Case Study

TPA Dialysis

2 cases over 12 months

Million-Dollar Dialysis Savings

A third party administrator (TPA) approached Specialty Care Management (SCM) with an employer group that was experiencing its first two renal dialysis claimants. The TPA realized it needed a solution to avoid the potentially devastating claim costs that would affect the employer’s bottom line and upcoming renewal. After assessing the situation, SCM reviewed the employer group’s plan document, identified areas of concern, made recommended language changes to protect the plan, and ultimately amended the plan. At no cost to the employer group, SCM patient advocacy nurses assisted the patients in understanding ESRD, renal dialysis and the benefits of participating in Medicare. With participation in SCM’s renal dialysis program, the patients could select providers of their choice with no disruption in care and have access to SCM Patient Advocates who assist, coach and answer any questions that may arise.
The group selected the SCM all-inclusive case rate reimbursement model and utilized SCM’s Renal Dialysis Cost Management and risk transfer product. In the first 12 months, SCM saved the group more than $2.2 million dollars off billed charges, lasers were eliminated upon renewal and the patients remained with their provider of choice.
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