Addressing rising costs and low engagement with healthcare benefits

A leading manufacturer of industrial steel products experienced years of climbing medical costs, driven largely by high-cost claimants. An audit found high-risk plan members getting minimal benefits guidance and clinical support.  

Given the company’s employee-centered philosophy, leadership saw the need for a more proactive approach to employee healthcare benefits design. 

Transforming employee wellbeing with real-time support and education

Quantum Health collaborated with the client’s benefits team on a multipronged benefits optimization and cost-savings strategy. Objectives included boosting engagement and care coordination among high-risk members, reducing out-of-network and inappropriate care, and driving point solutions utilization. 

STRATEGIC CLINICAL PARTNERSHIP  

Now, a dedicated Personal Care Guide nurse, alongside other clinical experts, regularly engages each high-cost claimant through their entire healthcare journey. In one case, our pharmacy specialists were able to identify a federal program that subsidizes an otherwise prohibitively expensive blood-disorder drug, reducing spend as well as cost burden for the employee. 

ENHANCED, FOCUSED ENGAGEMENT 

Healthcare navigation had an immediate impact on the majority male workforce’s appropriate utilization. Employee engagement in benefits and care improved when Quantum Health configured the employee incentive offering to include designating primary care providers and preventive screenings. 

BENEFITS PLAN OPTIMIZATION 

In managing the client’s plan more precisely, Care Coordinators found past cases where claims had been paid on ineligible devices and procedures. Fixing that cost driver, plus routinely sharing plan performance analysis, is helping the HR team evolve their benefits strategy while relieving them of benefits-related inquiries and workload. 

Comprehensive healthcare navigation improves outcomes, engagement and cost trend

Adopting a more strategic, clinically capable member services solution is paying off. Proactive benefits education and guidance are growing utilization and member satisfaction, and more employees are progressing from high-risk to moderate or low risk.  

The client’s leadership sees cost trend and workforce productivity both going in the right direction. Each year, their partnership with Quantum Health delivered meaningful results and a significant return on investment.