Quantum Well being, a healthcare navigation firm, has launched a navigation providing for Medicare Benefit plans, which the corporate shared solely with MedCity Information.
Headquartered in Dublin, Ohio Quantum well being It has historically served self-insured employers and helps join workers with digital well being suppliers and options. It helps three.1 million members and almost 500 employers.
With its new Medicare Benefit providing, the corporate helps MA plans meet CMS necessities, conduct annual well being danger assessments and join members with a main care physician. It additionally presents navigation help with its Healthcare Warrior groups, which embody advantages professionals, claims specialists and nurses. These groups can enhance star scores and assist with challenges like accessing drugs and managing medical payments. Moreover, the corporate is “launch and handle data-driven multi-channel outreach campaigns for focused interventions geared toward closing gaps sooner,” in accordance with the announcement.
“Healthcare is changing into extra advanced,” Zane Burke, CEO of Quantum Well being, mentioned in an interview. “And it's changing into a problem, and none of us actually need to be within the healthcare system. All of us need to be as near dwelling as doable in one of the best state of well being. That's no completely different when you're a senior and so they need to be as wholesome as doable doing the issues they need to do. …It's actually very in line with what we're doing from a core perspective.”
Burke added that the corporate's Complete Care Options platform is also supplied to MA clients. The platform presents a collection of digital options that clients can select to enroll in, together with Headspace for psychological well being providers, Hinge Well being for musculoskeletal providers and KidneyLink for kidney illness help.
Whereas the corporate has been providing navigation help to employers for a while, Quantum has tailor-made help for Medicare Benefit plans.
“We’ve designed our Medicare Benefit navigation service to satisfy the distinctive wants of Medicare Benefit plans and their member populations by leveraging our core capabilities that help acute take care of an more and more growing older inhabitants, increasing supplier networks and choices. of digital care to cowl under-penetrated markets and rural populations, addressing SDOH wants, all to shut scientific care gaps and enhance scientific outcomes,” mentioned Dan Shur, chief product officer at Quantum Well being, in an announcement.
The monetary mannequin with MA plans shall be a mix of per-member-per-month contracts and at-risk contracts, Burke mentioned. Nonetheless, he mentioned he can’t share any MA shoppers but.
Quantum's launch into the grasp's market comes at a time when grasp's enrollment is rising. Greater than half, or 51%, of eligible Medicare beneficiaries are enrolled in a Medicare Benefit plan, in accordance with KFF. Nonetheless, Medicare Benefit plans additionally face elevated scrutiny and modifications to CMS star scores. The typical star ranking fell from four.14 in 2023 to four.04 in 2024, in accordance with Paperwork. Quantum Well being goals to assist enhance star scores with its navigation platform, in accordance with Burke.
“Final yr, a whole lot of star scores went down yr over yr,” Burke mentioned. “What we noticed after we analyzed the info is that we will have a major affect on these star scores if we merely execute our core resolution set.”
Burke mentioned Quantum Well being is the “first impartial navigation firm to go to market.” [MA] house.” Different healthcare navigation platforms embody Accolade and Pleasure of well beingthat serve employers.
The information follows one other current one. commercial from Quantum Well being that the corporate is partnering with Vanderbilt Well being Affiliated Community (VHAN) to help self-funded employers. Quantum's navigation platform is connecting to VHAN's community in Tennessee and surrounding states.
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