Medical breakthroughs are occurring more rapidly than ever. Genomic testing, gene editing (CRISPR), targeted cancer treatments and new specialty pharmaceuticals are just a few of the emerging advancements that promise to help people live longer, healthier lives. How to help employees find the right care in an increasingly complex and costly healthcare system is a top priority for today’s employers. 

Warranted wariness

A lack of trust in traditional health insurance industry has pushed employers and employees to look for new alternatives. Digital solutions have proliferated but rather than enhancing the consumer experience, they further fragment it. Consumers on an unchosen healthcare journey are often bewildered and frightened but must navigate new medical technology, complex benefits, out-of-pocket costs, various digital apps and life and financial barriers on their own. Consumer navigation and care coordination has become more and more attractive to employers and employees who are looking for support and guidance.

Consumer navigation and care coordination must be highly responsive and fully immersed in an individual’s healthcare journey. This means working closely, with providers, third-party administrators and pharmacy benefit managers to ensure the best possible care at the most affordable cost. It must provide support and guidance by specialists and clinicians who possess the expertise, empathy and technology to truly understand, anticipate and solve consumers’ needs in the moment they need help.

Targeted expertise

For employers, having an independent expert who can eliminate the factors that drive up health plan costs, such as unnecessary diagnostics, out-of-network care, excessive in-patient stays, avoidable readmissions, redundant services and unreasonably costly sites of care for specialty medications is crucial. For employees, consumer navigation and care coordination provides the help they need to maintain or recover their health, reduce the stress and confusion of facing an illness or injury and be more productive in the workplace.

As the market leader, Quantum Health has proven this type of solution builds trusting consumer relationships as validated by a Net Promoter Score in excess of 70 and a reduction of employer and employee out-of-pocket costs by an average of 5% in year one and over 11% within three years.