Shift Shapers Podcast

16 Nov 2020

Ep #336: Specialty Care Management – With Craig Clemente

David Saltzman 0 Comments

This week’s episode features a conversation with Craig Clemente, President & 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 document
  • 08:19 Involving patient members and educating about specialty care
  • 14:34 Managing the costs of specialty drugs and air ambulances
  • 18:42 The future of specialty care


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.”

Listen to the Full Interview:

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