Personalized healthcare navigation improves member experience and reduces costs
Challenge

Embracing their geographically dispersed employee population and large retiree presence, Abbott sought to find a comprehensive solution that connected their employees with the right care at the right time.  Embracing their geographically dispersed employee population and large retiree presence, Abbott sought to find a comprehensive solution that connected their employees with the right care at the right time.  

Solution

Reducing specialty drug costs and improving benefits through care coordination services

By teaming up with Quantum Health, they were able to prioritize the benefits experiences for their 80,000 members and reduce claims costs, leading to significant improvements. 

REDUCING SPECIALTY DRUG COSTS 

We collaborated with Abbott to implement a highly effective specialty pharmacy site-of-care strategy. By shifting cases from inpatient to outpatient or home settings, Abbott saved an average of $40,000 per case while elevating the member experience. 

SIMPLIFYING POINT SOLUTIONS 

Managing 24 unique point solutions was taxing HR. Through integration, training and vendor summits, we collaborated with Abbott and engaged with high-risk members directly, guiding them to the appropriate resources. As a result, employees’ communication and understanding of available benefits significantly increased. 

ADVANCING FERTILITY BENEFITS 

Facing a year with $17M in claims costs and numerous neonatal intensive care unit cases, Abbott partnered with us to analyze data and plan design. They identified fertility treatment as the common factor among these cases. In response, Abbott built a business case for an enhanced fertility program. 

Our Care Coordinators successfully guided employees to centers of excellence, resulting in zero fertility NICUs since 2017. 

Results

Healthcare navigation drives ROI, reduces high-cost claims and improves member engagement

95%

engagement with members who had claims over $50K

$59M

5-year estimated cost avoidance

42%

reduction in surgical inpatient days ($311K cost avoidance)

2.7:1

ROI in 2022

Our partnership with Quantum Health is unique because they advocate for our employees and company plan. They’re an extension of our company — they represent our mission, share the same values, and have the same level of care for our employees as if they were their own.

Susana Pociejewsk
Manager of U.S. Health Plans, Abbott

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