Quantum Well being, a healthcare navigation firm, has launched a navigation providing for Medicare Benefit plans, the corporate shared with MedCity Information solely.
Dublin, Ohio-based Quantum Well being has historically served self-insured employers and helps join staff with suppliers and digital well being options. It helps 3.1 million members and almost 500 employers.
With its new Medicare Benefit providing, the corporate helps MA plans adjust to CMS necessities, conduct annual well being threat assessments and join members with a main care doctor. It additionally presents navigation assist with its Healthcare Warrior groups, which embody advantages professionals, claims specialists and nurses. These groups can enhance Star Rankings and assist with challenges like accessing medicines and coping with medical payments. As well as, the corporate is “launching and managing data-driven, multi-channel outreach campaigns for focused interventions aimed to shut gaps sooner,” in accordance with the announcement.
“Healthcare is getting extra advanced on a regular basis,” stated Zane Burke, CEO of Quantum Well being, in an interview. “And it’s getting difficult, and none of us really need to be within the healthcare system. All of us need to be as near house in the very best well being standing. That’s no completely different when you’re a senior, they usually need to be as wholesome as they are often doing the issues they need to do. …Actually, it’s very according to what we’re doing from a core perspective.”
Burke added that the corporate’s Complete Care Options platform may be provided to MA purchasers. The platform presents a collection of digital options that purchasers can select to contract with, together with Headspace for psychological well being providers, Hinge Well being for musculoskeletal providers and KidneyLink for kidney illness assist.
Whereas the corporate has been providing navigation assist to employers for a while, Quantum has tailor-made the assist for Medicare Benefit plans.
“We have now designed our Medicare Benefit navigation service to satisfy the distinctive wants of each Medicare Benefit plans and their member populations by leveraging our core capabilities supporting acute take care of an more and more growing old inhabitants, increasing supplier networks and digital care choices to cowl much less penetrated markets and rural populations, addressing SDOH wants, all to shut scientific care gaps and enhance scientific outcomes,” stated Dan Shur, chief product officer for Quantum Well being, in an announcement.
The monetary mannequin with MA plans will likely be a mix of each per-member-per-month contracts and at-risk contracts, Burke stated. Nevertheless, he stated he can’t share any MA purchasers but.
Quantum’s launch into the MA market comes at a time when MA enrollment is on the rise. Greater than half, or 51%, of eligible Medicare beneficiaries are enrolled in a Medicare Benefit plan, in accordance with KFF. Nevertheless, Medicare Benefit plans are additionally going through elevated scrutiny and modifications to CMS star rankings. The common star score dropped from 4.14 in 2023 to 4.04 in 2024, in accordance with Chartis. Quantum Well being goals to assist enhance star rankings with its navigation platform, in accordance with Burke.
“This previous yr, many star rankings declined yr over yr,” Burke stated. “What we noticed once we seemed on the information is that we are able to have a major influence on these star rankings if we simply ran our core resolution set.”
Burke claimed that Quantum Well being is the “first unbiased navigation firm that’s launching into the [MA] area.” Different healthcare navigation platforms embody Accolade and Well being Pleasure, which each serve employers.
The information follows one other current announcement from Quantum Well being that the corporate is partnering with Vanderbilt Well being Affiliated Community (VHAN) to assist self-funded employers. Quantum’s navigation platform is being related with VHAN’s community in Tennessee and surrounding states.
Picture: designer491, Getty Photographs
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