Let's Learn More About Our Newest Program KCC

By: Will Rumsey, Senior Vice President Of Sales

“It’s difficult to get to your destination if you can’t see where you’re going.”

Specialty Care Management leads the industry in cost containment strategies within the renal space. Our CKD Management Program aligns qualified members with a Clinical Registered Nurse Coach to work with and guide the member, their family and/ or caregiver through their treatment. Additionally, our Outpatient Dialysis Repricing Program will provide a fixed, capitated Case Rate for members activity receiving treatment.

Both programs make a massive impact on the employees and employers dealing with kidney disease and dialysis, both clinical and financially. However, Specialty Care Management is often introduced to an employer that is currently dealing with these issues; months or sometimes even years after they have begun.

Kidney Care Complete (KCC) is designed to assist in identifying members who have moderate, high-risk or active chronic kidney disease (CKD), and pending or active outpatient dialysis.

KCC will enable Specialty Care Management to take a proactive approach by identifying risk within monthly claims files and addressing members with comorbidities before they progress to CKD or active outpatient dialysis.

The program will act as a funnel to graduate member to the appropriate service, outlined below in image 1.

For a monthly PMPM fee, Specialty Care Management will review claims and engage with qualifying members. To ensure a positive impact of KCC for all employers, the offering comes with a Performance Guarantee, where Specialty Care Management will contractually guarantee to generate a positive ROI against PMPM fees paid, or a full refund will be provided.

The impact of identifying members and placing them in the appropriate program will have multiple effects:

CKD Management 

• Identify comorbidities of members and initiate the outreach from our Clinical Team to address the possibility of kidney disease before it starts.
• By addressing the potential of kidney disease before it starts, this will allow the member and their Nurse Coach to design an action plan to slow down, stop, and reverse the health issues (diabetes, hypertension, etc.) that will lead a member to CKD.
• If dialysis is not preventable, the Nurse Coach will assist the members to have an optimal start. This will prevent a member from crashing into dialyses, which often involves multiple days in the ICU and will be a horrific experience for them and their family.

Outpatient Dialysis Repricing 

• Providing 24/7 access to clinical guidance to members that oftentimes have been recently diagnosed with kidney disease.
• Provide a fixed, capitated Case Rate that is inflation proof and provides budget certainty for the employer and their healthcare spend.
• Impact the number of Months of Savings for each client by identifying an outpatient dialysis claims at the first month, and not months or years after the claims has been devastating the plan.

For any broker, employer group, TPA, or stop loss provider that has the desire to take control of kidney disease and dialysis, the proactive approach of KCC is the most practical way to accomplish this. For more information on how to get started, please contact your local Specialty Care Management Representative, or contact sales@specialtycm.com.