Case Study

Healthcare Specialty Firm Seeks to Impact Costs Associated with Chronic Kidney Disease Claims

  • Increased chronic kidney disease-related incidents. 
  • Exorbitant kidney dialysis costs associated with Stage 4 and 5 CKD patients.
  • Client’s business model provides services to same dialysis providers, submitting excessive charges.
  • Our team performed multiple analyses including evaluations of all associated CKD costs, current market dialysis costs, and client’s claims to identify providers associated with outlier claim costs.
  • We collaborated with health care professionals and experts to develop a CKD management program that improved early intervention guidelines, and advised on proper performance guarantees that client can implement with its vendors.
  • The client has seen a significant reduction in the need for dialysis within its population.
  • Expected 2023 health plan savings for the client is $3.5 million.

The Challenge

The client, a Fortune 350 Healthcare Specialty Firm, provides services to dialysis providers as a function of their business model, and these same providers are part of the client’s own health plan network. Dialysis charges among the providers were widely varied and, in some cases, the client would receive charges for 25x the Medicare reimbursement rate for the same treatment. Our client needed Symphony Consulting to help lower costs while not disrupting their vendor relationships.

The Solution

Our Symphony Consulting team took care to become educated on the modern-day intricacies of dialysis prevention, treatment, and costs. We further evaluated expenses associated with CKD, including expenses related to illnesses that may ultimately develop into CKD patients, and current market dialysis costs.

We identified which providers were overcharging and engaged with them and other health care professionals to develop a CKD management program. The program includes a focus on prevention and intervention in addition to appropriate treatment costs.

“Like most employers, we face difficult decisions in providing a full suite of benefits for our most important asset, our people. Symphony showed us how looking deeply into our current spending we could find better pricing, reducing our costs AND providing a benefit enhancement with no cost shift to employees.”

-Symphony Consulting Client

The Outcome

Following implementation of the CKD management program, the client has seen a significant reduction in patients needing dialysis and treatment costs.

Symphony Consulting will continue servicing the client by providing quarterly reviews on CKD performance measures and dialysis cost reductions to meet the vendor’s performance guarantees.