensive data, allowing them to provide optimal guidance in even the most complex cases. Quantum Health has long differentiated itself by providing comprehensive solutioning across multiple sectors. A single patient could require everything from a specialist referral (requiring record transfers) to home caregiver coordination, family support services, and even relocation assistance.

A Healthcare Warrior can more effectively anticipate and address these complex interconnected needs with data-driven insights while still providing the sensitivity and compassion needed in difficult moments of the healthcare journey. Technology may be an enabler, but the real power lies with the person using that technology.

Having spearheaded the navigation industry, I’ve seen how some in the business try to “dumb down” the job and turn it into a simple task of wayfinding: point the patient in X direction and hope for Y result. The reality is far more nuanced than that. By combining real-world data insights with human care and compassion, we ensure patients aren’t just signposted in a certain direction but are taken by the hand and led that way, with confidence, together.

Looking to the Future: Empowering Patients Through Partnership

Going forward, healthcare complexity will continue to increase, requiring navigation to become less transactional and more strategic than ever before. Quantum Health remains dedicated to defining next-generation navigation standards as the industry continues to evolve. But just as our patients can’t do it alone, we can’t either. That’s why we’re partnering with others, like Embold Health, who enhance our work by providing clinical intelligence and AI-powered insights we couldn’t develop alone.

With collaborators like these, we will continue to innovate in pursuit of better healthcare outcomes and lower costs. At the core of this evolution, our mission remains unchanged: No one should navigate their healthcare journey alone. With new partners like Embold Health by our side, we can ensure this is not the case while continuing to protect the interests of the ultimate healthcare consumer — the patient.