Quantum Well being, a healthcare navigation firm, has launched a navigation providing for Medicare Benefit plans, which the corporate is sharing completely with MedCity Information.

Based mostly in Dublin, Ohio Quantum well being has served historically self-insured employers and helps staff join with healthcare suppliers and digital healthcare options. It helps 3.1 million members and nearly 500 employers.

With the brand new Medicare Benefit providing, the corporate helps MA plans meet CMS necessities, conduct annual well being threat assessments and join members with a major care doctor. It additionally supplies navigation assist with its Healthcare Warrior groups, together with advantages professionals, claims specialists and nurses. These groups can enhance star rankings and assist with challenges reminiscent of entry to drugs and dealing with medical payments. As well as, the corporate “launching and managing data-driven, multi-channel outreach campaigns for focused interventions aimed toward closing gaps sooner,” the announcement stated.

“Healthcare is changing into more and more complicated,” stated Zane Burke, CEO of Quantum Well being, in an interview. “And it turns into a problem, and none of us truly wish to work in healthcare. All of us wish to be as near dwelling as doable in the most effective state of well being. It's no totally different once you're a senior and so they wish to be as wholesome as doable and do the issues they wish to do. …Actually, it aligns very effectively with what we do from a core perspective.”

Burke added that the corporate's Complete Care Options platform may be provided to MA prospects. The platform affords a collection of digital options that prospects can select to contract with, together with Headspace for psychological well being companies, Hinge Well being for musculoskeletal companies and KidneyLink for kidney illness assist.

Whereas the corporate has provided navigation assist to employers for a while, Quantum has tailor-made its assist for Medicare Benefit plans.

“We designed our Medicare Benefit navigation service to fulfill the distinctive wants of each Medicare Benefit plans and their member populations by leveraging our core capabilities to assist acute take care of an more and more growing older inhabitants, increasing networks of suppliers and digital care choices to cowl less-penetrated markets and rural populations, addressing SDOH wants, all to shut gaps in medical care and enhance medical outcomes,” stated Dan Shur, Chief Product Officer of Quantum Well being, in a press release.

The monetary mannequin with MA plans will probably be a mixture of each per-member-per-month contracts and threat contracts, Burke stated. Nonetheless, he stated he can't share any MA prospects but.

The launch of Quantum on the MA market comes at a time when MA registrations are rising. Greater than half, or 51%, of eligible Medicare beneficiaries are enrolled in a Medicare Benefit plan, based on KFF. Nonetheless, Medicare Benefit plans are additionally coming underneath rising scrutiny modifications to CMS star rankings. The common star ranking fell from 4.14 in 2023 to 4.04 in 2024, based on Paper. Quantum Well being needs to assist enhance star rankings with its navigation platform, based on Burke.

“Over the previous 12 months, many star rankings have dropped 12 months over 12 months,” Burke stated. “What we noticed once we appeared on the information is that we are able to have a big influence on these star rankings if we simply use our core options.”

Burke claimed that Quantum Well being is the “first unbiased navigation firm to enter the [MA] house.” Different healthcare navigation platforms embody Accolade And Well being pleasureserving each employers.

The information follows one other current report 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 will probably be linked to the VHAN community in Tennessee and surrounding states.

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