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Preventing or delaying the need for dialysis is one of the most effective ways to reduce Plan healthcare costs. The Dialysis Carve Out program is based on two key components: our proprietary plan language and our reasonable value payment re-pricing methodology. Together, these components balance savings, flexibility and defensibility for our clients. The Dialysis Carve Out program includes case management services designed to identify at-risk members before they need dialysis. Case managers are specially trained registered nurses and licensed social workers. They work closely with patients, families and providers to help ensure high quality, cost-effective care. Case managers can answer questions and help patients understand their treatment options with a focus on enhancing the overall member experience. While early intervention may help some members avoid the need for dialysis, case management needs to be complemented with additional cost-saving mechanisms to help protect plan assets when members do progress to End Stage Renal Disease and require dialysis services.



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