CASE #1: Third Party Administrator

DCC received a referral from a client that included an entire year of dialysis claims totaling over $370,000.00. 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 year’s worth of claims and going forward.

DCC was able to secure an 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 85% off savings off of the billed charges, thus preserving the member benefit and reducing risk to the plan.

When the Plan for this member decided to change Third Party Administrators, DCC stepped in to transfer the agreement from the previous client in order to retain the discount and was successful. 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: Reinsurance Carrier

DCC, Inc. received a referral for a member from one of our reinsurance clients. The claims for this member were averaging $59,000 per month. The employer group had made the decision, during their most recent renewal period, to amend their plan document to include DCC’s Outpatient Dialysis Carve Language for the application of U&R for these claims. In a 9 month period the employer group has achieved net savings on these claims of over $350,000.

CASE #3: TPA (Home Dialysis)

DCC received a referral from a client for a member that was receiving their 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 receives 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.

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 DCC received the referral the member’s annual dialysis charges were well over $500,000. DCC was asked to research the member’s situation and identify options for better managing her benefits.  DCC contacted the outpatient dialysis clinic supporting the patient at home.  DCC explained that the member had a very limited lifetime benefit and that if they would work with us to negotiate a more reasonable rate it would create a positive outcome for all parties.

Despite DCC’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. DCC began researching Independent providers that used the same home equipment the member was using. DCC 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 allowed for an extension of her lifetime benefits, reduced out of pocket costs to the family, and reduced the risk to her employer. 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 #4:  Self Insured Employer Group

In 2009 DCC, Inc. was approached directly by a large manufacturing organization and soon after began managing this self-insured plans cost containment strategies related to dialysis.  During this time, DCC has re-priced claims on four different dialysis patients covered under the plan and achieved excellent savings.  During the time that DCC has been working the group the plan experienced total billed charges of $829,293.00. DCC has produced savings for the plan of better than $648,000.00 during this time period and as of yet has neither had any patient balance billed nor had any of the claims overturned.

CASE #5: Taft Hartley Union Group

Beginning in January of 2010 DCC, Inc. began working with a Taft Hartley union group to help them reduce the huge charges they were receiving from several different dialysis provider organizations for their members treatments. During the time that DCC has worked with this Union DCC has repriced claims on ten different members within this group. The billed charges by these several dialysis providers during this time period were $2,592,017.00. Through the implementation of the DCC programs and the utilization of DCC’s Renal Data Management program the group obtained savings of $2,164,928.00