Quantum Health doesn't operate like a traditional healthcare company.

Quantum Health doesn't operate like a traditional healthcare company. Founder and CEO Kara Trott believes that's why the care coordination and consumer navigation company is seeing such success as a disruptor in the industry.

"We have been very, very focused as a company on doing the things that actually create value for the consumer experience and that are matched up to how consumers actually experience the healthcare journey. That's very different than (the rest of) our industry, because most of the drivers in our industry are very transactional, it's designed for convenience of administration, financial risk management," says Trott, a former corporate attorney and strategic marketing consultant for brands like Citibank, Ford, Walmart and Coke.

After two years of research following the "healthcare journeys" of 3,200 patients and over 290 physicians, Trott launched Quantum. The patient-focused concept that is the foundation of Quantum operations was based on Trott's application of the techniques she'd used to solve consumer challenges in merchandising and retail sectors.

"We saw the model start to come together, (then) it was just the idea of taking it from theory into practice and seeing if it really would work in real practice." Trott says she was surprised to see the niche unfilled when she founded Quantum in 1999.

"I'd come from industries where the consumer was king: You don't make a move without studying the consumer. In retail and consumer goods and products, if you don't get that right, you don't survive. So I was really shocked in health insurance when people are going through such difficult challenges, that there's simply no comprehension" of the healthcare process from the patient perspective, says Trott.

She and her team determined that the average patient spends 11 months dealing with a healthcare incident. They are often under physical, emotional and financial stress. When patients reach the inevitable bottlenecks in the insurance claims process or personal roadblocks to treatment, their recovery can derail, leading to higher costs and poor health results.

Quantum works with the benefit members of the large self-insured companies who are their clients. "A big piece of that is working with that consumer in just how they journey, and dealing with what we call process behavioral gaps," says Trott. Quantum's innovative "pod" structure assigns each company beneficiary group to a devoted team of care coordinators and multi-disciplinary nurses. These 25- to 30-person teams act as single points of personal contact for each covered employee in an organization, helping them with everything from ordering new insurance cards to chronic condition management, pharmacy benefits and a range of non-health related issues that negatively impact treatment.

For example, one beneficiary undergoing a high-risk pregnancy was ordered on bed rest. Because of her obligations to her other children and transportation problems, she disobeyed the order and missed appointments. The situation presented a threat to the lives of the mother and her unborn child, along with the potential for six-to-seven figure medical bills should it result in a risky pre-term delivery.

"We talked to her employer and convinced them to pay for housekeeping and transportation to the doctor's office. The employer paid $3,000 for those services, said 'Yes,' and avoided the preterm delivery. She delivered safely, no complications, at full term," Trott reports.

The flexibility of Quantum's self-insured clients also promotes the personalized solutions Quantum is able to formulate with patients. Quantum works with over 500,000 individuals through 70 clients. Trott says the pod structure makes the intense one-on-one care possible. Each pod will work with between one and eight clients, depending on the number of employees enrolled in the company health plan. "They know those companies, they know their benefit plans, they know how they want their people treated," says Trott.

Care coordinators go through a "cultivation" period of six to eight weeks during which they are trained in a classroom setting, work with a member conversation coach, then partner up in a pod.

Only a small percentage of Quantum's employees come from a call-center background, says Trott. Quantum's best care coordinators come from the retail, hospitality or social services sectors; jobs where "they actually had to sit in front of a customer in an intense situation, listen to them, hear the question behind the question, express empathy and compassion and solve the problem right then," says Trott. Patients are more than just a number, despite Quantum's client volume.

The healthcare industry is "increasingly becoming a retail industry with a more direct connection with the consumer," says Trott. As a company that has a proven track record with all of the major insurance companies through its base of large, self-insured corporate clients, Quantum is prepared to continue on the 46-percent membership growth rate it's experienced through the past four years. GE Ventures and Altaris Capital Partners are among several investor groups that committed capital to Quantum last year.

"This market's just sort of created some openings here in the last two years, and we've stepped into that in a very, very strong way," says Trott.



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