Self-funded benefits

Clinical Care Management.

Build your clinical care management program.

No two people are alike, and neither are their health needs. Our multi-disciplinary care team provides advice, resources and the personalized support each member needs whether they’re regaining or sustaining a healthy lifestyle.

Our in-house approach to clinical care management combines all components of care management into one complete program to improve members’ overall wellbeing and empower them to make healthy decisions. Our programs are designed to meet people where they are on their health journey, from wellness to complex care management and everything in between.

Maestro Health’s clinical care management programs focus on integrating data insights and personalized service, allowing our teams to make strategic and smart decisions that result in better outcomes at a lower cost for each member.

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Position your health plan members for success in finding and maintaining their health.

We’ve built our self-funded solution around the core components of a good health plan: administrative solutions, clinical care management and cost management, with options to help you personalize your offerings.

We give you the power to take control of your healthcare expenses and deliver benefits that fit the needs of your health plan members. Your health plan members have their own definition of what healthy is for them. Our personalized approach guides each member to their ideal version of healthy across our care continuum. 

What we offer:

  • Utilization review and pre-certification
  • Acute case management
  • Expedited access coordination to reference-based pricing (when appropriate)
  • Overall wellbeing management, from physical wellness to mental health
  • Chronic condition management
  • Complex condition management
  • Biometric screenings

A self-funded solution designed for people.

Clinical care management is just one piece of the puzzle. Our self-funded solution is built around the three key components of any great health plan, allowing you to control costs and support members’ wellbeing. Check out how we tailor administrative services and cost management for our clients.

Administrative Services

We offer support and guidance on behalf of employers. Focus on the people and the business—we’ve got the rest.

  • Plan, claims & eligibility management
  • Member education & support
  • Web portal & mobile app
  • Analytics & reporting

Cost Management

Our team works with advisors and employers to lower costs by finding optimized solutions that do not compromise quality of care.

  • Provider network access options
  • Out-of-network repricing management
  • PBM maintenance
  • Alternative reimbursement & access strategies

A tech-enabled approach to clinical care management.

We look at the whole person to create a personalized health profile for each member so we can help them on their path to a healthier lifestyle.

Here’s how we personalize our clinical care management services:

We consult with you to figure out what’s best for your health plan members, from plan designs to company wellness challenges and incentives.

We gather member health statuses using data like health risk assessments, biometric screenings and real-time claim analytics.

We implement and manage care with scalable plans, care management, continued claim reviews and more. We continue to consult with you on your overall plan design and needs and work with members to maintain or achieve their healthy.

We use industry leading, evidence-based MCG guidelines to support clinical decision-making across the continuum of care.

We help members navigate the healthcare system, influencing both the quality of their outcomes and the cost of care. We provide timely intervention and expedite at the most appropriate level of care to effectively minimize the impact of a chronic condition or illness.

Our proprietary program, AutoTrigger™, reviews all historical claims data on a daily basis to flag members who are at risk or already experiencing catastrophic conditions.

Personalized clinical care management. Healthier outcomes.

Our clinical care management services are designed around the whole person, not just their condition. Our nurses develop 1:1 relationships with each member, resulting in personalized care and healthier people.

Here’s what some of our members are saying:

“I’ve lost 87 pounds since I started working with my nurse coach. She encouraged me every step of the way and helped me set realistic goals. I’ve learned so much about how to take care of myself. What a life-changing program!”

“After talking with my nurse coach, I realized I didn’t even know what preventative exams were recommended for my age group. I may have ended up with cancer if I never had that test.”

“At almost 40 years old with a pacemaker in my chest, I was scared when I learned I was expecting another child. Having a maternity nurse coach meant the world to me.”

“Managing my diabetes is overwhelming at this point. Even when the basics like knowing when and where to eat are still confusing to me.”

“I felt tired and short of breath. When I talked to my nurse coach, she immediately sent me to my doctor who said I was in congestive heart failure. He said my nurse coach was to thank for avoiding having to be hospitalized.”

Healthier members lead to a healthier bottom line.

The top 5% of members drive 51% of the healthcare costs for a business. Our personalized approach to clinical care management means we can target at-risk members before they impact your healthcare costs.

Meet our team.

Our multi-disciplinary clinical team is led by registered nurse case managers, including health coaches, registered dietitians and care coordinators. We engage both the member and their family to deliver support through self-managed education, personalized care plans, collaboration with healthcare teams and coordination of resources. Because of the breadth of our team, we’re able to match each member to our nurses’ clinical backgrounds.

Here’s a look at what we bring to the table:

  • 16 registered nurses, all certified case managers (with over 20 years of combined clinical and industry experience)
  • 3 utilization review and management nurses (with over 15 years of experience)
  • 2 Masters of Science in nursing
  • Certifications in transplant management
  • Certifications in diabetes education and management
  • 1 family nurse practitioner
  • 2 certified health coaches with degrees in health promotion
  • 1 wellness coordinator with a Bachelors of Science in health promotion
  • 1 health and wellness account executive with a Masters of Public Health

Let’s reconnect people with their health.

We’re here to create a self-funded solution that delivers healthy outcomes and lower costs without slashing benefits. Get in touch with us to learn more.

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