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Renal dialysis cost containment strategies gaining momentum

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Posted May 8, 2012 by Samuel H. Fleet at 10:01AM. Comments (0)

With self-funding moving down stream to the smaller and middle markets, employers of all sizes are now looking for ways to mitigate risk and reduce expenses associated with employee health care. That goal of saving money exists alongside maintaining high-quality care for employees.

One example where savings can mount quickly: kidney dialysis. With treatment sometimes running as much as $50,000 a month for a single patient, it doesn’t take much for a self-insured company to surpass their benefits budget. The impact often spreads beyond the treatment year by driving up the renewal cost for stop-loss insurance. 

By partnering with experts in managing the costs of dialysis, companies can save an average of more than 50% of their current billed charges. With fees based on a percentage of the savings, the strategy can exceptionally lower cost. Insurance brokers and agents can help companies capture these savings by bringing them together with innovative benefit managers.

Start with the Statistics

The right place to look for savings is where there is frequent use and high costs. Kidney dialysis meets both of those criteria.

Currently, there are more than 27 million people with chronic kidney disease in the United States.

More than 354,000 people receive dialysis treatments at least three times per week.

The kidney dialysis market totals $27.3 billion and is expected to grow 37% this year alone. In the past five years, health insurance providers have increased their charges for dialysis claims by more than 65% — a trend that is likely to accelerate.

It all adds up to a large burden for companies that self-fund their healthcare expenses and rely on stop-loss insurance to cover excess costs.

Strategies that Work

An effective dialysis program uses both effective technology and targeted strategies to control the cost of kidney dialysis in three ways:

1. Bill Review – After ensuring the proper plan language is in place, invoice review using current market data allows bills to be paid at Usual and Reasonable rates that reduce unfair price differentials and help preserve plan assets. When your decisions are supported by experienced experts you can obtain reliable savings with the confidence that your members will be protected from balance billing.

2. Home hemodialysis – Breakthroughs in portable equipment allow patients to undergo dialysis at home. Not only are costs lower but also life expectancy is greater and there are fewer complications.

3. Epogen carve-out – Charges for the anemia drug epogen are often inflated and can top $70,000 a year. By carving out epogen from other prescriptions to allow discount purchasing, cost reductions as high as 90% have been achieved.

Benefit professionals know the best way to keep customers coming back is to show them innovative ways to control their cost. An effective dialysis management program optimizes the way kidney dialysis is paid for and how treatment is provided. It’s a win-win for companies and their employees that pays for itself.

If you’re a broker with tough questions, I’m here to provide unbiased answers and feedback to help you take the next step in adapting your business. Feel free to leave your question in the comments.

Fleet is president of AmWINS Group Benefits, a wholesale broker of comprehensive group insurance programs and administrative services. He can be reached at asksam@amwins.com.

 

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