Specialty Care Management

Specialty Care Management is the industry leader in risk mitigation and cost containment of renal dialysis claims. Leveraging a combination of clinical programs and financial strategies.


What is Specialty Care Management?

Yeah, Specialty Care Management is a risk mitigation and cost containment platform specializing within the renal space. We have two core solutions. First, our outpatient dialysis risk mitigation. This is where we can work proactively with groups, which would be groups with no active dialysis, or the groups with members receiving treatment. There is no cost, no PEPM, and no percentage of savings within the solution. We will review claims data, generate a fixed capitated case rate. On average, we're saving over 82% off billed amounts and over 54% off paid charges. As the case rate is inclusive of provider and management fees, this provides 100% budget certainty for the group. Also, we have chronic kidney disease or CKD management. This is a one-to-one nurse coaching program that assists members in slowing down, pausing, and ideally reversing the comorbidities of kidney disease and dialysis.

How is Specialty Care Management different?

Sure, so we differentiate ourselves in a couple areas, but most focused on transparency and budget certainty. This is shown in the case study on the screen. A consultant came to us with a group that had a member on active dialysis. The billed amount for this member annually was over $1.2 million and the paid charges were over $790,000. SCM was able to underwrite a case rate for just over $271,000. We were able to generate over $519,000 in real savings for the group, over 65% off of their paid charges. And as SCM does not charge a percentage of savings fee, the group was able to reinvest these savings into other healthcare costs, other benefits, or anything that will help the company grow. And as the member did not have to change providing facilities 'cause we did not require them to do so, there was no disruption to the care for the member.

Who is a good fit for Specialty Care Management?

Yeah, the simple answer would be any self-funded group, but to be more specific, groups with trending kidney disease or active dialysis. And it can be very difficult to know which populations have these related issues as 90% of individuals with kidney disease don't know they have it. So what SCM can do to assist is offer for no cost, a renal risk assessment. And what we'll do is review claims data, identify comorbidities and kidney disease within a population, and generate a renal risk assessment report similar to the one you see on the screen. And based on the results, can provide recommendations for potential savings and enhanced member experience. To take advantage of this, please follow up with us today.

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Duration: 02:55

Posted: Friday, May 24, 2024