By Samuel H. Fleet
As companies search for new ways to control rising healthcare costs, they increasingly are turning to sophisticated strategies and data-mining technologies that target distinct slices of medical spending. Their goal is to reduce expenses while 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 bust 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 percent of their current billed charges. With fees based on a percentage of the savings, the strategy is essentially cost-free. 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 percent by 2012. In the past five years, health insurance providers have increased their charges for dialysis claims by more than 65 percent - 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
At AmWINS, our Dialysis Management Solutions program uses both effective technology and targeted strategies to control the cost of kidney dialysis in three ways:
- 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 (U&R) rates that reduce unfair price differentials and help preserve plan assets. When your decisions are supported by our experienced experts you will obtain reliable savings with the confidence that your members will be protected from balance billing.
- 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.
- 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 percent have been achieved.
Insurance agents know the best way to keep customers coming back is to show them innovative ways to control their cost. Dialysis Management Solutions 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.
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