Blog // HealthSmart Blog // June 2019

When your employees receive bad news about their health

6/25/2019 9:38:56 AM

When your employees receive bad news about their health

By Chris Tamez, Senior Client Services Executive, HealthSmart

Our proprietary Specialty Case Management solutions include: 
  • Oncology
  • Chronic Kidney Disease
  • Dialysis
  • Transplants
  • High Cost Drug Management

When employers decide to self-fund their health plan, there are many advantages and cost-savings to be had. They can get more flexibility in designing a plan that is right for them and enjoy cost savings through a better plan design and reduced premiums. But what happens when an employee receives a bad call about their health? If they find out they have a serious – even catastrophic – health condition, how does an employer with a self-funded plan manage this?
Members who become ill with complex health conditions like cancer or chronic kidney disease can be very challenging. For members, navigating treatment plans for these conditions can be overwhelming and downright scary. This can be scary for plan sponsors too as the costs can be financially catastrophic.
When situations like this arise, “out-of-the-box” thinking can help members and plan sponsors navigate through complex health conditions. This is how we think at HealthSmart. We’re always looking for creative ways to improve member health while saving our clients money. To help members and plan sponsors when members are faced with serious health condition, our Care Management Solutions team has developed several innovative, proprietary clinical solutions. These solutions have literally saved our clients millions of dollars while advocating for our members with dignity and respect.
Two examples of the costliest conditions employers are faced with are members who require organ transplantation or dialysis. In these cases, treatment can run in the millions of dollars.   
Transplant Program
Our Transplant Case Management program helps members navigate through the entire organ transplant process to ensure they receive the best care and support while controlling the extraordinary costs of organ transplantation. This program guides the member through the entire process with end-to-end case management from the initial evaluation through post-transplant care. With access to four national centers of excellence networks, members will get the best rates at the nation’s leading Transplant Centers of Excellence for all types of organ transplants. Plus, members have access to a dedicated team of case management experts, including registered nurses, dietitians, and PharmDs.
The bottom line is, we make sure members get the best care with optimal savings. Does it work? Our recent case study reveals some amazing results. In one case, the amount billed was over $4 million! With our program, that amount was reduced by nearly $3 million, for a savings of 69 percent. In another case, the amount billed was over $1 million, but our program saved $775,000. When we say we can save millions, we’re not kidding.
Dialysis Program
End stage renal disease affects almost 650,000 people per year in the United States. With annual charges upwards of $800,000 per year, dialysis is among the costliest of medical treatments. If one employee requires dialysis, the costs can be extreme. In some cases, employers may have multiple employees requiring dialysis. When that happens, the costs can be extreme, even devastating.
We take a unique approach to managing dialysis and the associated high costs. We leverage an integrated clinical and plan design approach to identify current and future risk of the multiple stages of chronic kidney failure. Using predictive modeling to evaluate each member’s risk profile, we can then develop custom care plans to head off avoidable complications and disease progression.
As with our other programs, we have an experienced care team to work with the member through the entire process, including registered nurses to manage care coordination, registered dietitians for nutritional management, PharmD for polypharmacy and dialysis claims administration.
The results are significant. This program saves our clients an average of 79 percent of network charges.  In one case, a client had three members that had been receiving dialysis, which accounted for more than $3.3 million claims spend. Using our program, they saved nearly $3.1 million. Learn more here.
Innovative programs that save millions of dollars
There is truly no other suite of programs like those offered by HealthSmart Care Management Solutions. We provide fully integrated, comprehensive solutions so our clients can provide quality healthcare while stretching their healthcare dollars. With our Specialty Case Management solutions, we save our clients millions of dollars while advocating for our members with challenging health issues.

If you would like to learn more, brokers should contact their HealthSmart VP of Sales, or complete the form to the right and we will contact you.