John B. Youngs President & CEO of Prodigy Health Insurance Services, LLC

Prodigy like most stop loss carriers has been plagued with runaway costs associated with dialysis treatment for our ESRD patients. Like many of our colleagues, we struggled to understand the cost variations among our patient population even when treatment regimens and settings were the same.

In an effort to control the dialysis exposure, we searched for cost management solutions among a variety of vendors. Once our research was done, we had identified Specialty Care Management (SCM) as a dominant provider in the area of dialysis cost management. While we understood the SCM impact, many of our clients voiced concern over the potential challenges of a Medicare style re-pricing, so we started with a couple of patients. The SCM re-pricing process virtually eliminated all challenges and when appeals were filed, SCM was quick to respond protecting both our client and their member.

The SCM team generated significant savings across our entire dialysis patient population with net savings averaging more than 60% after all fees and costs. The end result is that Prodigy has reduced our loss ratio and improved the underwriting position. I would recommend that any stop loss carrier, TPA or client consider the SCM solution for their dialysis exposures. The impact to the bottom line is worth exploring.

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