Dialysis Management Solutions™

Protecting Health Plans and Improving Member Outcomes.

Kidney disease represents one of the most significant and fastest-growing cost drivers for employer-sponsored health plans with a single dialysis claimant potentially exceeding $1 million in annual claims. Dialysis Management Solutions (DMS) addresses this challenge head-on through a comprehensive, data-driven approach that delivers meaningful savings while improving the quality of care for members at every stage of kidney disease.

DMS Services:

The DMS program components below are helping clients save over 90% off billed charges on average.

Plan design

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. Benefit from our experience and avoid costly mistakes.

Data mining

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. Don’t miss the signs of CKD and ESRD in your groups.

Case management

Case managers can help patients understand how lifestyle and behavioral choices can impact their health and provide guidance on how to implement changes that could delay or prevent to progression of CKD to enhance their healthcare experience and improve their overall quality of life. 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. 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, DMS offers RVP re-pricing services. 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.

Early Identification. Smarter Intervention.

DMS leverages advanced data-mining techniques to identify members at risk of kidney failure earlier than traditional methods allow. By intervening sooner, our dedicated case management team provides members with the education, resources, and personalized support needed to slow disease progression and improve health outcomes — from prevention through end-stage renal disease (ESRD) and ongoing outpatient dialysis treatment.

Measurable Savings for Self-Funded Plans

Our proprietary Reasonable Value Payment repricing methodology works in tandem with case management services to reduce dialysis claim costs, eliminate waste, and protect plan assets at every stage of the disease continuum. The DMS solution is available to any self-funded health plan — whether a dialysis claim currently exists or not — making it an ideal proactive measure for plan sponsors looking to get ahead of a potentially significant liability. Implementation is straightforward, and our clients have experienced dramatic, documented results.

A Broader Suite of Cost-Containment Solutions

Beyond dialysis management, we offer a full range of services designed to lower costs and strengthen the financial integrity of self-funded plans, including pharmacy audits, medical audits, and dependent eligibility audits — giving plan sponsors a comprehensive toolkit for managing risk and maximizing the value of every healthcare dollar.

Dialysis Management Solutions