Specialty Care Management

Specialty Care Management focuses on the cost containment within the renal space by offering an industry leading CKD Management Program and unique repricing strategies for outpatient dialysis claims.

What is Specialty Care Management?

Yes, Specialty Care Management provides cost-containment strategies specifically within the renal space and we do this with our three core products. The first one being Kidney Care Complete, which is our data analytics arm where we scrape monthly claims data to identify members with kidney disease or that are trending towards or soon-to-be on outpatient dialysis. The next will be Chronic Kidney Disease, CKD, Management. Well, this is our clinical arm, so we have a one-on-one coaching dynamic for members with kidney disease or on outpatient dialysis to help them navigate a very intimidating space. And lastly will be our Outpatient Dialysis Repricing, where we take a historically very volatile claim and we apply a fix-capitated case rate to provide budget certainty and that'll affect the entire healthcare ecosystem between the company's spend as well as stop-loss.

How is Specialty Care Management different?

Yeah, we try to differentiate ourselves in a couple areas. The first one being, taking that data-driven proactive approach by identifying potential high claims before they exist is the best strategy of the model. So, we really do pride ourselves on being proactive in that area. Next will be our best-in-class clinical nurse coaching, where again, it is a very intimidating time for members to be diagnosed with kidney disease or to go on dialysis, so to have that resource for themselves, their caregiver, as well as their family is something that we really do pride ourselves on. And lastly, will be our outpatient dialysis case rate. Again, taking a typically high, six-figure claim and mitigating that cost and having that fix-capitated and inflation proof brings a lot of value to that employer. And typically, we're 82% off of bill charges and nearly 54% off paid claims, so we can make an immediate impact.

Who is a good fit for Specialty Care Management?

Yeah, so we'll look for clients that, first of all, their funding. So, we'll look for self-funded clients so we can make an immediate impact on their healthcare spend. Next will be pretty clearly, employers that have members actively on outpatient dialysis. We do not have to wait until renewal to make an impact. We can implement ourselves off cycle, so that's a very, a good fit for us. And lastly, like-minded channel partners between brokers, GAs, TPAs, stop-loss providers and so on. People that want to take a proactive approach and get in front of potential high claims would all be a great fit for us.

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Duration: 02:46

Posted: Friday, April 14, 2023

Video tags: Under 50 EEs, 51 - 100 EEs, 101 - 250 EEs, 251 - 500 EEs, 501 - 1000 EEs, 1001 - 2500 EEs, 2501 - 5000 EEs, Over 5000 EEs