Coming in 2024: Your personal health care navigator

In 2015, April Floyd's then 9-year-old son, Dominic, became very ill. His parents didn't know what was wrong with him when they rushed him to the hospital. He was later diagnosed with Crohn's disease, a chronic gastrointestinal disorder, and is now doing well. But at the time, Floyd—senior director of Johns Hopkins University's Office of Benefits & Worklife—had to confront a confusing and complicated health care system. Coping with it was a formidable challenge, despite her professional expertise.

"This is what I do for a living—I do benefits, I do insurance—and I had trouble getting answers to basic questions, finding the right specialists, advocating on his behalf, all the while also trying to be his mother," she recalls. "He was incredibly sick, and I had a hard time figuring out his treatment and care. There wasn't a 'navigator' there just for me. I would have loved to have had somebody help me work through it."

She will have one in the future. And so will you.

As part of JHU's forthcoming medical benefits package, employees will have access to Quantum Health, a service that provides a personal team of nurses, benefits experts, and claims specialists who will be available to help employees with any questions or problems they may have. Employees will be able to choose from three CareFirst plans, which will vary in benefits depending on your needs and those of your family. Quantum will be available with all of them, at no extra cost.

Annual Enrollment starts Oct. 11 and ends Oct. 31. While insurance changes become effective Jan. 1, 2024, employees can call Quantum starting Dec. 1. Quantum will be available Monday to Friday, 8:30 a.m. to 10 p.m. Employees need not sign up for Quantum; they will be enrolled automatically.

Quantum's Healthcare Warriors, as they are known by clients, will be able to answer questions regarding claims, billing, and benefits; help you find in-network providers, verify coverage, obtain prior approval, if needed, and get in touch with your doctors to coordinate your treatment; help you review your care options; provide information on health issues; and even help you save on out-of-pocket costs.

CareFirst will still process claims and provide a network of doctors, but Quantum will be the go-to source for everything else. "It will become the new front door for all our health insurance and health care needs," Floyd says. "Anytime an employee has a question, needs a doctor or a new ID card, Quantum will help. It will be customer service for all your health care needs. You will never have to contact CareFirst. Quantum will always be available to help people navigate the health care system."

Quantum will assign a personal care guide nurse for patients with chronic conditions, for example, and those patients—and family members and caregivers—will be able to reach out directly to the same nurse whenever they have an issue or problem. Outside of the nurse's personal time off, absences, or sick leave, or the nurse changing jobs, "the goal is to keep the member and their family/caregivers with the same nurse throughout the duration of their health care journey," according to Quantum.

For example, Floyd says, "suppose you have an abnormal mammogram, and the doctor has to call in for prior authorization for another mammogram or biopsy. The doctor will contact Quantum for that. Quantum will be aware of what the employee is going through and reach out immediately. They will say something like, 'Hi, I'm a nurse with Quantum—not your insurance company. We heard from your doctor that you had an abnormal mammogram, and we can help. Do you need another radiology appointment? We can help you make it. Did you know that you can call me back with any questions you have? Do you know about Johns Hopkins' Employee Assistance Program or Work Stride program?' The nurse will become a navigator and resource for the employee."

Quantum says that the goal is "to stick with members until issues are fully resolved."

These services differ in important ways from the way things work now. For example, employees sometimes must field their questions and problems directly with the insurance company, a situation that has not always been optimal.

"The insurance vendor isn't always that helpful, or can cause more confusion," says Diana Abbott, director of Benefits Strategy and Service. "The Benefits Service Center does a phenomenal job at helping our employees as much as we can, and we often go back and forth with the insurance provider on their behalf—but insurance is complex, and we are not nurses or doctors and cannot always help in the ways our employees need it.

"Quantum has dedicated nurses and care coordinators who will work with our employees and their family members," Abbott adds. "They will call the doctor's office any time there is an issue or to clarify how our benefits work. Quantum will be able to help our employees through a new diagnosis and understanding what that might mean. This is an invaluable service when you need it."

Floyd, recalling her own experiences, says that she won't soon forget a frustrating argument with hospital caregivers about her son's medication. They tried to give him a drug that the doctors had not told her about, and she feared it was a mistake—and wouldn't let them administer it. She turned out to be right.

"Some of our employees have experiences like this every day, but not every parent is as informed and able to fight back as I did," she says. "At the same time, it would have been so much easier if I'd had someone else—a nurse advocate who knew me and my family—in the trenches with me. It's a benefit I really wish I'd had then and am very happy to have now."