More than 42,000 organ transplants were performed in the United States in 2022, according to data from the United Network for Organ Sharing. In addition to organ transplants, thousands of patients also received transplants of bone marrow, stem cells and other tissues.
Although transplants have become increasingly common, they remain risky, expensive, and surrounded with uncertainty for patients and their families. For example, in 2020, the average billed charges for a heart transplant were $1,664,800, from 30 days pre-transplant to 180 days after, according to Milliman’s triennial transplant report. The average billed charge for a kidney transplant over the same time period was $442,500, and for a single lung transplant, $929,600.
In addition to the financial costs, the emotional and physical costs associated with transplants are very high. Many patients who need a transplant must make major lifestyle changes to qualify for a transplant. Most spend weeks, months or even years on a transplant list, waiting for the needed organ or tissue to become available. Selecting a transplant center that will meet their needs, getting added to the right list, and maintaining the health parameters to stay on the list can be overwhelming. After a transplant, most patients will be required to take anti-rejection therapies for the rest of their lives and remain under medical care.
For self-insured employers, the miracle of transplantation can be a lifesaving opportunity for member employees or their family members. But with high financial, emotional and health costs on the line, it’s crucial to get the process right.
Case Management Gets Transplantation Right
Getting a transplant requires a dizzying array of meeting health goals; conducting research to find the right transplant center; undergoing evaluation and qualification; and managing the financial components, stress and emotions throughout the process. Most patients and their families need help with all of that, and a dedicated transplant case management team can provide that help.
According to research presented at the 2022 American Transplant Congress, transplant patients who participated in dedicated care management programs fared significantly better than those who did not. They had significantly lower 30-day and 90-day rejection rates, fewer 30-day and 90-day readmissions, lower transplant mortality and 90-day mortality, and fewer in-hospital bed days after the transplant, compared to those who did not participate in a care management program.
When a health plan offers specialized transplant care for its members, an employee or employee family member who needs a transplant can immediately connect with a care coordinator. The care coordinator can help assuage fears and provide actionable advice and information, helping to research the best transplant centers in the patient’s vicinity, assisting patients with health habits to prepare them for a transplant, and coordinating financial management for the long-term process.
“Transplant care is very complicated, and we want to put patients in the best position possible to get the transplant and the care they need with a positive health outcome,” says Debbie Farley, director of large case management at Lucent Health, powered by Narus Health. “There are so many pieces to the puzzle, and in addition, the patients need the same emotional and physical support that any patient needs.”
Most third-party-administrators outsource specialized care management to other vendors, but integrating that service into your health plan administration ensures that the care management perspective is included in decisions about cost, providers and technology resources.
How Care Management Works
When transplant case management is included as part of health plan administration, members get access to expert help as soon as they learn about the need for a transplant. Dedicated case managers provide education, support and advocacy for the member, while working with the third-party administrator, employer group and stop-loss carrier to coordinate services throughout the transplant process.
Lucent Health’s trained transplant nurses are experienced in assessing the financial impact of transplant care as well as coordinating care and educating and supporting the family and patient. This assistance continues from the beginning of the transplant discussion through the transplant evaluation process, organ listing, waiting period, transplant admission and for at least one year post-transplant. Under the Narus umbrella, a covered patient has access to behavioral health support, nutritional assessment and support, and ongoing support from the chronic care management team after the transplant care has ended.
Learn more about Lucent’s case management program and how it can cut costs for self-insured companies while boosting health outcomes for plan members. Download your copy of our e-book, Improving Outcomes for Employees Undergoing Transplants, today.