Clinical Care Management.
Engaging members with their health is our priority.
Every member has their own definition of what healthy looks like for them. That’s why we take a personalized approach designed to help members define and meet their goals across the continuum of care.
Our in-house clinical care management program leverages a multi-disciplinary care team who provides personalized advice, resources and support each member needs to improve their health and wellbeing and empower them to make healthy decisions.
We focus on integrating data insights and personalized member support, allowing our multi-disciplinary teams to make strategic and smart decisions that result in better outcomes at a lower cost for each member.
We’ll work with you to understand which clinical programs work best for your members.
Analyze & Review
We’ll look at your historical health claims data, including health risk assessments and biometrics. Autotrigger™, our proprietary claims analysis platform reviews historical and current claims data to flag at-risk members for clinical intervention.
Using Autotrigger, we’ll put our scalable managed care strategies in place and match each member to the most appropriate care management program.
Manage & Support
We’ll help members navigate the healthcare system, provide timely interventions and expedite appropriate levels of care to minimize the impact of a chronic condition and drive healthy outcomes.
We use industry-leading, evidence-based guidelines, like MCG and PAM, to support clinical decisions and measure improvement.
Quantifying savings from clinical interventions can be tough. Luckily for you, we did the math. Check out our case study to see how we showed one group how our in-house clinical care management programs could net them over $3M in savings and avoided costs.
Programs designed to meet your members wherever they’re at.
Our approach to clinical care management combines all components of care management into one complete program to improve members’ health and 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.
Meet Autotrigger™, our proprietary claims analysis platform.
Autotrigger scans claims daily against over 10,000 diagnosis codes and benchmarks to help flag at-risk and risk-rising members for our clinical team as early as possible. By intervening with members as early as possible, we can help avoid costly claims and help drive better health outcomes for the members who need support.
Our in-house clinical care management program results in serious savings.
Want to see how our approach results in lower costs and better health outcomes? Download our latest case studies and info sheets to see how personalized care management means better cost management.
Quantifying care management savings can be tough. Luckily, we did the math for you. We looked at how our in-house clinical care management programs could result in serious savings for an actual group of 250 lives over a 12-month period. We leveraged data across the industry and our book of business to show you how our clinical interventions translate into savings.
Our clinical, operations and client experience teams worked together closely to help keep our clients and their members informed and supported. Using our proprietary claims review platform and review process to identify at-risk members, we developed a rapid-response identification and outreach strategy so we could act quickly while keeping our focus on our clients. Our approach helped our clients save over $100k.
We sat down with Stephanie Williams, our VP of Clinical Services, to learn more about the clinical care management programs at Maestro Health and how we’re re-shaping care management to put people first.
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.
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
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
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.