Real-Time Insights: The Key to Meeting Employee Healthcare Needs

When your employees seek healthcare, every moment counts. A delayed diagnosis can mean more complex treatment, which means a greater burden for patients and increased financial strain. 

Unfortunately, the healthcare benefits industry traditionally relies on predictive modeling to identify and engage with healthcare consumers, soliciting people for clinical programs based on existing data like medical or prescription claims. With this model, you can engage with patients only after a claim is made—as a result, employee healthcare needs are addressed reactively rather than proactively.

Quantum Health provides healthcare navigation services designed to connect with patients before a claim is submitted, allowing for a proactive approach to care. Employers rely on us to work directly with their employees to provide integrated care coordination, claims administration, and personalized support throughout the patient journey. 

Our service is based on our Real-Time Intercept™ (RTI) model, which posits that the best time to reach patients is before they make a claim. I call it our “secret sauce” to success, as it’s a major factor in ensuring our members, the people covered under the healthcare plans we service, are taken care of.

The Problem with Relying on Predictive Modeling for Patient Engagement

The problematic nature of relying on predictive modeling to engage with patients first became clear to me in the 1990s, when I was conducting the longitudinal research study that would become the basis for Quantum Health’s consumer navigation services. 

Spanning two years and including 3,200 patients, the study essentially examined consumer behavior. We asked the following questions:

• When and how did people make healthcare decisions?
• How did they interact with healthcare providers and insurance carriers?
• What challenges did they encounter on the journey? 

The most extensive part of the study was a phone survey of patients, in which they were asked to discuss their healthcare journeys.

As my research team and I analyzed those experiences, it became clear that the key to helping people effectively navigate the healthcare journey was to connect with them as soon as possible—ideally before an insurance claim was made. 

We determined that a health benefits plan could serve as a vital point of connection that enables a more consistent flow of information between providers and patients. For instance, a 2020 study published in Frontiers in Modern Health indicated that patients with chronic conditions only interacted with their healthcare providers for about five percent of their total healthcare journey. 

What about the other 95 percent of the time—who provided guidance then? There was a gap in the system. We recognized that a health benefits plan could offer opportunities for more regular communication and provide an outlet for patient-initiated contacts. 

Each of these moments of contact was an opportunity to reveal what patients were going through in the present and immediate future—creating a more comprehensive picture than claims, which reveal only the patient’s past. 

This logic forms the cornerstone of the RTI model, which Quantum Health has relied on for more than two decades.

Real-Time Intercept™: The Secret Sauce of Effective Employee Healthcare

Quantum Health’s RTI involvement is usually initiated by one of three things: a provider’s contact, a member’s benefits/eligibility inquiry, or a preauthorization request as part of utilization management. 

These inquiries provide critical information about a patient’s journey and give us, their care coordinators, the opportunity to help shape that journey while it’s in progress.

The result? Improved satisfaction with employee healthcare plans and, most importantly, the potential for better patient outcomes—and reduced costs. 

Through our RTI method, we pick up 95 percent of cases valuing $10,000 or greater. I would also suggest that timing matters—we pick up these folks on average 100 days before a claim exceeding $1,000 is paid; in that time gap, the patient is undergoing diagnostics, understanding and adapting to a “new reality” for their health status, making decisions about which providers to go to, trying to understand their benefits coverage, and often beginning treatment. This presents a valuable window of opportunity to influence their journey, and our high engagement rates allow us to impact their behavior in real time, leading to better care-path compliance, measurable changes in utilization, and claim savings.

Of course, intercepting people alone isn’t enough. Our care coordinators, who we refer to as Healthcare Warriors®, are trained to make the most of every point of intercept. They coordinate member, provider, and clinical services using technology, data-driven insights, and, above all, effective communication, relying on empathy and curiosity to truly understand members’ needs—a process I discuss in my article on Forbes.

As steadfast champions of our members, Warriors solve all kinds of problems, whether it’s straightening out billing errors or securing medication. They are trained to handle the "hard stuff" that may overwhelm patients—be it figuring out benefits, finding the best care provider for a given issue, eliminating barriers to access, educating patients on their options, or solving care coordination challenges. All of these things that can impact the success of the patient's journey.

Our Warriors are helped by cutting-edge technology, including artificial intelligence insights, making it possible for them to show up smarter at every touchpoint with the patient. This mix of tech and human elements allows patients to enjoy a people-centered approach, while ensuring Warriors have the information they need to provide seamless, personalized attention.

Most importantly, our Warriors recognize that each minute spent communicating with a member is an opportunity—a chance to gently question and listen, and provide the sort of personalized guidance that helps patients move through the healthcare journey with less stress and greater efficiency. 

In healthcare, where every moment counts, this can make all the difference in the patient’s journey.