Kidney disease and the costs to treat it are a growing problem that can wreak havoc on an employer’s health plan.  Estimates show more than 15 percent of adults in the United States have some level of Chronic Kidney Disease (CKD), and each year 120,000 Americans are diagnosed with End Stage Renal Disease (ESRD). The limited number of treatment providers restricts the ability of PPOs to effectively protect self-funded plan assets from the soaring cost of dialysis claims.  That is where Dialysis Management Solutions (DMS) can help.

The Solution

Dialysis Management Solutions utilizes regional pricing data and a proprietary re-pricing methodology to reduce outpatient dialysis claims, reducing direct costs and in turn allowing for more favorable stop loss renewal terms. DMS clients are currently saving an average of over 75% off billed charges by utilizing the following DMS services:

• Plan Design: Benefit from our experience and avoid costly mistakes. DMS provides employers with a flexible program backed by our proprietary plan language that is designed to withstand provider pushback and includes appeal support. The DMS plan language was developed to be as defensible as possible to ensure employer savings stick.
• Data Mining: Don’t miss the signs of CKD and ESRD in your groups. DMS will work with your TPA to implement monthly data feeds to help identify at-risk members while tracking the progression of CKD and initiating case management. Early intervention can play a critical role in improving the member experience and controlling overall costs.
• Care Management:  Our case managers can help patients make better informed lifestyle decisions, such as eating a healthy diet or limiting alcohol intake. The more the patient understands, the more likely they are to make better decisions.  Case managers can also assist members in planning for dialysis, giving patients enough time to choose the best facility and treatment modality for them based on their own unique patient profile, so they do not end up in the emergency room for their first dialysis treatment. In addition, case managers can help educate members on the importance of Medicare entitlement and the benefits of timely enrollment.
• Cost Reduction Strategies: The primary objective of the DMS program is to help employers save money on dialysis claims through prevention and reduction in claim costs. DMS has several methods to help self-funded ERISA plans reduce their dialysis claim costs. Negotiating Single Patient Agreements or Facility-Level Agreements often results in greater savings than those provided by many PPO networks. When negotiated agreements are not feasible with a particular provider, DMS offers re-pricing services using our proprietary Reasonable Value methodology. On average, our clients save over 75% off billed charges through the Reasonable Value re-pricing. Implementing the DMS program can also save employers money on their stop loss costs through reduced premiums and deductible lasers.

Get Started Saving

To receive a customized savings illustration based on actual dialysis claims, please provide DMS with a copy of the Plan Document, any PPO Network re-pricing discount information if applicable and a full month of claims for dialysis related services in the form of UB-92 or HCFA’s.

View our DMS site to learn more