HR leaders will face big challenges in the year ahead — including, another year of rising health plan costs and worsening population health. To understand how HR plans to move forward and what support they’re receiving from insurers and plan administrators, Maestro...
People-Focused Healthcare: How We Do Clinical Care Management
By Stephanie Williams, Vice President of Clinical Solutions
It’s not a surprise that healthcare can be confusing for employers or the member. High costs, unclear benefits and tough-to-navigate care options are just a few of the hurdles many people face when navigating the healthcare system.
Healthcare should be a holistic solution that puts the person at the center. That’s exactly how our clinical care management program works at Maestro Health. Our approach is designed to meet our members wherever they are on their health journey, from managing complex chronic conditions to maintaining healthy habits.
Here’s a look at how we do more for our members.
Our clinical care management is in-house.
Having our team in-house makes it easier and quicker for teams to align with the member’s needs, from claims analysis to the clinical team. All of our nurses are also certified in case management, meaning they have the knowledge and expertise to address more than just the symptoms that brought the member to us in the first place, like financial hardships and emotional stressors.
We develop personalized relationships with our members.
Our clinical care management programs are designed around each member and their needs. Our nurses develop personal connections with each member through regular phone calls, coaching and support. These relationships are critical to our holistic approach to care management—we’re treating more than just symptoms.
Delivering the right care at the right time means looking past the chart and engaging with the member to understand all of their needs, both physical and emotional.
Here’s how we connect with our members:
One of our care managers was working with a member to manage a recent cancer diagnosis. Through their regular check-in calls, the nurse learned that the member was dealing with more than just a cancer diagnosis—they didn’t have hot water or reliable transportation. The care manager helped the member come up with a care plan and connected them with community resources to get a hot water heater installed and set up regular transportation to their doctor appointments.
Not only were we able to make sure the member avoided complications and had a care plan in place, we were able to give them a better quality of life outside of their immediate condition so that the member had less to worry about, ensure a safe home and prevent unnecessary healthcare costs.
We focus on continuous engagement, not just annual reminders and biometric screenings.
Our approach to wellbeing and care management extends well beyond open enrollment and email reminders. When we engage with our members, we often find that without our help, they wouldn’t know what their options are or, in some cases, just how serious their condition is.
Here’s how we engage our members:
One of our care managers called to check in on a member who had been recently discharged from the hospital for severe abdominal pain due to a liver issue. During the call, the member said they were still feeling ill and vomiting. The care manager recommended that the member go back to the hospital where it was discovered that they were also suffering from dehydration.
Without that follow-up, the member likely would have experienced worsening symptoms and an extended hospital stay. But that one call resulted a more educated member, a shorter hospital visit and a healthier outcome, all of which mean less healthcare costs for everyone.
Healthy people result in lower healthcare costs, but you can’t have healthy people if your health plan isn’t designed to support them.
When we work with our members, we’re doing more than just your average clinical care management program. We’re connecting people with their health by putting them at the center of everything we do, resulting in better health outcomes and lower healthcare costs.
Get in touch with us to learn more about our human-centered approach to self-funded benefits.