From High Cost to Under Control

Case Study

SCM Solution Overview – Financial Impact

Effective Date: August 1, 2022, with a 12-month rate period spanning from August 1, 2022, to July 31, 2023.

Escalating High-Cost Claims, Particularly In Renal Dialysis Treatments.

CLIENT BACKGROUND:

A self-insured employer sought assistance from Specialty Care Management (SCM) to address escalating high-cost claims, particularly in renal dialysis treatments. The organization approached SCM after a referral from a nationally recognized employee benefits broker, seeking a solution to reduce costs and regain control over their renal related healthcare expenditures.

ENGAGEMENT APPROACH:

SCM prepared a comprehensive management plan tailored specifically for the Employer, targeting cost reduction while ensuring quality care for members undergoing renal dialysis treatments. The plan leverages SCM’s unique case rate approach to provide predictability in expenses, shielding against market inflation and fluctuating billed charges. Further by partnering with SCM, the client gains access to a robust clinical management team, capable of addressing comorbidities and precursors to high-cost claims, as well as complimentary data analytics.

OUTCOME:

The adoption of SCM’s solutions resulted in significant savings for the Employer. By transitioning to SCM’s case rate approach, the organization achieved total additional savings off of their paid claims amounting to $519,460 annually.

Are there millions in extra savings hidden in your health plan?

Conclusion

The partnership between the self-insured Employer and Specialty Care Management exemplifies the effectiveness of proactive, transparent, and innovative approaches in controlling high-cost healthcare claims. By embracing SCM’s solution, the client successfully mitigated financial risks while ensuring optimal care for their members undergoing dialysis treatments. This case underscores the importance of strategic collaborations and tailored solutions in navigating complex healthcare challenges, ultimately leading to sustainable cost control and improved patient outcomes.

We look forward to discussing this and other examples of our work, and invite you to a complimentary discovery call and renal risk analysis.

We look forward to discussing this and other examples of our work, and invite you to a complimentary discovery call and renal risk analysis.

About Specialty Care Management (SCM)

Specialty Care Management (SCM), established in 2002, operates with a clear mission to enhance the value of healthcare plans for all stakeholders involved. Specialty Care Management (SCM) works with self-insured employers of all sizes to mitigate risk and control cost linked to high-dollar renal dialysis claims, while improving member population health.

Our program verticals encompass Dialysis Risk Management & Repricing, Chronic Kidney Disease (CKD) Clinical Coaching, and Comprehensive Data and Risk Stratification Analysis. Our team brings together leading talent across Healthcare Administration, Clinical Case Management, and Provider/ Payee Contract Law. Further, our solutions can be implemented off-cycle and include performance guarantees.

Central to SCM’s philosophy is simplicity, transparency, and proactive management of high-cost renal claims, ensuring predictable and sustainable cost control for their clients.