As president of Renalogic, Mark Masson is shaking up the profit-driven industry of kidney dialysis, which is now dominated by just two companies that control 80 percent of the $24.7 billion U.S. market.
“These two behemoths have created the system where those paying the bills don’t have any power,” Masson said. “That’s the basis of the disfunction in the dialysis industry, today.”
Founded in 2002, Renalogic started leveling the playing field by offering dialysis cost containment services to its clients, which include regional health plans, TPAs, coalitions pools, municipality groups, and self-insured companies with anywhere from 25 to 35,000 employees. To date, Renalogic’s clients have collectively saved nearly $1 billion.
How does Renalogic protect health plans against catastrophic dialysis claims?
Renalogic provides a complete spectrum of specialized services within two programs, cost containment for dialysis claims repricing and intervention that manages the risk associated with chronic kidney disease (CDK), which left unmanaged leads to kidney failure and dialysis. Renalogic reprices dialysis claims using their proprietary usual and reasonable method. In November 2020, the Renalogic method was validated by a 9th Circuit Court ruling as a safe harbor for plans that still rely on a multiple of Medicare to reprice dialysis claims. The Kidney Dialysis Avoidance Program (KDAP) relies on specially certified Nurse Health Coaches to engage those members who are among the highest claims cost cohorts in every plan. The result is cost savings and cost avoidance for the plan and improved health and vitality for its members.
Both cost containment and KDAP rely on and benefit from predictive modeling and artificial intelligence that pinpoints plan members who have or are developing chronic kidney disease, even those without a diagnosis. They mine data, reviewing the risk of every member so that clients know when imminent dialysis claims will be coming. Both clients and their members have more time. Renalogic’s team uses that valuable time to create and administer tailored care plans that most often, help members avoid dialysis altogether and for those not participating in KDAP, offer support, advocacy, and education which lead to a soft landing into dialysis.
“This information is hard to get, but it keeps us ahead of the curve,” Masson said. “And while having information is good, making the information actionable, and really driving results is where we live. No matter where at risk members appear in stratification, we can intervene with education, support, and get ahead of the curve. In an industry where the risk of CKD and Dialysis has been hidden, this is a game changer.”
Central to Masson’s strategic plan for growth is an alliance with fellow healthcare-industry disrupter Stonebrook Risk Solutions, in which Renalogic is also an investor.
An Encino-based startup, Stonebrook is creating a national network of regional health plans. The multistate plans can serve middle-market employers and stretch beyond the geographic boundaries of their existing provider networks. Using its proprietary digital platform, Total Value Analytics, Stonebrook does a deep dive into the finances of regional plans, calculating every aspect of cost. Aggregating these datapoints, the company aligns risk among multiple noncompeting regional plans so that they are operating within the same risk-adjustment environment.
By creating the first nationwide network of best-in-class regional health plans, Stonebrook is giving consumers a real alternative to corporate healthcare conglomerates. The ecosystem which Stonebrook is creating is raising the bar for regional health plans. Stonebrook assists health plans so they can better understand costs and once identified, address the risk with best-in-class solutions. By partnering with Renalogic, Stonebrook can help those regional healthcare plans contain and prevent the stratospheric costs of dialysis.
With an innovative platform like Stonebrook and targeted solutions from Renalogic, employer groups can benefit from their strength in numbers as leverage with dialysis providers. “We create a value for the market and have a disrupter very similar to us,” Masson said. “More competition means better quality care and better value.”
As Stonebrook’s platform grows and more regional plans buy in, Relalogic will have an opportunity to assess and drive a solution set that is integrated within Stonebrook’s platform. “This partnership is mission-driven, setting employer groups up for real change and success where they haven’t seen it before — in their health plan,” Masson said. “We are not interested in status quo.”
“The large dialysis companies have prioritized their profits over helping people. By prioritizing shareholders, the large dialysis providers continue to escalate an already massive cost of care,” Masson said. “The industry is not going to fix itself. Stonebrook and Renalogic are a one-two punch when it comes to fighting catastrophic claims costs.”