We are proud to say since the inception of our program in 2014 with thousands of participating members, not one member has progressed to dialysis while actively participating in the program. Our nurses also work with members already on dialysis to continually educate and help them with lifestyle choices, home modality options, Medicare coverage, and related provider utilization.
We have proprietary algorithms that incorporate all diagnoses and procedure codes that are associated with chronic kidney disease. We identify individuals with kidney disease diagnoses or kidney related procedures, as well as individuals not yet diagnosed but who have medical conditions that make them at-risk for kidney disease.
We have developed proprietary clinical pathways based on all five stages of Chronic Kidney Disease (CKD) and upon member outreach and engagement. Renalogic’s Registered Nurses work with each member on an assessment of the member’s health status. Depending on the member’s risk for kidney disease progression, calls are scheduled with the member for clinical intervention, coaching and member education. Our nurses are available 24 hours a day, seven days a week, however the majority of communication occurs Monday through Saturday within the hours of 6am-10am and 5pm-9pm.
Our overall engagement rate is 42% but has been steadily increasing to 78% or higher due to the growth of kidney disease in the U.S. Our reach is national with registered nurses certified in all 50 states.
If a member has CKD and is not on dialysis, the member typically remains in the program as an active participant until the member has met their primary health and behavior goals, their eGFR has stabilized or increased, and they have remained compliant with their goals for six months. This can range from nine months to one year on average.
Our nurses educate the member about the options and advantages of early transplant, discuss transplant options (familial living donors, paired living donors, deceased donors) and encourage early contact with a transplant center so that the member can get on the waiting list as early as possible. If the Plan has a transplant network or identified Centers of Excellence, we would refer the member to the transplant nurse for evaluation, and then continue to collaborate with the transplant nurse while the member is awaiting transplant.
Renalogic has been providing cost containment services since 2002 and in 2013 we implemented our first Outpatient Dialysis Benefit Carve Out within the self-insured marketplace.
Nearly 80% off total billed charges.
No. Our pricing methodology is proprietary and is not a derivative based on Medicare or any other single, arbitrary reference point.
Referenced based pricing uses either geographically focused customary charges and paid amounts or a derivative of Medicare which does not meet the burden of proof in reducing charges. Additionally, since the two largest dialysis providers see more than 80% of the dialysis patients, they are able to manipulate geographic charges and rates.
You may. If it happens, Renalogic supports our clients throughout out the process by reviewing the issues, providing all necessary information, making recommendations for responses, and working with all the stakeholders to ensure the appeal is addressed. Since 2002, when the company began, none of our clients have lost an appeal where we supported the response.
No. We have never lost a provider appeal.
We currently offer four pricing model variations of our cost containment program:
- Flat fee
- Percentage of Savings
- Per participating member per month (KDAP)
Yes, in most cases. Our legal team reviews the necessary PPO, ASA, and health plan documents prior to implementation to identify any potential restrictions to applying our pricing methodology.
Yes. Renalogic has been working directly or in conjunction with the largest TPAs and their related PPOs and have successfully implemented and executed legal “Outpatient Dialysis Carve Out Programs”.
No and that is what allows our program to be the most successful in the industry.
Very rarely does this happen within our program, but if it does happen then Renalogic will work directly with the plan, member, and provider to immediately address this issue. If necessary, we may contact federal authorities to ask them to intervene.
Depending on the complexity of the plan, there could be a nominal fee for our due diligence review of the plan and ASA/PPO agreements.
Yes, Renalogic is focused on being a Member Advocate. We will always educate members on the nuances of qualifying for Medicare, different types of treatments, appropriate access to the Kidney Fund Foundation, and transplant education. We are now offering a clinical intervention model for these members to ensure pharmaceutical compliance, proactively addressing provider and ER utilization, and always providing family support and education.