Redefining ROI in healthcare navigation

Connecting action to impact reshapes how employers measure value

Healthcare costs are climbing fast — and so is the pressure on employers. With another 8-9% increase projected for 2026, it’s no longer enough to manage spend. Today’s HR and benefits leaders are expected to drive business outcomes through smarter strategies — not just administer benefits.   

For years, healthcare navigation has promised better member experiences and lower costs. But ROI has remained difficult to define. According to Alliant, many navigation and point-solution programs rely heavily on engagement metrics like participation rates or platform usage, but "engagement alone does not equal results." Without integrated analytics linking those activities to medical and pharmacy claims data, it's difficult to prove where value is truly generated.

That’s why leading employers are embracing a new approach grounded in measurable action and real-time attribution. By connecting care interventions directly to outcomes, they’re gaining deeper visibility into where value is created, how it’s sustained and how to scale it.  

Rethinking ROI in a high-stakes environment 

This shift is leading to greater accountability, especially from finance leaders who want to know what’s working and what isn’t. 

Not all navigation solutions deliver the same level of impact. Some rely on cherry-picked cost-savings analyses or highlight isolated success stories rather than demonstrating consistent, measurable results across an entire book of business.  

To move forward, employers need ROI models that clearly connect interventions to measurable results — not just call counts or clicks. They want to understand what worked, how it created value and where to focus future strategies. 

The ROI of smarter healthcare navigation 

Smarter navigation delivers value across every dimension — from validated financial savings and improved clinical outcomes to enhanced member and HR experience, stronger workforce productivity and better management of high-cost specialty drugs. 

Quantum Health delivers consistent, measurable ROI for employers across every industry. Our independently validated actuarial report shows we provide an average of: 

• 5.9% average claims savings in year one 
• 14.7% average claims savings by year five 
• 3.3:1 to 5.3:1 ROI 

Additional outcomes across our entire book of business:  

• Net Promoter ScoresTM of 70+ from members and providers 
• 80%+ household engagement and 91% engagement for members with high-cost claims 
• 16.8% increase in preventive care utilization 
• $3.53 PEPM in productivity gains — equal to 1,380 workforce hours per 1,000 employees 

Seeing impact in real time: Introducing Action to Impact™ 

In June 2025, Quantum Health launched Action to Impact, a next-gen reporting capability that attributes specific interventions to measurable outcomes at the member level. 

Powered by a dynamic AI engine and 25+ years of proprietary data, the platform connects every touchpoint — from navigation and clinical support to provider interactions — to quantifiable results, including cost savings, improved care and better experiences. 

It provides internal teams with real-time feedback and gives employers transparent, actionable insights they can use to refine benefits strategy and prove outcomes with confidence. “Our enhanced reporting pinpoints the most complex journeys, identifies where the greatest value is created, and outlines next steps to maximize results,” said Chris Reed, Director of Value Creation at Quantum Health. “As our dataset matures, insights become even more predictive, helping clients stay ahead of emerging challenges." 

Complementing actuarial insights 

Actuarial validation remains the gold standard for measuring long-term impact. But real-time attribution adds visibility into what’s working now — empowering midyear decision-making. 

The two are most powerful together. Actuarial models validate total savings, while Action to Impact helps explain how those savings happened. 

As pressure mounts and expectations rise, navigation partners must do more than promise results. They must prove them.  

It’s time to hold navigation vendors to a higher standard — one that delivers measurable value, not just engagement.