From Insight to Impact: How Access, Answers and Action Lower Healthcare Costs
Healthcare costs continue to rise faster than wages. High-cost claims are becoming more common, specialty drugs are changing the cost equation and employees are being asked to navigate an increasingly complex system. For employers, adding another point solution or shifting more responsibility to employees is no longer enough.
That challenge set the stage for Quantum Health’s recent webinar, AI with Impact: Pairing Access, Answers and Action to Lower Healthcare Costs. Nancy Sansom, Chief Marketing and Communications Officer, and Shannon Skaggs, Chief AI Officer, explored how a more connected approach to healthcare navigation can improve the member experience while helping employers manage costs.
Their framework comes down to three essentials: access, answers and action.
As Sansom explained, “Members need more than information. They have plenty of information.” What they need is help turning that information into a confident decision and a clear next step.
Access: Make the right care easier to reach
Access shouldn't be thought of as just finding the nearest available provider. Instead, access must help members reach high-quality care and relevant resources at the moment they need them.
The webinar highlighted the scale of the challenge: more than 100 million Americans lack access to primary care. When people cannot get care early, conditions can worsen and costs can rise. Virtual primary care can help close that gap by providing 24/7 access for immediate and ongoing needs, including preventive care, chronic condition management, medication management and behavioral health support. In Quantum Health’s model, members can connect by chat with a physician, not a bot, in less than 60 seconds, with a median response time of about 22 seconds.
Choosing the right provider also matters. Data showed substantial cost differences across providers, ranging from 57% in obstetrics and 62% in primary care to 94% for orthopedic care and 89% for joint and spine care. Quantum Health’s provider-rating methodology draws on more than 230 million healthcare journeys and evaluates appropriateness, effectiveness and cost. With provider steerage in place, clients’ members typically save 10% on out-of-pocket expenses.
Answers: Solve the “question behind the question”
Employees often begin with simple questions: Is this covered? What will it cost? Is this explanation of benefits actually a bill? But the initial question may reveal a larger need involving provider selection, clinical guidance or an underused benefit.
As Skaggs put it, there is often a “question behind the question.” Effective navigation does not stop after answering the administrative issue. It uses that moment to understand the member’s situation, explain options and connect the person with the right expertise, without forcing them to start over with a new department.
“We as human beings don’t think of ourselves as patients, body parts or conditions, so why should we treat members that way?” Skaggs asked. That perspective makes an interdisciplinary, connected support model especially important.
That same principle applies to HR and finance leaders. They need clear answers about what is driving medical and pharmacy trends, which populations are engaging with benefits and whether interventions are producing measurable value. Bringing claims, clinical, engagement and provider data together can help leaders move from retrospective reporting to timely, actionable insight.
Action: Intervene while decisions can still change
Information only creates value when it leads to the right next step. Quantum Health’s teams help members coordinate care, resolve billing and authorization issues, select providers and connect with clinical support. The goal is to reduce administrative burden so members can focus on getting better.
Timing is critical. Using more than 26 years of data, Quantum Health identifies early indicators that someone may need support. On average, members are engaged 90 days before the first claim is received. One case shared in the webinar illustrated why that matters: during the 90 days before a cancer-related claim appeared, Quantum Health had 24 interactions (nine with providers and 15 with the member) and helped influence five major decisions. A claims-only model would not have recognized the journey until those decisions had already been made.
AI empowers humans without replacing them
A recurring theme was the balance between technology and people. AI can assemble context, surface patterns and recommend possible next steps. Clinical decisions remain with experienced professionals who can evaluate the evidence and bring empathy, compassion and judgment to each interaction.
The takeaway for employers is straightforward: better outcomes and lower costs require more than access to information. Members need access to the right care, answers tailored to their circumstances and hands-on help taking action early enough to change the trajectory.
Want to see how this approach works in practice? Request a demo and talk with the Quantum Health sales team.
