Dialysis Management Solutions™

Helping employers manage all aspects of outpatient dialysis claims by reducing costs and focusing on patient care.

Kidney disease and the costs to treat it are a growing problem for employer health plans. Dialysis Management Solutions (DMS) uses data-mining techniques to identify members at risk of kidney failure earlier in the process and offers case-management services to provide members with education, assistance and support that improve overall levels of care. Combining case management services with proprietary Reasonable Value Payment re-pricing methodology allows DMS to deliver cost-savings and protect plan assets through all stages of kidney disease, from prevention through ESRD and outpatient dialysis treatments.

The DMS solution is available for any self-funded health insurance plan, whether a dialysis situation exists or not. One dialysis claimant can cost an employer’s plan more than $1 million per year. Our services are easy to implement and have produced dramatic results for our clients. Our focus is to eliminate waste and add value to the bottom line. All self-funded plans can benefit from implementing such a program as a proactive measure.

In addition to the savings on dialysis claim costs generated by DMS, Amwins offers several other services aimed at lowering costs and preserving plan assets for self-funded plans. Key products and services include dialysis management solutions, pharmacy audits, medical audits and dependent eligibility audits.

DMS services:

The DMS program components below are helping clients save more than 75% off billed charges on average.

Plan design

DMS provides employers with a flexible program backed by our proprietary plan language that is designed to withstand provider pushback and includes appeal support. The DMS plan language was developed to be as defensible as possible to ensure employer savings stick. Benefit from our experience and avoid costly mistakes.

Data mining

DMS will work with your TPA to implement monthly data feeds to help identify at-risk members while tracking the progression of CKD and initiating case management. Early intervention can play a critical role in improving the member experience and controlling overall costs. Don’t miss the signs of CKD and ESRD in your groups.

Case management

Case managers can help patients understand how lifestyle and behavioral choices can impact their health and provide guidance on how to implement changes that could delay or prevent to progression of CKD to enhance their healthcare experience and improve their overall quality of life. Case managers can also assist members in planning for dialysis, giving patients enough time to choose the best facility and treatment modality for them based on their own unique patient profile, so they do not end up in the emergency room for their first dialysis treatment. In addition, case managers can help educate members on the importance of Medicare entitlement and the benefits of timely enrollment.

Cost-reduction strategies

The primary objective of the DMS program is to help employers save money on dialysis claims through prevention and reduction in claim costs. Negotiating Single Patient Agreements or Facility-Level Agreements often results in greater savings than those provided by many PPO networks. When negotiated agreements are not feasible, DMS offers RVP re-pricing services. On average, our clients save over 75% off billed charges through the Reasonable Value re-pricing. Implementing the DMS program can also save employers money on their stop-loss costs through reduced premiums and deductible lasers.

DMS in the news:

A June 2022 Supreme Court ruling illuminated the significant issues in the widely accepted dialysis care for-profit models. While legislation that would impose new coverage requirements does not appear to be included in the 2023 Omnibus Spending Package at this time, significant challenges for patients and insurers are still very much in play.

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Case Study

In total, the client has saved over $13 million off billed charges since implementing the DMS program.

One of our TPA partners introduced DMS to one of their large hospital system clients who needed assistance managing escalating dialysis claim costs. The client had nearly 10,000 employees but even at that size was still unable to negotiate or access reasonable discounts from the dialysis providers in their local area. Over the prior 2 years, the client had 4 or 5 active dialysis patients each month and paid over $7.5 million in dialysis claims.

They were spending an average of about $850,000 per patient per year and that was AFTER the PPO discount. They needed a solution to this major expense problem.

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