Hospitals and health systems face a distinct set of challenges when it comes to overseeing employee benefits. They need solutions that support their mission, encourage utilization of affiliated providers and help manage the total cost of care. At Meritain Health®, we support hundreds of health care customers and more than two million members nationwide. By designing benefits strategies that align with their goals, we’re supporting what matters most to health care organizations, from unmatched flexibility and savings opportunities to a seamless member experience.
Flexible network design and multi-tier capabilities
Every health care organization operates in a unique environment, with its own provider relationships, market dynamics and strategic priorities. As a result, network design has become one of the most important tools for balancing affordability, access and quality.
We’ve developed deep expertise in custom network and multi-tier design, allowing organizations to tailor network arrangements around their specific goals. With flexible configurations of up to five tiers, clients can encourage utilization of preferred providers, support affiliated network relationships and create opportunities for savings while maintaining appropriate access for members.
Wrap network options can further expand access beyond local networks when needed. Our flexible claims platform can even be customized down to the procedure level. This means services unavailable within a client’s domestic network can be covered at a higher benefit level through non-domestic providers, helping organizations balance access while protecting network value. In many markets, we also offer access to strategic value-based care arrangements that support efficiency, quality and preventive care.
Keeping care local with customized tools
Preserving care within an organization’s own network is about more than cost management. It strengthens provider relationships, promotes continuity of care and helps maximize investments made in care delivery systems.
To help with these goals, we offer customized provider search tools that make it easier for members to identify and access preferred providers and facilities. A customized look and feel allows the experience to align with a client’s brand. Search results can also prioritize tier one and tier two providers to support domestic utilization strategies. By simplifying navigation and helping members make informed decisions, tools like these contribute to a more intuitive and connected health care experience.
Helping members stay connected to care
Health care workers face demanding schedules and unique challenges navigating their own health and well-being. Our wellness-focused approach helps make resources, programs and support more accessible when and where they’re needed.
Members can access plan information online, connect with support resources and engage with digital tools around the clock. As an Aetna® company and part of the CVS Health® family, we also bring access to a broad range of enterprise capabilities, resources and expertise at both a local and national scale.
Offering collaborative clinical solutions
As health care organizations continue to advance population health and value-based care strategies, many are seeking benefits partners that can complement and support existing clinical initiatives. We’re proud to offer flexible, right-sized clinical programs designed to align with organizational priorities.
Through care management, condition-specific support and specialized clinical resources, we help engage members earlier, improve outcomes and create opportunities for meaningful savings. Programs may be integrated into a broader population health strategy and tailored to specific workforce needs. Areas of focus can include behavioral health, oncology, specialty drug management, maternity care, pediatric support, sleep health, chronic conditions and results-based utilization management.
Providing insights that support better decisions
Access to meaningful data is critical for managing costs, improving outcomes and optimizing network performance. That’s why we’ve invested in analytics capabilities specifically designed for health care organizations.
Our reporting, offered through Meritain Health Ready Data, provides deeper visibility into utilization patterns, diagnostic trends, admissions data and other key performance indicators that help inform strategic decision-making.
Health care-specific reporting also provides insight into domestic and non-domestic utilization trends, helping organizations identify where services may be occurring outside preferred networks and uncover opportunities to improve engagement and alignment. These insights support continuous improvement efforts while helping clients better understand the impact of their benefits strategy.
In addition, clients benefit from dedicated compliance resources, consultative account support and health care-focused expertise that can help navigate an increasingly complex regulatory and benefits environment.
Creating better health, together
Today, Meritain Health supports more than 300 health care clients nationwide, including hospitals, health systems and organizations across the care . This experience gives us a deep understanding of the unique challenges health care organizations face and informs the solutions we bring to our customers.
Through flexible network design, advanced analytics, clinical collaboration and a deep understanding of the health care industry, we’re helping organizations align their benefits strategy with their mission. Together, we’re helping create healthier workforces, stronger organizations and healthier communities.
