Transplants

cancermanagement

Specialty Care Management (SCM) offers a premier Centers of Excellence network based upon clinical leadership, cost-effective access, and competitive rates at leading transplant centers, including:

  • Over 240 organ and bone marrow programs in 18 states;
  • Over 60 pediatric transplant programs;
  • Alliances and affiliates that expand the network to 400 transplant programs in 25 states;
  • Single case Letter of Agreement negotiation for out-of-network referrals, if requested;
  • Access fees tailored to client preference.

A growing demand for these complex medical procedures and treatments, while maintaining affordability is a major concern for payors, as well as patients/employees. High quality providers/facilities present efficiencies and cost-
predictable pricing options. SCM positions itself to maximize win-win relationships that are advantageous to both providers and payors. Naturally, employees/patients benefit tremendously.

Several factors differentiate SCM’s Tertiary Care Program, including:

  • Flexible access fees:
    – percentage of savings up to a cap or,
    – fixed fee schedule
  • Relationships with special-request transplant centers;
  • Individualized billing and repricing services:
    – Drives the quality of the process for both payors and providers
    – Improves accuracy and timelines of payments;
  • Active, single case negotiations at special-request transplant centers.

Organ Transplant Case Rates

  • Hospital inpatient and outpatient services/pre and post;
  • Physician inpatient and outpatient services/ pre and post;
  • Organ procurement costs;
  • Case rate period beginning one day pre-op;
  • Outlier per diems for inpatient days after case rate period may range from $1,800 med/surg day to $3,500 ICU day;
  • Pre-transplant may be included in case rate or a percentage of case rate;
  • Pre-transplant and port-discharge care at 15%-30% discount.

Bone Marrow/PSC Transplant Case Rates

  • Hospital inpatient and outpatient services/pre and post;
  • Physician inpatient and outpatient services/ pre and post;
  • Outlier per diems for inpatient days after case rate period may range from $1,800 med/surg day to $3,500 ICU day;
  • Pre-transplant and port-discharge care at 15%-30% discount;
  • National Marrow Donor Program registry search fees billed separately.

Transplant Tertiary Network Case Study

A 39-year-old patient required a kidney transplant and was in his primary network. The primary network had available a 25% discount.

  • SCM was able to offer them a case rate at the same facility, utilizing the same provider, with an additional net savings (above the 25% available from primary) of 27.1% off the primary network’s rate;
  • Overall savings from original billed charges was 55.6%