Why Quantum Health’s CEO Believes He Has the Winning Formula for Healthcare Navigation

Why Quantum Health’s CEO Believes He Has the Winning Formula for Healthcare Navigation
Why Quantum Health’s CEO Believes He Has the Winning Formula for Healthcare Navigation

The healthcare navigation market — especially companies targeting self-insured employers — is fairly crowded. You have public companies like Accolade, failed public companies like Castlight Healthnow private and merged with Vera Whole Health and a raft of other private companies like Included Health, Rightwayand HealthJoy. Not to mention point solutions for diabetes, MSK, hypertension, weight loss and so on that aim to lower costs related to these conditions for employers and health plans.

But the CEO of Columbus, Ohio-based private health navigation firm Quantum Healthbelieves it’s miles ahead of all these direct and indirect competitors. In a recent interview, Zane Burke said the company has been profitable since 2000. That’s, a feat that other, better-known players like Accolade have yet to achieve. The financial strength will likely cast the firm in a positive light to investors when Quantun decides to go public. Burke was coy about the IPO question and wouldn’t address it directly, but what he did talk about at length is the leg up Quantum has when it comes to interactions with providers:

“We take provider calls, so we are the only ones that takes providers. Nobody else in the industry [does that]. Sixty-eight percent of our call signals — the feed for our artificial engine — comes from those provider interactions. Simple things like if a provider calls and asks, ‘Is John eligible for this treatment – is this in network?’ we know right then that John is about ready to go on a healthcare journey. In the traditional healthcare sense, [it takes] 120 days [for employers] to get that claim and it’s [the] first time you see it. Cow’s out of the barn. The game is over at that point in time. [slightly edited]

This early pulse that Quantum gets can help in navigating the employee to the right set of providers for whatever the current healthcare need is. And that can in turn help to lower costs for the employer and provide a better outcome for the patient.

Why Quantum Health’s CEO Believes He Has the Winning Formula for Healthcare Navigation

Zane Burke, CEO of Quantum Health

“You have to be in that life flow of the member,” Burke declared to deliver the good outcomes and a better experience.

An equity research analyst recently commented on this provider interaction that Quantum touts.

“Accolade doesn’t spend a lot of time talking about whether they engage with providers as much as Quantum claims they do so,” said Jailendra Singh, a research analyst with Truist Securities, in an interview last week

In a research note published on January 16, Singh wrote:

“…Quantum advocates can engage with providers to understand the diagnosis and outcomes of a service to gain additional insights. In other words, Quantum can leverage intercept opportunities from provider interactions on top of member interactions to enhance its navigation services.”

Burke believes that the company’s technology platform allows’s Quantum’s “healthcare warriors” — the company’s employees who engage with members both physically and digitally — to have a comprehensive picture of the member.

“So they can say, ‘I can see you have access to Livongo. Oh I can see that you’ve done your A1c once but you didn’t test again. Is it a training issue? Is it something else?’ ” he explained.

And this, according to Singh, is precisely what employees want: a healthcare advocate. He contended that most people do not want to call their employers or insurers for help with a medical need. It’s because there’s no trust there.

“Put, Quantum and Accolade and Included [Health] in the mix there – they are the guys that act like they are the employees’ voice and they are going to act on their best interests,” Singh said. “They are trying to build trust on the employers, insurance company side.”

Singh declined to comment on whether Quantum will be more successful than competitors given all the financial and platform strength that Burke touts. Instead he acknowledged the opportunity as a whole.

“The market is still very under-penetrated and there are still a lot of greenfield opportunities for these players,” he said, noting that the market can easily support multiple companies vying for the employee benefit dollars.

Accolade of course is a public company, which has seen its fortunes — at least measured by its stock performance — founder. Roughly six months after it went public, the stock achieved a high of $59.28 in December 7, 2020, and has been on a downward slide ever since. It is currently trading for a little over $9.

Singh attributes the lackluster performance on a couple of factors. First, investor sentiment has shifted.

“Over the past two to three years, investor interest has shifted from focusing on the companies growing just top line to the companies growing top line and [being] profitable and generating cash flow,” he said.

Also, earlier last year, Accolade lost a large customer contract to Included Health.

“By way of background, Included Health maintained a long-standing relationship with Comcast, with Grand Rounds serving Comcast since 2014 and Doctor on Demand since 2015. Desiring a one full-stack solution, Comcast moved to All Included Care, which offered premium navigation, behavioral health, primary care, specialty care, and communities (a diversity & inclusion tool),” Singh wrote in a November 14 research note.

But Accolade hasn’t lost any big contracts and in fact contract retention recently has been pretty good, he said in the interview.

Quantum Health too has been holding its own in terms of customer retention — it has a 92% client retention, according to Needham senior analyst Ryan MacDonald. The company also boasts of high ROI – $2.50 for every $1 spent — on employee benefits.

“We give 2.5 to 1 ROI. That’s not cherry picking — I pick one client on a Saturday,” Burke declared. “That’s our entire book of business.”

The ROI is likely attractive to employers looking at solutions to manage spiraling healthacare costs, including for chronic conditions. Burke said that he also has a winning argument for employers who are slowly tiring of point solutions and want one place to send their employees to.

“[Employers] are not getting value out of all the point solutions stuff,” he said. “We want to do deeper integrations [with other vendor solutions] and say, “You don’t want the Livongo app, the Hinge app, whatever else is out here. You just want to go to one place.” [Hinge, Teladoc, are partners of Quantum Health.]

While winning with its core customer base of self-insured employers is vital, Burke is also looking to diversify Quantum’s customer base.

Last year, the company made investments in the government market to take care of state employees’s health needs.

“We invested last year in government and healthcare. We”ll invest this year in labor and health plan side of the business…No one should have to navigate their healthcare journey alone.”

Photo: Eightshot Studio, Getty Images and Quantum Health

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