In December 2020, Congress signed the Consolidated Appropriations Act (“CAA”) into law. Among other provisions, the CAA includes the No Surprises Act. The No Surprises Act requires all group health plans, including grandfathered plans, to apply in-network cost sharing...
Better Benefits Exist With Maestro Health.
We’re putting employers in control of their healthcare costs with a sustainable, scalable self-funded solution. Our approach to self-funded benefits is designed to arm you with more flexibility, transparency, cost management strategies and plan insights.
There are a lot of choices out there when it comes to benefits, and a lot of those decisions rest on how to provide stability for the bottom line and for your employees. A self-funded solution can give you that stability and a whole lot more at costs that are designed around your budget (not someone else’s overhead).
Working with an independent TPA like Maestro Health can mean the difference between addressing cost drivers with benefits strategies and services tailored to your population versus your costs going up year after year.
Ready for a better health plan solution that benefits both your bottom line and your people? Here’s a look at the benefits of self-funding with Maestro Health as your TPA.
Flexible plan designs.
Other plan types force you into a one-size-fits-all design, sticking you with services you don’t use, fees you have no say in and zero insights to manage your plan. Our self-funded solution opens you up to a lot more options and flexibility.
Here are just a few of the ways we help you customize your plans to fit your needs:
- Network options, including national PPO, narrow networks and wrap networks
- Direct contract management
- Stop loss shopping
- Clinical care management programs, including wellness and chronic condition management
- PBM management
- Ability to plug and play with the vendors you want (we even have a fully vetted list of preferred partners)
Access to your data.
Stability is built on informed decisions. You can’t manage your costs if you don’t know what’s driving them. When you work with us, you get access to your data at no extra charge alongside a suite of 26 custom reports and Maestro Health Analytics™, our powerful analytics platform.
Our dedicated team works right alongside you to understand what’s driving plan costs, what’s impacting your members and all the details in between.
Here are a few of the insights we surface to help you manage costs and drive plan performance:
- High-cost members, like ER frequent fliers
- Gaps in care
- Plan costs by month
- Avoidable care and ER analysis
- Medications and mark-ups
Predictive modeling and risk mitigation.
Healthcare is unpredictable, which is why we’re always expecting the unexpected. We work with employers and brokers to help you assess all the variables so you can plan out long-term health plan stability.
With our partner Claros™, we’ll model out all possible scenarios and cost variations using your claims data (or a model that closely represents your group) to show you what your max and expected costs look like, compare different plan models and help you design a plan with your specific risks in mind.
We’ll also help you shop stop loss options so that you can have the right protection in place for catastrophic claims or overall bad claims year (2020 anyone?).
Driven by data, led by people.
We use data as the foundation of our solution, from the strategies we put in place to how we help you create the best plan experience. But we won’t leave you on autopilot. We value a people-first approach, from brokers to HR teams to members. Here’s what that looks like to us:
- Our in-house repricing team leverages market analysis and industry methodologies through Pricegauge™, our proprietary platform, to reprice out-of-network claims based on local market rates and national benchmarks.
- Autotrigger™, our proprietary claims analysis platform, enables our in-house multi-disciplinary clinical team to reach out to at-risk members as early as possible and prevent costly claims. Here’s how it works:
- Autotrigger reviews historical claims each day against 10,000 diagnostic codes and flags any members who may be at-risk or risk-rising.
- Our nurse case managers reach out to the member to engage or enroll them in a care management program and assess their condition.
- We’ll continue to work with the member to manage goals and their condition.
Tired of bad benefits? We’ve got a solution for that. Learn more about our self-funded solution and our people. If you’re ready to chat options, our self-funded experts are here to show you what self-funding looks like for your business.