Transforming member support to reduce healthcare costs

A leading construction products distributor with over 5,500 active members needed different strategies to address rising healthcare costs. They added a reference-based pricing (RBP) plan and sought better ways to promote healthy lifestyles and manage high-cost claims. To drive utilization, they also needed more strategically focused and effective member engagement. As a result of the company’s partnership with Quantum Health, Care Coordinators began proactively educating members and providers on the details of RBP authorizations and billing. Further, our comprehensive approach — including obtaining preauthorizations, directing members to in-network providers, and delivering ongoing support throughout members’ entire healthcare journey — improved outcomes and reduced costs. 

Implementing initiatives to boost engagement and education

COST DRIVERS 

With about 120 members accounting for 33% of high-cost claims, this employer’s need for case management was significant. Our Personal Care Guide nurses work one-on-one with members who have chronic or complex medical conditions, ensuring they stay on treatment plans. 

SINGLE POINT OF CONTACT 

RBP can lead to many questions because it eliminates the concept of “in-network” and allows employers to set the amounts they are willing to pay for services. We serve as the single point of contact for members and providers, ensuring everyone gets the information they need while reducing the workload for the company’s HR team. 

BENEFITS EDUCATION 

With associates working at order desks and on loading docks nationwide, benefits engagement and education is a challenge. We treat each member interaction as a chance to actively listen and make referrals to the appropriate resources. 

Prioritizing proactive member engagement