Clients

Case Studies

Case Studies – ESRD Cost Containment

CASE #1: Third Party Administrator

Renalogic (formerly DCC, Inc.) received a referral from a client that included an entire year of dialysis claims totaling over $370,000.  The member’s claims had been sent in bulk by the facility due to eligibility issues that had just been resolved. The client’s hope was that we could successfully negotiate an agreement for this member for the years’ worth of claims and going forward.

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Renalogic was able to secure a single patient agreement (SPA) at a daily treatment rate with a reduced contract rate for Epogen, administration supplies and medications. The discounts that were achieved by this agreement averaged an 85% savings off of the billed charges, thus significantly reducing cost to the plan.

When the Plan for this member decided to change Third Party Administrators, Renalogic successfully stepped in to transfer the agreement from the previous TPA in order to retain the discount. The gross savings off of billed charges continued at an average of 85% until the member was no longer primary on the plan.


 

CASE #2: Home Dialysis Negotiation

Renalogic (formerly DCC, Inc.) received a referral from a client for a member who was receiving hemodialysis at home. Prior to starting treatment at home the member was receiving care at an outpatient dialysis clinic owned by one of the two large dialysis chains. Unfortunately, like more than 90 percent of all members that receive in-center dialysis, the member began experiencing many of the quality of life reducing side-effects that occur when receiving the standard three treatments per week.

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Despite the fact that the member had numerous health issues which resulted in the complete failure of her kidneys, she was determined to take control of her health. The member researched the available treatments and decided that short daily home hemodialysis was the best option for her.

At the time Renalogic received the referral the member’s annual dialysis charges were well over $500,000. Renalogic was asked to research the member’s situation and identify options for better managing her benefits.  Renalogic contacted the outpatient dialysis clinic supporting the patient at home. 

Despite Renalogic’s best efforts the provider emphatically declined all attempts to negotiate. It was decided that because the member’s site of treatment was her home, any provider in her area could support her. Renalogic began researching Independent providers that used the same home equipment the member was using. Renalogic was able to find an Independent provider and negotiate a rate agreement that would reduce charges by over $1,400.00 per day.

The successes attained by moving this member have reduced out of pocket costs to the family, and reduced the risk to her employer. The total annualized savings for this member exceeded $500,000.   In all, the employer group is paying almost 70% less to the new Independent provider than they were to the large publicly traded dialysis provider where the member originally began her treatments.


 

CASE #3:  Third Party Administrator (TPA)

In 2008 Renalogic (formerly DCC, Inc.) began working with a large TPA with an evident dialysis cost issue.  Since 2008, DCC’s strategic relationship with this TPA has created costs savings in excess of $50,000,000.  Assisting with numerous employer groups and patients, the relationship Renalogic has developed with this TPA has had not only a substantial impact on proven cost savings, but also education to the TPA for its groups, members and constituents.  Navigating through the complexities associated with dialysis costs and solutions, Renalogic has become a partner that its clients have come to trust and rely on.  During our tenure with this TPA, Renalogic has never had a claim overturned or experienced a balance billing for any member. 

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Through our successes with cost containment, we have also have become a solution driven option for this TPA’s chronic kidney disease population.  Enrolling in our CKD management program to assist in delaying the progression of CKD, the TPA is already seeing the effects of our services, with delayed CKD progression, as well as hard dollar medical savings.  Based on our current experience with this TPA, Renalogic fully expects to continue providing verifiable cost savings and improved quality of life through our integrated combination of ESRD cost containment and CKD management solutions.  


 

CASE #4: Taft Hartley Union Group

Beginning in 2010, Renalogic (formerly DCC, Inc.) began its relationship with this Western Based Union Group.  Servicing over five separate Plans to date, Renalogic has successfully saved this client over $15,000,000 in verifiable savings, averaging over $3,000,000 per year.  Renalogic’s unique and proven approach has been deemed highly successful within Union Groups. 

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Offering full service support beginning from our custom and proprietary data identification system, all the way through plan language analysis and consulting to re-pricing and appeal support, Renalogic’s services have become a core alternative to successfully manage the complexities of dialysis cost  containment for this Union Group.  With dialysis costs continually rising, providing successful solutions has provided relief to groups suffering from the high dollar costs associated with this disease.   The consultative solutions provided to this Union have achieved consistently positive results including no member balance billing issues or overturned claims history.  We look forward to continuing to provide services to reduce costs and improve outcomes, also utilizing our proprietary CKD management program.


 

Case Studies – CKD Management

Case Study 1- CKD Management Program

Mr. R, a 60 year old male patient with a history of hypertension, neurogenic bladder, and hydronephrosis, and no CKD diagnosis was identified thru his medical claims as being in the Core risk category within the CKD Management program.  He also had neck pain, anxiety, migraines and a GI disorder.  Several messages were left for him by the Renalogic nurse explaining our program and offering support and education to reduce his risk for chronic kidney disease, which he ignored and did not return.  Two months after identification of his potential CKD risk, Mr. R developed acute renal failure, with a subsequent ER visit and hospital admittance.   He was diagnosed with Stage 5 CKD based his kidney function tests, and advised by his hospital nephrologist that he was imminent for starting dialysis.  Upon his discharge from the hospital, the Renalogic nurse called him again.  After ignoring the nurse’s calls for six months, Mr. R. finally answered the nurse’s call saying “I guess I needed you about 6 months ago!”

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The nurse began working with him, teaching him about options including home dialysis, transplant and paired-donation, and his Medicare benefit.  He was somewhat knowledgeable about in-center dialysis, but had no knowledge of home options, vein sparing, access, dietary support, self-care measures, or danger signs of progressing kidney disease.  The nurse taught him to focus on factors in his control:  diet, exercise, adherence to medications, controlling his blood pressure and danger signals.  He was very receptive to transplant, and several family members offered to donate a kidney.

Within two months, his kidney function tests showed a 25% improvement.  The nurse continued to focus on symptom management and depression.  Over the course of the following 16 months, Mr. R remains dialysis-free, and his kidney function has improved a total of 47%, to Stage 3 levels.   A dialysis avoidance of 18 months (and counting) has saved Mr. R’s employer group plan more than $540,000 in cost-contained dialysis costs to date.   


 

Case Study 2- CKD Management Program

Mrs. H., a 50 year old non-compliant female patient was identified for the CKD Management program with CKD Stage 5.  The Renalogic nurse contacted Mrs. H., who was in denial and extremely angry about her diagnosis, the prospect of imminent dialysis and her inability to return to work based on her current health status.  Mrs. H had been on medical leave due to her multiple comorbidities, and she wanted above all to return to work. 

Upon receipt of the copy of the patient introductory letter to Mrs. H, her nephrologist called the assigned Renalogic nurse requesting the nurse’s assistance with getting Mrs. H. compliant so that an access could be placed.  Mrs. H had repeatedly not shown up for the access placement surgery.  Through working with the Renalogic nurse, Mrs. H. became more compliant and the access was placed. She also started to lose weight, started exercising, and overall became a willing participant in her health care.

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Seven months after the access placement, Mrs. H is still dialysis-free, her kidney function has improved slightly, and she has been able to return to work two days a week.  The access placement in lieu of an inpatient urgent start dialysis with catheter has saved the Plan $88,000 and the member has avoided dialysis for one month and counting, a total savings to the Plan of $119,000 to date.