Independent Navigation Unlocks Health Equity Opportunity for Employers

By Dr. Stanley Crittenden, MD, FASN
Chief Medical Officer
Quantum Health

In the realm of employer-sponsored healthcare, any question about whether employers intend to promote health equity among their employees appears to be answered. Business Group on Health’s 2024 Large Employer Health Care Strategy Survey found 95% of large U.S. employers plan to adopt at least one strategy to address health inequities.

Next question: Which care delivery models or plan design strategies mitigate or solve access, affordability and bias inequities? Answers mostly have been lacking from the traditional healthcare and benefits industry.

Meanwhile, new research by Quantum Health finds compelling insights into independent navigation’s capacity to support health equity. In particular, the analysis spotlights navigation’s ability to address equity obstacles in real time as health plan members use benefits and make care decisions with their providers.

Most employers are intent on promoting equitable access to healthcare. Given that vision, navigation’s ability to fill what has been a solutions gap is a significant step toward making progress on health equity.

Minding the Gap

As a board-certified internist and nephrologist, I can attest to the inability of traditional systems and approaches to ensure patients experience an equitable healthcare journey. Consider:

• In a 2022 survey by The Physicians Foundation, most doctors said they lack the time, staff, resources and financial incentives to help patients with the social determinants of health (SDOH) that so often contribute to care-access inequities.
• Traditional insurance carriers are not structured to do the needs assessment and proactive solution-finding to tackle members’ highly individualized, often overlapping, health equity challenges.
• Some benefits vendors and models (e.g., a caregiving benefit, nutrition counseling, subsidized transportation services) can address certain SDOH. However, the overwhelming majority of employers cannot afford a benefits ecosystem broad and varied enough to address the myriad equity issues that arise in a large, diverse member population.
• Even the best-intentioned human resources (HR) and benefits teams typically lack the time, training and resources to identify and troubleshoot equity barriers. In Quantum Health’s recent study on healthcare benefits engagement, 53% of employers surveyed say they have less time than they need, or no time at all, to directly support employees on their healthcare journeys.
• Further complicating matters, employees often are reluctant to disclose their health equity challenges to employers and colleagues.

These factors have left employees and employers facing an equity solutions gap. The result: Members too often postpone or avoid preventive and primary services. They are unable to follow prescribed treatment plans. Ultimately, they suffer the harmful physical, emotional and financial effects of inequitable access to healthcare.

Enhanced Engagement as Inequity Antidote

Quantum Health’s navigation solution differs markedly from a carrier’s member services model in its level of personalized, proactive engagement and advocacy. Its agnostic approach to benefits guidance and care coordination is unique compared with other types of advocacy and concierge vendors or carriers, which provide only transactional support or promote access primarily by funneling members to proprietary virtual healthcare services. Quantum Health is the only navigation solution that engages with members proactively, well before a medical claim is processed, to better understand their personalized healthcare needs. This early engagement through Real-Time Intercept® drives member utilization; other forms of navigation do not. Lastly, Quantum Health’s Care Finder™ provider search capabilities drive higher-quality, more cost-effective and personalized member care.

As the go-to benefits contact for members and their providers, Quantum Health is uniquely poised to intervene early to positively influence care journeys. Our Healthcare Warriors®, also known as care coordinators, include benefits experts and licensed registered nurses — trained to actively listen for, and holistically address, each member’s physical and behavioral health needs, as well as any health equity challenges.

Quantum Health Warriors bring AI-powered insights and solutioning tools to each member engagement. They have visibility into the member’s full health profile, the employer’s entire benefits offering, plus robust databases of community, education and financial assistance resources.

In short, Quantum Health’s model places benefits and clinical experts in the flow of members’ life and healthcare experience. Once there, they are equipped to guide each member to and through whichever combination of benefits, care and resources is most needed and helpful.

Addressing Health Equity at Scale

In 2024, an internal analysis sorted more than 2 million members Quantum Health serves into three cohorts. Sorting was based on demographic and geographic likelihood to face a variety of SDOH barriers, from income inequality to lack of nearby medical facilities. The analysis found:

• Equitable early engagement. Quantum Health’s ability to engage and support members early in care journeys, via its Real-Time Intercept capability, was consistently high across all three cohorts.
• Consistent service satisfaction. Each cohort reported high, nearly identical Net Promoter Scores® (NPS®) — scores more than twice the insurance category average. This suggests members consistently experienced (and valued) the benefits guidance and problem-solving support they received from Quantum Health. 

In short, the analysis found no population segment was underserved or felt left behind by their employers’ investment in a highly advanced member engagement solution, in this case, a solution purpose-built to identify and overcome equity barriers so each member gets the benefits support and healthcare they deserve.

As Quantum Health’s recently appointed chief medical officer, and as a physician who knows how elusive equitable healthcare can seem, I feel inspired by the potential to help more organizations make real progress toward their visions for health equity.

A solutions gap remains — only if we choose not to fill it.