Employers looking to save on health insurance costs by self funding often face the dilemma of either paying market rates for the services of a fully insured provider, or plugging together third-party solutions that may save on costs but don’t always interoperate.

In March, Maestro Health of Chicago, Ill. introduced maestroEDGE, a solution intended to resolve both the integrated technology and cost-savings concerns around employer-provided health insurance. CEO Rob Butler says the platform includes the wraparound services of a thin-client web portal, the decision support of individual brokers and benefit advisers, and integrates with the Maestro Health self-funded TPA.

Butler, who traces his roots in the benefits and technology sector to the days he helped grow health plan administrator PayFlex industry into a property later acquired by Aetna, says maestroEDGE represents “a modernized approach to the way self-funded insurance has traditionally been offered,” combining client onboarding, account management, private exchange services, and benefits administration with a self-funded solution. By streamlining a variety of services in a single solution, Butler believes maestroEDGE can lend greater clarity to a number of employer needs.

“There’s a very high level of employers and employees who just don’t understand benefits,” says Butler. “They don’t know what their plan is all about, they struggle with what those benefits mean, or they’ve got several vendors. You can simplify it for the employer and create a solution that allows the employer to shop, enroll, and live on one platform.”

Providers who offer a cloud-based benefit enrollment tool typically save costs by cutting out broker services. Instead, maestroEDGE combines a self-funded solution with a modular, online onboarding and benefits education platform that the company says, “empowers brokers” to compete against larger, automated service providers.

“It helps the broker maintain and grow their business,” Butler says. “It gives them a modern, innovative solution that we can customize by broker, by employer. We allow the broker to brand it their way. Once the broker relationship takes off with the local employer, they don’t care that it’s my name on the software.”
In addition, Maestro helps simplify benefits messaging while retaining the decision support capabilities of a benefit adviser. The solution can also compile historic data to create analytics-based guidance that can further inform executive strategies.

“I think what we’ll figure out is how to do a good job taking that data from our claims and create a better decision-support tool,” Butler says. “We can help you enroll, and when you have a life event change, we’re the same ones helping you, and it’s on an integrated platform.”

Barbara Gniewek, Principal at PricewaterhouseCoopers says that Maestro’s approach considers the supply side of healthcare, and not just the demand side.

“Part of the beauty of an exchange is getting employees to understand healthcare better, but also to get a better understanding of price differentials and protocols, so that when you’re seeking healthcare, they’re using the best protocols, and therefore the best pricing,” Gniewek says.

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“There’s a very high level of employers and employees who just don’t understand benefits."

Leveraging care management strategies helps bridge employee information and patient advocacy needs, and with a TPA that offers the option of controlling services beyond just claims payment, it can drive better health outcomes. In such a scenario, she says, the differentiator becomes whether the network connected to the platform delivers services that are as valuable to the insured as to their employer.

“If we can get people to play in these care management programs, the outcomes are ultimately better,” Gniewek says. “The kicker is you’ve got to have the network. Do you have to have the big, broad network, or can you use narrower, high-performing networks?”

“Everyone’s figured out the demand side—right plan, tools, transparency—and they’re trying to overlay this care management, whether through advocacy or high-touch care management,” she says. “The last piece is how to get the right network together on these platforms.”

She adds, “I’m not sure that the big health plans are going to lease their network to a TPA.”

Maestro Health says its platform’s technology is flexible and modular, allowing clients to go “all-in or à la carte,” with the ability to choose individual components of maestroEDGE without having to implement the entire platform.

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