Quantum Health, a healthcare navigation company, has launched a navigation offering for Medicare Advantage plans, the company shared with MedCity News exclusively.
Dublin, Ohio-based Quantum Health has traditionally served self-insured employers and helps connect employees with providers and digital health solutions. It supports 3.1 million members and nearly 500 employers.
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With its new Medicare Advantage offering, the company helps MA plans comply with CMS requirements, conduct annual health risk assessments and connect members with a primary care physician. It also offers navigation support with its Healthcare Warrior teams, which include benefits professionals, claims specialists and nurses. These teams can improve Star Ratings and help with challenges like accessing medications and dealing with medical bills. In addition, the company is “launching and managing data-driven, multi-channel outreach campaigns for targeted interventions aimed to close gaps faster,” according to the announcement.
“Healthcare is getting more complex all the time,” said Zane Burke, CEO of Quantum Health, in an interview. “And it’s getting challenging, and none of us actually want to be in the healthcare system. We all want to be as close to home in the best health status. That’s no different if you’re a senior, and they want to be as healthy as they can be doing the things they want to do. …Really, it’s very consistent with what we’re doing from a core perspective.”
Burke added that the company’s Comprehensive Care Solutions platform could also be offered to MA clients. The platform offers a selection of digital solutions that clients can choose to contract with, including Headspace for mental health services, Hinge Health for musculoskeletal services and KidneyLink for kidney disease support.
While the company has been offering navigation support to employers for some time, Quantum has tailored the support for Medicare Advantage plans.
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“We have designed our Medicare Advantage navigation service to meet the unique needs of both Medicare Advantage plans and their member populations by leveraging our core capabilities supporting acute care for an increasingly aging population, expanding provider networks and virtual care options to cover less penetrated markets and rural populations, addressing SDOH needs, all to close clinical care gaps and improve clinical outcomes,” said Dan Shur, chief product officer for Quantum Health, in a statement.
The financial model with MA plans will be a blend of both per-member-per-month contracts and at-risk contracts, Burke said. However, he said he cannot share any MA clients yet.
Quantum’s launch into the MA market comes at a time when MA enrollment is on the rise. More than half, or 51%, of eligible Medicare beneficiaries are enrolled in a Medicare Advantage plan, according to KFF. However, Medicare Advantage plans are also facing increased scrutiny and changes to CMS star ratings. The average star rating dropped from 4.14 in 2023 to 4.04 in 2024, according to Chartis. Quantum Health aims to help improve star ratings with its navigation platform, according to Burke.
“This past year, many star ratings declined year over year,” Burke said. “What we saw when we looked at the data is that we can have a significant impact on those star ratings if we just ran our core solution set.”
Burke claimed that Quantum Health is the “first independent navigation company that is launching into the [MA] space.” Other healthcare navigation platforms include Accolade and Health Joy, which both serve employers.
The news follows another recent announcement from Quantum Health that the company is partnering with Vanderbilt Health Affiliated Network (VHAN) to support self-funded employers. Quantum’s navigation platform is being connected with VHAN’s network in Tennessee and surrounding states.
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