It’s simply guiding members to the resources and care they need, when they need it. Successful healthcare navigation offers proactive provider collaboration, meaningful member engagement and expert clinical support. Quantum Health brings all these elements together through a simplified navigation experience, establishing a single point of contact that’s easy to use. We increase awareness and benefits utilization while providing support and guidance to members through every step of their healthcare journey.

According to the J.D. Power 2023 U.S. Medicare Advantage Study, just 31% of Medicare Advantage plan members say their plan made it easy for them to find care. This statistic is relevant as 43% of the 2023 Star Ratings will be based on member survey measures driven from CAHPS® and the Health Outcomes Survey (HOS).

The way Medicare Advantage members experience access and quality of care will have direct impact on Star ratings. Healthcare navigation provides members with the resources, access and guidance to positively impact each Star scoring category, which in turn increases member retention.

Medicare Advantage plans with prescription drug (Part D) coverage are rated based on 38 unique quality and performance measurements across five main categories. Some of these categories are directly related to the way the member interacts and perceives the access and quality of care.

These categories are:

• Member experience: Health plans are rated based on members’ experience with the entirety of their care, including care from doctors and physician practices.
• Member complaints: A health plan is evaluated by how frequently members submit complaints, whether members choose to leave the plan and whether performance improves from one year to the next.
• Customer service: Health plans are rated on how well they respond to customer requests.

Members having a positive experience and perception of their health plan, results in higher satisfaction and decreased likelihood of attrition – which directly impacts Star ratings.

There is increased pressure from CMS and members to improve experience, control costs and enhance benefits, services and capabilities.

Lack of member engagement, low member satisfaction and inconsistent provider communication can impede the ability to gain member trust and influence member behavior.

Healthcare navigation connects resources to provide members the guidance and support they need to understand benefits and cost, access providers, answer clinical and medication questions, connect with available resources during critical care needs, etc. A single point of contact guides them every step of the way to ensure an exceptional member experience and positive health outcomes.