Craig Clemente's guest appearances

Craig Clemente

The ShiftShapers Podcast

Self-Funded With Spencer

Megan Chiarello

Lester Morales

Mark Testa

John Troutman

Sanjay Prasad

Michael Zipursky

Brian Clarke

Josh Butler

Ryan Miller

Jennifer Morgan

Jake Thompson

Gleb Tsipursky

Tommy Breedlove

Josh Jackson

Matt Newman

OwlTail

In this Episode, Craig Clemente, President &amp; COO of Specialty Care Management (SCM), came on the show to discuss the growing problem of Outpatient Dialysis, and how his organization specializes in controlling the cost of this treatment for self-funded employers.--- Support this podcast: https://anchor.fm/spencer-harlan-smith/support

In this Episode, Craig Clemente, President &amp; COO of Specialty Care Management (SCM), came on the show to discuss the growing problem of Outpatient Dialysis, and how his organization specializes in controlling the cost of this treatment for self-funded employers.--- Support this podcast: <a href="https://anchor.fm/spencer-harlan-smith/support" rel="payment nofollow" target="_blank">https://anchor.fm/spencer-harlan-smith/support</a>

Episode 11 - Craig Clemente

This week’s episode features a conversation with Craig Clemente, President &amp; Chief Operating Officer at Specialty Care Management. Specialty care is both a claims exposure and a clinical component and Craig details how plans need to focus on both. He also explains the nuances of the plan document language and the need to have member champions to spread awareness. Finally, Craig discusses the steps plans can take to bring down the extreme costs of specialty drugs and air ambulances.What You’ll Learn From This Episode:01:45 Specialty care defined: When do they get involved?06:36 Explaining the language of the plan document08:19 Involving patient members and educating about specialty care14:34 Managing the costs of specialty drugs and air ambulances18:42 The future of specialty careQuotes:06:54 “It is really important that we look at this not as a diagnosis in that you cannot be discriminatory in any way in your plan document, whether that’s for again dialysis or anything else.”13:28 “Ultimately, I think one other key component is you always try to find that individual within the member population that’s going to be your kind of vocal champion, your internal supporter.”16:48 “Average cost of an air ambulance ride is about $49,000 and many times, it’s much much higher than that. And there’s no real regulation in this space.”18:24 “We’re seeing that we’re upwards of 70 to 80 percent off total bill charges in those scenarios even with companies that have never traditionally given anything over and above 30 percent historically.”19:12 “The overarching theme here is risk management and understanding that risk management works well beyond a single BUCA entity, for example, where you’re just putting one solution in place to manage everything.”

This week’s episode features a conversation with Craig Clemente, President &amp; Chief Operating Officer at Specialty Care Management. Specialty care is both a claims exposure and a clinical component and Craig details how plans need to focus on both. He also explains the nuances of the plan document language and the need to have member champions to spread awareness. Finally, Craig discusses the steps plans can take to bring down the extreme costs of specialty drugs and air ambulances.What You’ll Learn From This Episode:<ul><li>01:45 Specialty care defined: When do they get involved?</li><li>06:36 Explaining the language of the plan document</li><li>08:19 Involving patient members and educating about specialty care</li><li>14:34 Managing the costs of specialty drugs and air ambulances</li><li>18:42 The future of specialty care</li></ul>Quotes:06:54 “It is really important that we look at this not as a diagnosis in that you cannot be discriminatory in any way in your plan document, whether that’s for again dialysis or anything else.”13:28 “Ultimately, I think one other key component is you always try to find that individual within the member population that’s going to be your kind of vocal champion, your internal supporter.”16:48 “Average cost of an air ambulance ride is about $49,000 and many times, it’s much much higher than that. And there’s no real regulation in this space.”18:24 “We’re seeing that we’re upwards of 70 to 80 percent off total bill charges in those scenarios even with companies that have never traditionally given anything over and above 30 percent historically.”19:12 “The overarching theme here is risk management and understanding that risk management works well beyond a single BUCA entity, for example, where you’re just putting one solution in place to manage everything.”

Ep #336: Specialty Care Management - With Craig Clemente