After spending 5 years working for one of the leading national dialysis providers where he was the national director of collections and appeal litigation for out-of-network operations, our founder started DialysisPPO in 2006, bringing a new and unique approach to the payer side of this market.
As the only medical diagnosis that qualifies a patient for Medicare entitlement, regardless of age, creative reimbursement strategies and techniques are almost universally overlooked by Plans. We have implemented our program for hundreds of self-funded health plans, and have saved our clients more than $260,000,000.
The following Case Study is from one of our clients. This self-funded, self-administered health plan was incurring significant costs for dialysis treatments for members with End-Stage Renal Disease (“ESRD”). In the first three years of their partnership with DialysisPPO, the group saved $6.9M.
At the inception of our program, the group had three active dialysis cases, across three different dialysis centers and two states. Over time, five more dialysis cases presented in five additional dialysis centers across two states.
The overall savings for the group was $6.9M, with the savings by member and facility very consistent – all in the range of 74%-77%. The difference in the absolute dollar savings by patient was attributable to the length of time each case was active - newer cases less time, older cases more time.
| Billed Charges |
Allowable + Fees |
Net Savings |
Savings % | |
|---|---|---|---|---|
| Member #1 | $1,654,814 | $426,004 | $1,228,810 | 74% |
| Member #2 | $1,909,796 | $468,776 | $1,441,020 | 75% |
| Member #3 | $1,534,401 | $386,856 | $1,147,545 | 75% |
| Member #4 | $863,599 | $201,266 | $662,333 | 77% |
| Member #5 | $1,081,070 | $264,625 | $816,445 | 76% |
| Member #6 | $884,105 | $209,693 | $674,411 | 76% |
| Member #7 | $678,110 | $162,732 | $515,378 | 76% |
| Member #8 | $550,113 | $129,742 | $420,370 | 76% |
| Total | $9,156,006 | $2,249,694 | $6,906,312 | 75% |
These results are consistent – actually slightly less than - the experience across our entire client base, which had an average savings > 80%. Since our inception in 2006, our clients have saved over $260,000,000.
