Quantum Health, the leading consumer healthcare navigation and care coordination company, has officially announced an expansion of its specialty pharmacy services to help self-insured employers and plan members save money. According to certain reports, this development attached to Premier Pharmacy navigation solution effectively builds upon the expertise of Quantum Health’s clinical pharmacy team, which is already known for advising members on cost-effective care under their medical benefit. Owing to the stated expansion, the company should be able to conceive value driven, clinically equivalent alternatives under their pharmacy benefit as well. To put things into perspective, Quantum Health’s specialty pharmacy capability, in its current shape and form, packs together utilization management, a site-of-care program, and the company’s proprietary Real-Time Intercept® capability to help its in-house Pharmacy Services team offer clinically appropriate medication options. This involves collaborating with providers to curate treatment right at the onset of a care journey, and therefore, ensure that the treatment is optimized clinically and financially.
Talk about Quantum Health’s Premier Pharmacy Navigation Solution on a slightly deeper level, though we begin from the promise of member identification, where one can use claims, formularies, and clinical criteria, alongside Quantum’s proprietary algorithms and platform, to identify more drug-level intervention opportunities. Having referred to intervention, the solution in question also tends to offer safe, effective, and appropriate therapeutic alternatives for the purpose of delivering high-value interventions and helping users generate a better return on their money.
“Quantum Health is committed to expanding our efforts in managing specialty medication costs,” said Zane Burke, CEO of Quantum Health. “By enhancing our strategies and extending our reach to the point of prescription, we aim to provide the most appropriate, high-value care from the start. While specialty medications make up a small percentage of prescriptions, they account for roughly 50% of total pharmacy spend. Our unique view into these trends through our health benefits navigation platform allows us to proactively engage with providers and direct members to the appropriate medication and best health.”
Next up, we must get into the facility to educate and support members. You see, by helping members access crucial insights, Quantum Health’s pharmacy support team is able to make them feel more involved throughout the process. This paves the way for a more collaborative healthcare journey. Not just that, Quantum Health is also focused on educating the providers’ contingent. Such a feature, like one might guess, should go a long distance in the context of facilitating new prescriptions and bringing the most effective treatment options for members.
The entire development delivers a rather interesting follow-up to the findings of Mercer’s 2023 National Survey of Employer-Sponsored Health Plans, where it was discovered that prescription medications remain the fastest-growing component across employee health benefits, with specialty drugs’ share rising by more than 10% in 2023. Another detail worth a mention here is rooted in the MedCity News and Quantum Health annual “The INDEX” benefit consultant survey. This particular survey saw nearly 28% of healthcare benefits consultants recommending pharmacy spend management as a way to improve employers’ healthcare spend. On the other hand, 61% of consultants were also found to be advising clients, rather often, on drug cost and pricing strategies. Hold on, there is one more study contextualizing the importance of such a development. Conducted back in 2023, this one covered over 200 Quantum Health employer clients and 1.8 million members. In essence, the study found that Quantum’s navigation platform achieved a 91% success rate in shifting the site of care for members’ specialty drug treatment, while simultaneously saving plan sponsors around $2.08 per member per month on specialty drug costs.