TPA Dialysis Case Study

In November, 2013, one Third Party Administrator began utilizing SCM to manage its dialysis claims. The SCM legal team reviewed each Plan’s Summary Plan Description and provided recommended wording for inclusion in a plan amendment. The Plans approved the amendment and engaged SCM in working with the patients to maintain quality dialysis care at an affordable cost. No member was in any way required to change the source of their dialysis treatments. No patient incurred any additional out-of-pocket costs as a result of the involvement of SCM. The results shown below demonstrate the power of the SCM product without costing the patient any additional personal cost or disruption of dialysis service.

 

Process Period    # of Groups # of Patients Provider         Billed Charges              SCM SCM
 Repriced Amount Gross Savings
2012(2 months) 2 2 $141,883.46 $18,135.54 $129,747.92
2013 (full year) 2 2 $840,530.94 $191,759.02 $648,771.92
2014 (full year) 2 2 $739,233.28 $107,177.46 $632,055.82
2015(5 months) 2 2 $698,049.27 $78,086.69 $619,962.58
Totals $2,419,696.95 $395,158.71 $2,030,538.24