TodayManage the claim after care
Cost is reviewed only once care has already happened, and the claim has already been created.
Care
ClaimCost Management
ClaimCost Management
Control how specialty care enters your health plan — before claims are created.
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The ShiftHealCo governs how specialty care enters the plan—before the claim is created.
TodayCost is reviewed only once care has already happened, and the claim has already been created.
ClaimCost Management
With HealCoGovernance is applied at the entry point — before a pathway is chosen, and before a claim exists.
GovernanceRoutingCareClaim
Make the governing decision before specialty care becomes a claim.
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Define how care enters and moves through your plan.
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Establish clinical criteria and pathway steps.
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Set provider supply, approved options, and capacity.
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Apply rules, benefits, and incentives that guide decisions.
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Publish the governed pathway with confidence.
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Maestro applies the pathway at the point of entry.
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Maestro turns plan governance into action — routing members, enforcing pathways, and recording each decision back to Decision Desk.
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Governed Routing: Executes pathways configured through Decision Desk.
Pathway Enforcement: Applies employer-defined rules, clinical criteria and approved care options at entry.
PPO Fallback: Preserves the existing network when a governed pathway doesn’t apply.
Decision Logging: Records routing actions back to the governance record.
See the decisions, actions, and evidence behind governed care.
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Real-world evidence from HealCo's operating experience—built through years of care delivery, network collaboration, and governance in action.
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Contact UsNo. HealCo overlays the existing health plan infrastructure.
The TPA continues to administer the plan and process claims, while the PPO remains available as the fallback network. HealCo adds a pre-service governance layer that determines how care should enter the existing system before a claim is created.
The TPA processes what happened. HealCo governs what should happen next.
Not necessarily.
HealCo is designed to begin without replacing the existing health plan, TPA, carrier, or PPO.
An employer can start with a defined specialty-care pathway while preserving its existing administration and network. HealCo adds the governance and routing layer around that infrastructure.
Over time, an employer may choose to modify plan design, incentives, direct contracts, bundles, or other components to strengthen pathway adherence, but replacing the underlying plan is not a prerequisite to begin.
HealCo changes how the existing plan is used before it requires changing what the plan is.
Very little by design.
HealCo layers into the existing administration rather than requiring the TPA to rebuild it. Initial deployment requires the agreed eligibility and claims-data exchange for the account, while the TPA continues its existing eligibility, claims, payment, and network functions.
Initial exchange can use standard batch/SFTP workflows.
HealCo strengthens the incumbent broker relationship rather than replacing it.
The broker remains the employer's benefits advisor and relationship owner. HealCo provides an additional infrastructure layer that can be incorporated into the employer's existing benefits architecture.
Sold through the incumbent stack, not around it.
Governed routing turns an employer's healthcare strategy into an executable pathway before care begins.
The employer establishes the governance rules and approved pathways. When a member needs care, Maestro executes the appropriate entry pathway—such as primary care, imaging, a specialist, women's health, pharmacy, a bundle, or the PPO fallback.
The routing decision is recorded so the employer can evaluate whether care followed the governed pathway.
HealCo creates a record of the governance decision, the routing action and, where data is available, what happened afterward.
The evidence is designed to show:
What pathway was establishedWhy it was selectedWhat routing decision was madeWhether the member followed the governed pathwayHow encounter and claims activity corresponded to that decisionThe goal is an attributable, exportable governance record created as decisions occur—not reconstructed after claims have already been incurred.
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Start with a focused deployment or request a brief to explore the fit.
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