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...
How Maestro Health Does Clinical Care Management Better.
Blog Post
How Maestro Health Does Clinical Care Management Better.
Going self-funded has big benefits for many employers which can result in serious cost savings and better health outcomes.
Our in-house clinical care management program leverages a data-driven approach to personalize the care experience for each member we work with. Because our clinical care management program is in-house, we’re able to deeply integrate our programs with your health plan data, from understanding the needs of your group to targeting the right care for the right members at the right time.
We’ve built our programs to meet each member where they’re at on the continuum of care, from those who need a little extra help maintaining wellness goals to those juggling multiple chronic conditions. At the end of the day, our approach results in better health outcomes for patients while lowering healthcare costs for everyone. We work across the entire continuum of care to deliver the care each member needs to reconnect with their health and meet their goals.
Here’s what an integrated clinical care management solution looks like to us:
Acute Case Management
Members who struggle to manage an illness and who might not have a primary care team often have high pharmacy costs; utilize the ER for primary, non-emergency care; and have extended hospital admissions due to complications with their illness. Our clinical team engages these members to:
- Create individualized care plans
- Educate members on how and where they can seek out appropriate
- Help members work with their entire care team, like primary doctors, pharmacists and other providers
We’ve helped our clients see an average savings of $4,754 per member, per year through our acute care management program alone. By educating members on how to manage their conditions, understand where to seek out appropriate care and provide personalized care plans, we’re empowering each member to truly take control of their health. This means better health outcomes overall, fewer unnecessary ER visits and better plan utilization.
Complex-Condition Management
Also called “polychronic”, this program targets members struggling to manage multiple chronic conditions and frequently visit the ER. These members, along with acute cases, tend to drive the majority of high-cost healthcare spending for the plan and often result in lasers at stop loss renewal. Our clinical team works one-on-one with each member to:
- Create an individualized care coordination plan
- Review utilization – a process for analyzing the healthcare services provided to a member to ensure the member is receiving the highest quality care at a fair cost
- Help coordinate and provide prior authorizations and pre-certifications
- Empower each member to manage their conditions through medication review and care coordination
- Steer members to appropriate avenues of care, including coordinating with their PCP and helping avoid re-admissions or ER utilization
We document and measure member improvement using PAM scores, MMG benchmarks and other industry-leading resources to ensure members are on the right track and to help quantify cost savings for the plan. Our team will also work with your stop loss carrier at renewals to help reduce lasers and increases by leveraging documented progress and improvement for high-cost claimants and conditions impacting the group overall.
We’ve helped our clients see an average savings of $6,125 per member, per year with our chronic condition management program alone.
Chronic Care Management
This program serves chronic-risk risking members, or those that have at least one chronic illness. Care management is standard for any health plan that leverages stop loss, but instead of putting members on autopilot or using a fully automated process, we’re leveraging technology so that we can tailor the care experience around each member’s needs.
Our clinical team connects 1:1 with the member to:
- Provide 1:1 guidance to help manage chronic condition(s) and guide them through their healthcare journey
- Empower members with educational materials to better their condition and overall wellness
- Steer members to appropriate avenues of care
- Focus on continuous engagement throughout the process, not just at open enrollment
We helped a single group save $464,962 through chronic condition management in a single year through chronic condition management alone. By providing 1:1, personalized care plans for the members who engaged with our program, we’re able to put members back in control of their health and reduce lasers at renewal with well-documented case notes for each member we work with. This means that members are more engaged with their benefits, their health and their day-to-day care teams so that they can truly manage their health long-term.
Personalized Health Coaching
Members who are living unhealthy lifestyles or report out-of-range biometric statistics are labeled as “risk-rising”. Our clinical team reaches out and partners with the member to:
- Give personalized health and wellness advice and coaching
- Educate on the importance of wellness and provide healthy lifestyle information
- Reconnect each member with their health goals
By tailoring plans to the needs of each member, we can drive better health outcomes. Because no two members are alike, so why should their care be cookie cutter? By helping members connect with their health through setting attainable goals, understand what “healthy” looks like to them and engage with their benefits, our health coaching program provides lasting results and more engaged members.
Wellness Management
This program targets the plans healthy members or those that do not currently have health risks or progressive conditions. Our clinical care management team proactively engages members to:
- Perform ongoing health assessments like biometric screenings (test for blood pressure, cholesterol levels, BMI and more)
- Provide timely educational materials and host friendly competitions around relevant health and wellness initiatives
- Coordinate workplace incentive programs to promote continuous engagement with healthy lifestyles
Wellness doesn’t stop at enrollment, and neither do we. We’ll work with clients year round to help engage their members with their benefits and understand the needs of their group. This means we’re able to help avoid more costly issues (like ER usage) and engage all members with their own wellbeing.
A robust clinical care management program is critical to boosting the benefits of a self-funded health plan solution. Want to see how our in-house clinical care management program can result in savings for your business? Contact us for a preliminary claims analysis to see your potential savings.
