COLUMBUS, Ohio, Sept. 19 /PRNewswire/ -- With healthcare costs continuing to escalate across the nation, Quantum Health today announced that the company’s innovative Coordinated Healthcare(TM) program saved participating employers $15.4 million over the past year -- holding their costs about 15% under budget. This emerging model of healthcare -- which works cooperatively with patients and their physicians to better coordinate healthcare activities -- has held employers’ annual cost increases to just 5-6% over the past six years, about one-third the national average.
The cornerstone of coordinated healthcare is a staff of “care coordinators,” who provide patients and families with information and guidance to help navigate through the healthcare process, reducing delays, duplication and waste along the way. Employers hire the coordinated healthcare program to serve their employees. The Care Coordinators are combined with specialized plan designs, patient advocacy and education, and advanced care management systems to create a coordinated health benefits plan.
The cost savings are generated by more efficient utilization of healthcare services. For instance, under the Coordinated Healthcare model, the use of specialty physicians decreases some 14%, while the more favorable use of primary care physicians for general diagnosis increases by an average of 26%. As a result, employers using the program in 2004 saw:
- Inpatient admissions decrease by 13% - Inpatient length of stay decreases by 16% - Inpatient days drop by 27% - Visits to the emergency room decline by 15% - Prescription costs drop by 10-15%
Quantum Health has been rolling out the coordinated healthcare model in employer health benefit plans since 1999. The company, whose management team includes several professionals from the field of consumer behavior and decision modeling, developed the concept based on research in the mid-1990s on the decision processes that drive healthcare utilization.
The company was founded by Kara J. Trott, a former healthcare attorney who had previously been a market researcher running projects for consumer goods and service companies such as Citibank and Ford Motor Company. Using her strategic marketing background, Trott led a research team that conducted interviews with thousands of patients and hundreds of doctors and their staffs. Among the key findings:
- 18-20% of healthcare events never needed to occur and could be eliminated through better coordination between physicians, patients, and their families. - 61% of individuals who attempt to “self-navigate” healthcare wind up at the wrong specialist, resulting in a delayed diagnosis and an average of $3,500 of unnecessary cost. - Physicians want help from someone who can guide and inform their patients -- under their direction -- after they leave the treatment room.
Trott said that more recent healthcare research showed that some 50% of patients leave the physician’s office unsure of their diagnosis and what they are supposed to do to manage their condition.
“It’s really no wonder that healthcare costs are rising out of control,” Trott said, “because the actual process that patients follow in healthcare is frequently out of control.”
“It’s such a complicated process with services provided by a disjointed array of providers, many of whom spend just 7-10 minutes with the patient. Information and diagnostic reports do not flow from one provider to another, even though the patients think they do. Doctors have no choice but to duplicate the tests for themselves.”
Trott saw the opportunity for a healthcare plan designed to facilitate the cost effective delivery of services. This focus on making healthcare more efficient stands in stark contrast to traditional insurance models that create savings by cutting benefits, shifting costs to employees, getting deeper discounts, or dictating medical protocols to physicians.
While the financial results help the employers, Trott said the most gratifying result is the positive impact on patients’ lives. She cited several comments recently received from program participants:
- “Your people have bent over backwards for me, even when I was really grouchy...they have taken care of my situation with such grace and consideration.” - “I couldn’t believe it when you called after I got out of the hospital just to ask how I was doing and if I had any needs or questions.” - “When I talk to a Care Coordinator, I know the answer is coming shortly and that it is the right answer. My Case Manager is the best...she calls me to check in and I can call her any time if I have questions.”
Trott gave the following as an example of coordinated healthcare in action:
- A patient contacted by Care Coordinators three days after discharge from a hospital reported that a specialist physician had ordered an MRI, and he dreaded getting back into the car and “being stuffed into that machine” while he was recovering from surgery. The Care Coordinators contacted the physician and alerted him that another specialist had just obtained an MRI four days earlier. They arranged for those MRI results to be sent to the second specialist, avoiding a $2,000 MRI and preventing further discomfort for the patient.
“Situations like this are commonplace and easy to fix,” Trott said. “We probably see that 5-6 times a day.”
In addition to the patient education, advocacy and guidance provided by the Care Coordinators, the Company utilizes advanced care management systems to track and guide patients through what Trott called, “the healthcare loop.” She said that healthcare has to be viewed as a process, from wellness to preventive screening, disease management, and acute care coordination.
“Most costs today are driven by patients with chronic conditions that can be effectively managed, and the number of such patients is rising rapidly with the aging baby boomers. The only hope of controlling healthcare costs is a comprehensive program that helps your employees manage their chronic conditions from the very earliest point of detection.”
The Coordinated Healthcare model is being noticed not only by the employer community, but by others in business and government as well. Trott and Randy Gebhardt, President and COO of Quantum Health, were selected by the U.S. Small Business Administration (SBA) for a recent meeting with President George W. Bush, during which they explained their approach to healthcare management and cost control for businesses.
Additionally, Trott was named regional Entrepreneur of the Year in the Emerging Business category in the prestigious annual Ernst & Young competition recognizing entrepreneurs in more than 40 countries. Trott now competes for the national awards, which will be presented at a November ceremony in Palm Springs, CA. Past EOY recipients include many companies who have since grown to become household names include Amazon.com, America Online, Applebee’s, Best Buy, Dell Computer, eBay, Enterprise Rent-A-Car, Starbucks and many others.
“What pleases us most about the results we are able to achieve,” says Trott, “is that participating employers are able to preserve their health benefits for their employees. At the same time, employees and their families receive a more reassured and satisfying healthcare experience. In an industry with such crazy waste and inefficiency, there truly is an opportunity to create a win-win solution.”
About Quantum Health LLC
Quantum Health LLC, based in Columbus, Ohio, operates coordinated healthcare programs for employee benefits plans, an important response to today’s runaway healthcare costs and increasing patient dissatisfaction. The program achieves superior cost control through specialized plan designs, patient education, and a staff of Care Coordinators who advocate for patients and assist physicians and their office staffs in guiding patients through the confusing healthcare process. Over the past six years, the program has held participating employers’ annual cost increases to just 5-6% including program fees, one-third the national average.
To learn more about Quantum Health or coordinated healthcare programs, visit www.quantumhealthllc.com or contact Jon Staub, Director of Marketing at (614) 846-4318, ext.142.
Quantum Health LLC
CONTACT: Jon Staub, Director of Marketing of Quantum Health LLC,+1-614-846-4318, ext. 142
Web site: http://www.quantumhealthllc.com//
