Disease Management

Menu of Disease Management Related Services:

  • Financial Modeling
  • IPA Development
  • Vascular Access Database
  • Payor Contracting
  • Network Development
  • Consulting Projects Tailored to Your Needs
  • Physician/Hospital Organization
  • Renal Case Management
  • Provider Contracting
  • Ongoing Network Management

Integrated Delivery Network
The purpose of an integrated delivery network is to provide a vehicle upon which the various services required by patients suffering from End Stage Renal Disease (ESRD) can be “bundled” and offered to health care plans under an “at risk” payment methodology. By bundling such services as nephrology, outpatient dialysis, outpatient laboratory, and home infusion, an environment is created where all providers share incentives. Clinical outcomes are maximized at the lowest cost and problems are identified and managed early to prevent unnecessary use of high-cost clinical services. The nephrologist is responsible for the coordination of the entire spectrum of renal related services. Therefore, this concept provides a unique alternative to contracting for the magnitude of provider services required by the ESRD patient. The guiding principles are based on:

  • Complete integration of financial, clinical, and operational components of ESRD care;
  • Accountability for financial and clinical outcomes, including customer satisfaction within a continuous quality improvement context;
  • Coordination of care across the entire continuum of illness;
  • Identification of key providers who are experience rated and willing to share the risk for managing care under a fixed payment arrangement;
  • Definition of expected patient care outcomes objectively measured;
  • Definition of practice guidelines and protocols that best demonstrate practice parameters that enable the achievement of expected outcomes;
  • Definition and implementation of a format which applies managed care principles, and nursing case management to the delivery of care to the ESRD patient; and implementation of resource utilization controls to contain cost.

The network, therefore, is responsible for the administrative expertise, organizational structure, resources, data management systems, and corporate culture necessary to identify, integrate, and manage clinical outcomes and customer satisfaction.

Scope of Risk

Payor will realize primary savings from reduced hospitalizations. To maximize hospitalization savings, the network will manage:

1. Dialysis Services by:

  • Ensuring appropriate delivery of treatment
  • Measurement of key indicators reflecting adequacy of treatment
  • Assisting primary care physicians in determining the appropriate time to start therapy

2. Physician Incentives by

  • Ensuring utilization of appropriate protocols/critical pathways.
  • Nephrologists control approximately 85% of costs
  • Nephrologists assume risk for over-utilization of hospital services

HDS’s Case Management program is designed to meet NCQA criteria. Key Processes include:

  • Initial Patient Assessment
  • Care Planning
  • Case Management
  • Utilization Management
  • Outcomes Management
  • Specific roles are identified for the following:
  • Quality Assurance Committee
  • Renal Case Manager
  • Administrative Staff


HDS specializes in improved outcomes, continuous quality improvement (CQI), and assisting dialysis providers and nephrologists in program re-engineering under the evolving paradigm of disease management.

It is our belief that providers are at a higher risk under the current fee-for-service system. Where discounts are becoming more prominent in the managed care arena, providers are aggressively embracing a re-engineered system where they can benefit from cost savings under capitation. Our goal is to help various systems in this re-engineering process.