At HealthCare Reporting, we embrace the 80/20 rule. We know that 20% of members will drive 80% of the claims. A single dialysis claim could prove to be catastrophic for a self-insured medical plan. Our system is designed to manage your dialysis claims, helping you contain the cost of renal dialysis and detect members early before they go on dialysis.
At HCR, we pride ourselves on making solutions that are adaptable to third party administrators, general agencies, and benefit consultants who use a variety of funding arrangements for employee benefit health plans. Whether you work with fully self-funded plans or partially self-funded plans, we can work with you to manage your dialysis claims.
Advanced Claims Analytics identifies silent risks and active renal dialysis.
Dialysis Cost Containment helps reduce risk with predictable and quantifiable results.
Kidney Care Complete (KCC) engages members with high-risk and active chronic kidney disease members. Members voluntarily meet with a dedicated nurse coach to confront and manage renal related health issues.
The national average for outpatient dialysis is $250,000 per year per member on renal dialysis. This number can fluctuate depending on where the members get services and the network they use. In some instances, we have seen upwards of over $1 million per year and as low as $125,000 per year. It is important to keep in mind the road that it takes to get to dialysis.
With the table provided, you can see what the Medicare costs are for progressing in stages of Chronic Kidney Disease (CKD). Self funded plans will typically pay 400%-500% of Medicare for dialysis and CKD related care. We know that each time a member progresses stages in CKD that the costs go up by 77% per stage on average. In stage 1 and 2, CKD is not easy to identify, and when members progress to later stages of CKD, the costs increase significantly than in the early stages of CKD. HCR’s advanced analytics can catch members when they show their first signs of CKD.
HCR helps you spot the silent risks before they progress to dialysis and identify members that would be candidates for savings. Whether you work in healthcare, health benefits or human resources, our Advanced Claims Analytics can analyze your claims to identify the members on dialysis that are active risks as well as the high risk silent and moderate risk silent members on your health plan.
The primary goal is to empower brokers and plan sponsors to manage chronic diseases, reduce preventable emergency room visits, decrease the number of hospitalizations, and reduce health care costs associated with Chronic Kidney Disease and End Stage Renal Disease.
Kidney Care Complete is a different type of strategy based on a team approach to healthcare. While not a novel idea, the team approach takes providers out of silos under the traditional system where members are methodically referred back and forth between primary care and specialist. A specialty care team can use HCR’s advanced analytics to coordinate care, communicate directly with the member, and utilize nurse coaches to enable the member to take part in shared decision making of their health.
The self funded industry faces challenges with the ease in which they can digest data from their TPA. TPAs don’t share a consistent format, and it can be a challenge for brokers and consultants to obtain the data and then analyze it. At HCR, we specialize in management and analysis of self funded claims data. With the numerous connections HCR has with TPAs and PBMs, HCR can standardize claims formats into one standard claim format that allows us to build analytics that can digest and analyze a broker’s book of business on SIR. Upon receiving authorization, HCR can conduct a Renal Risk Assessment (RRA) of a broker’s book of business that is on SIR. The RRA will identify all the members at risk in one report. If you do not currently have groups on SIR, please reach out to Eric Browne ([email protected]) to discuss how we may be able to help.
HCR can analyze your self funded claims and provide you with a Renal Risk Assessment (RRA) at no cost. If you choose to act on the insights from the RRA, most of the heavy lifting will be done for you by a team of plan document experts that will craft a unique strategy for each plan sponsor. Each strategy is built so the members continue seeing their provider without interruption in treatment while giving the plan sponsor control over their renal risks.
In most cases, Renal Dialysis Cost Containment should save money, but it is possible where it makes sense to “keep things as they are.” However, there’s more risk for not acting than for engaging with the Renal Dialysis Cost Containment program. The risks for not acting range from increased risk exposure, potential for catastrophic claims that could bankrupt a self funded plan, decreasing quality of benefits due to allocating resources to cover out of control costs, and added ERISA scrutiny when the plan collects employee contributions. When a plan collects employee dollars, they have a fiduciary responsibility to ensure that they are paying the lowest costs and for the highest quality services with the employee dollars.