Clinical Expertise Empowering smarter healthcare decisions with Clinical-First™ navigation
Healthcare is complex. Delayed care, fragmented systems and unnecessary costs make it harder for employees to get the care they need. Quantum Health’s Clinical-First model changes that by intervening earlier, coordinating care smarter and driving better holistic health outcomes with an in-house clinical team.
Our unique model integrates care navigation, utilization management, wellbeing support and provider engagement to create a seamless healthcare experience. Starting with clinical expertise and provider collaboration, we ensure early intervention, prevent fragmented care and ultimately enable members to make the best decisions for their care.
Our clinically led model drives better outcomes
Unlike other navigation platforms, Quantum Health:
- Engages members at the earliest signs of a healthcare event, often before claims are filed, through Real-Time Intercept®
- Provides dedicated clinical support, including in-house doctors, nurses, pharmacists and care teams that work together to guide members
- Reduces healthcare costs through optimized care paths, utilization management and provider collaboration to cut unnecessary expenses
- Improves health outcomes by enabling more preventive screenings, fewer hospital readmissions and increased provider engagement
Our Personal Care Guide (PCG) nurses are dedicated advocates
Quantum Health is the only independent navigation solution with an in-house clinical support team – doctors, nurses and care coordinators working together. Our PCG nurses are embedded in each client’s team and become a member’s advocate to help assess, plan and evaluate the best options for their healthcare needs. They blend case management and chronic condition management with dedicated, empathetic support. PCG nurses guide members through care gaps, reducing preventable hospital visits and ensuring adherence to treatment plans.
Our approach goes beyond traditional utilization management
We fully own the utilization management (UM) process, advocating for our members in real time through proactive and ongoing consultation with the member’s provider, ensuring faster approvals, fewer denials and optimal site-of-care decisions.
We prevent denials by working directly with providers, resolving missing documentation before claims are submitted. Our nurses perform reviews, assess progress and help ensure the appropriate level and setting of care. All these factors help eliminate unnecessary inpatient days and address potential barriers to discharge, leading to cost-effective care and clinically better outcomes.
denial rate vs. the standard 9% carrier denial rate
Reduced inpatient stays
savings through utilization management and site-of-care review for specialty drugs on the medical benefit
It’s about ensuring they get the right care at the right time.
Our clinical first model increases preventive screenings and care leading to healthier employees and lower healthcare costs.
Our doctors, nurses, pharmacists and other experts provide personalized, holistic guidance that ensures smarter care decisions, reduced costs and better outcomes. Discover how our clinically integrated approach helps employers manage specialty drugs.
See how a clinically-led approach transformed their healthcare and benefits strategy.
National Church Residences turned to Quantum Health to improve preventive care and chronic condition management—engaging members 120 days earlier and reducing high-cost claims.