March is National Kidney Month: Highlighting Innovative $300 Flat-Fee Pricing Model to Review and Effectively Negotiate High-Cost Dialysis Claims

March 13, 2025

New Case Study highlights impact of this cost-containment approach

March is National Kidney Month, a time dedicated to raising awareness about chronic kidney disease (CKD), its growing prevalence and the significant financial burden it places on patients, healthcare payors and the broader healthcare system.

Addressing the financial impact of CKD is a high priority for H.H.C. Group. In response to the escalating financial burden, H.H.C. Group has pioneered an innovative flat-fee pricing model, charging a fixed rate of $300 per dialysis treatment, ensuring predictable and cost-effective payments.

This approach, integrated with our Reference-Based Pricing (RBP) strategy, sets us apart from traditional percentage-based pricing models, delivering remarkable savings and financial stability for self-insured employers and other healthcare payors, third-party administrators (TPAs) and stop-loss/reinsurance carriers.

CKD Prevalence Fuels High-Cost Claims

Chronic Kidney Disease (CKD) affects over 35 million Americans, with more than 808,000 living with End-Stage Renal Disease (ESRD). The financial burden of ESRD is substantial, as dialysis and related treatments are costly.

With Medicare spending on ESRD dialysis services projected to reach $6.6 billion in 2025—a 2.7% increase from 2024—the financial burden of kidney disease continues to rise. While Medicare reimburses dialysis at controlled rates, private payors often face significantly higher charges, making cost-containment strategies critical to managing expenses.

Case Study: Achieving Significant Savings on ESRD Dialysis Claims

A healthcare plan faced an ESRD dialysis claim totaling $833,054 for a 56-year-old male patient. By partnering with H.H.C. Group, the plan implemented RBP based on Medicare benchmarks, reducing the claim to $39,329.

With H.H.C. Group's flat-rate pricing of $300 per treatment, the total payment amounted to $43,200, resulting in net savings of $750,524—a 90.1% reduction in costs.

Comparative Advantage: H.H.C. Group's Pricing Model

Unlike competitors who charge a percentage of savings, H.H.C. Group's flat-rate pricing model offers predictable and often lower costs. For instance, in a scenario with 169 dialysis treatments and billed charges of $1,156,401:

• H.C. Group: Charges $300 per treatment, totaling $50,700.
• Competitor A: Charges 10% of savings, amounting to $107,022.
• Competitor B: Charges 15% of savings, amounting to $160,533.

By choosing H.H.C. Group, the plan saved an additional $56,322 compared to Competitor A and $109,833 compared to Competitor B.

 

H.H.C. Group's Cost-Containment Solutions

H.H.C. Group offers comprehensive cost-containment services tailored to address the financial challenges associated with ESRD treatments:

• Reference-Based Pricing (RBP): Aligns payment models with Medicare benchmarks, ensuring fair and consistent pricing for dialysis services.
• Claims Negotiation and Repricing: Engages directly with providers to negotiate reasonable payment rates, often achieving significant reductions in billed charges.
• Independent Medical Reviews: Provides objective evaluations to confirm the medical necessity and appropriateness of treatments, ensuring compliance and cost-effectiveness.

Ensuring Financial Sustainability in ESRD Care: A Smarter Approach to Cost Containment

National Kidney Month is an opportune time for all payors to recognize the financial impact of CKD and explore the opportunity for significant savings that result from H.H.C. Group's approach to managing ESRD treatment costs.

By implementing strategies like Reference-Based Pricing and flat-rate models, H.H.C. Group ensures financial sustainability while maintaining high-quality patient care.

For more information on how H.H.C. Group can assist in managing ESRD-related expenses, contact us today.