Company’s leading human-centered and technology-empowered navigation platform will now support Medicare Advantage plans to enhance member engagement, reduce member attrition, close gaps in care and boost Star Ratings.

DUBLIN, OH (March 13, 2024) Quantum Health, the leading consumer healthcare navigation and care coordination company, today announced it has launched a new navigation service to support Medicare Advantage plans as they look to enhance member experience and retention to help improve plans’ Star Ratings, close gaps in care and drive better clinical outcomes.

As the creator of the healthcare navigation market, with 25 years of experience serving over 500 self-insured employers and 3 million members, Quantum Health now extends its expertise and industry-leading navigation platform to benefit over 30 million Medicare Advantage members, aligning with the company’s strategic “Navigation for All” vision to make the healthcare experience simpler and more effective for all healthcare consumers. By helping Medicare Advantage members effectively navigate their care benefits and manage provider interactions, members get ongoing support, better and more appropriate care, and improved outcomes. Quantum Health’s industry-leading engagement with members and providers also helps drive a better healthcare experience and higher satisfaction rates for both.

There has never been a more critical need for innovation in the Medicare Advantage space. Medicare Advantage plans are under increased pressure from Centers for Medicare and Medicaid Services (CMS) and members to improve the beneficiary experience, control costs, and enhance value, services and capabilities. Historically, a lack of member engagement, low member satisfaction and inconsistent provider communication have impeded the ability of plans to gain member trust and influence member healthcare behavior. Lower provider performance, combined with 13% of Medicare Advantage members dropping their plan after one year and close to 80% of current members not being part of a 5-star plan, have resulted in Medicare Advantage plans revamping their member and provider experience, engagement and performance capabilities.

Last October, 2024 Star Ratings were publicly released reporting changes based on member survey measures driven from CAHPS® and the Health Outcomes Survey (HOS). CMS is emphasizing measures in the Star Ratings program that will accelerate equitable and meaningful member and provider experience, appropriate care journey guidance, and value-based care approaches. Close to 70% of Medicare Advantage plans’ Star Ratings measures are influenced by providers, and for the 2026 Stars Ratings (or the 2024 measurement year), at least 33% of Star Ratings will remain based on the member and provider experience performance of a contract. Quantum Health’s navigation platform uniquely connects all key stakeholders to ensure appropriate care, member satisfaction and Star Ratings improvement.

“Quantum Health’s navigation platform and our teams of Healthcare Warriors® and clinicians enabled by leading technology help millions of members today get access to the best care and support they need on their unique and personal healthcare journeys. Medicare Advantage plans are challenged with helping millions of people manage complex care. They need a proven navigation service that can be with their members throughout their healthcare experience while helping plans address gaps in care and drive better member engagement,” said Shannon Skaggs, president of Quantum Health.

Key components of Quantum Health’s Medicare Advantage service offering:

  • Improved member engagement and experience: Quantum Health will support members with a team of dedicated experts that provide proactive member support, along with helping Medicare Advantage plans comply with CMS requirements, conducting annual health risk assessments, confirming primary care physician (PCP) assignment, and helping members access needed care to proactively close care gaps and document future care needs.
  • Year-round member healthcare navigation support: Quantum Health’s dedicated Healthcare Warrior teams provide continual and proactive healthcare journey support that includes managing administrative, clinical and real-time interventions that assist in improving Star Ratings and increasing member satisfaction. This member support helps drive clinical strategies and informed solutions and services that help determine the most effective course of action for members.
  • Care gap closure: Quantum Health’s navigation platform and proprietary Real-Time Intercept®(RTI) capability will help Medicare Advantage plans maintain or improve their Star Ratings by launching and managing data-driven, multi-channel outreach campaigns for targeted interventions aimed to close gaps faster.

“We have designed our Medicare Advantage navigation service to meet the unique needs of both Medicare Advantage plans and their member populations. That means leveraging our core capabilities to support acute care for an increasingly aging population, expanding provider networks and virtual care options to cover less penetrated markets and rural populations, and addressing social determinants of our members’ health — all to close clinical care gaps and improve clinical outcomes,” said Dan Shur, chief product officer for Quantum Health. “Ultimately, Quantum Health’s navigation service will provide enhanced member-focused, omnichannel experiences that can serve members with efficiency and a cost-savings impact. This is what has made Quantum Health the leader in navigation for self-insured employers for 25 years.”

Quantum Health’s navigation platform currently supports members throughout their complex health journey with access to Quantum Health’s Healthcare Warriors and clinical teams dedicated to working with payers and providers to deliver the best possible care. Using RTI and generative AI, the company’s clinicians and care coordinators leverage data to empower members with a more integrated and streamlined healthcare experience, including more effective provider interactions. Members also gain increased benefits with expanded access to the highest-quality resources and providers, ultimately improving their health outcomes.

Learn more about Quantum Health’s new Medicare Advantage navigation offering here.

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