Case Study

Out-of-Network Open Lung Cancer Case

SCM Savings Breakdown
Total Savings = $17,540

From Out-of-Network to Outstanding Savings

A group came to Specialty Care Management (SCM) with an open lung cancer case. The patient was being treated regularly via an IV chemotherapy treatment at a hospital that was out of network, driving costs up for both the group and the patient.

With SCM facilitating the change to oral chemo, the group was able to avoid extraneous pharmacy and administration charges, yielding savings for these costs alone of $10,640— or $532 per day.
Additionally, SCM created savings in multiple areas through various strategic initiatives:

  • Direction to in-network facilities for appointments and treatments – $1,000
  • Self-administration of medication – $500
  • Avoidance of hospitalization due to oral chemotherapy treatment – $5,400

Overall, SCM enabled the group to experience significant savings of 32% off billed charges—totaling $17,540 — while the patient benefited from increased quality of life.

After collaborating with the provider and family, SCM was able to transition the individual to an equally effective oral chemotherapy treatment. SCM arranged for the treatment to be administered at the patient’s home at the optimal time to increase the drug’s efficacy, successfully limiting hospital stays and ensuring that the patient utilized in-network providers when necessary.
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About Specialty CM:

We’ve designed a new way to manage catastrophic claims—one that brings costs back under control and delivers a complete risk solution. Plus, with double the savings compared to typical network discounts, we deliver maximized savings every time.
Exclusive Program Features:
No Set-Up Fee or Cost Until Utilization so you don’t pay until you have a claim
Fixed, All-inclusive Capitated Rate that protects you from inflation while saving you more off provider billed charges
100% Success Rate on challenges and appeals