Specialty Care Management
Specialty Care Management is a privately held U.S. healthcare cost-containment vendor that delivers dialysis cost containment, CKD management, and adjacent care management services to self-funded health plans, brokers, TPAs, stop loss carriers, captives, employers, and PPO networks.
- Company typePrivate
- Founded2002
- HeadquartersLahaska, United States
- Headcount11–50
- GTM typeB2B
- OfferingServices
What Specialty Care Management does
Specialty Care Management (SCM) is a privately held U.S. healthcare cost-containment vendor founded in 2002 and headquartered in Wayne, Pennsylvania. The company specializes in dialysis cost containment and chronic kidney disease (CKD) management for self-funded health plans, with additional service lines spanning cancer management, transplant cost management, air ambulance negotiation, prevention programs (diabetes, weight, hypertension), and underwriting support. SCM operates a network-, TPA-, and provider-agnostic model under which members can continue seeing existing providers while SCM works behind the scenes to manage claims and care. Its technology platform is built around free renal-related data analytics for population risk stratification, capitated case-rate pricing with no percentage-of-savings fees, and RN-credentialed nurse coaching programs that engage members directly to slow CKD progression. SCM sells through a direct enterprise motion targeting brokers, TPAs, stop loss carriers, captives, employers, and PPO networks, and is led by President & CEO Craig R. Clemente with founder Robert A. Clemente serving as Chairman.
Specialty Care Management firmographics
Firmographics- Name
- Specialty Care Management
- Legal name
- Specialty Care Management
- Website
- https://specialtycm.com
- Company type
- Private
- Founded year
- 2002
- Operating status
- Operating
- Headcount range
- 11–50 employees
- Short description
- Specialty Care Management is a privately held U.S. healthcare cost-containment vendor that delivers dialysis cost containment, CKD management, and adjacent care management services to self-funded health plans, brokers, TPAs, stop loss carriers, captives, employers, and PPO networks.
- Ownership category
- akta.pro rank
Specialty Care Management industry classification
Industry- Product category
- Healthcare Cost Containment
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Agencies, Brokerages, and Other Insurance Related Activities (5242)
- SIC
- Hospital & Medical Service Plans (6324), Services-Health Services (8000)
- akta.pro primary industry
- Chronic Kidney Disease (CKD) Management Clinics (HLAKAHAB)
- akta.pro secondary industry
- Onconephrology (Kidney Care in Cancer Patients) (HLAKAHAM)
Keywords
Where Specialty Care Management is headquartered
LocationHeadquarters
- HQ city
- Lahaska
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Specialty Care Management business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure
Revenue model
- Dialysis Cost Containment Services: Capitated case rates for dialysis management including all outpatient center charges with no percentage of savings fees. No set-up fees or costs until utilization begins.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Annual | Capitated Case Rate Model |
Go-to-market motion1 record
Distribution channels1 record
Marketing channels3 records
Specialty Care Management product offering
Product offeringCore offering
Specialty Care Management (SCM) provides healthcare cost containment services focused on dialysis and chronic kidney disease (CKD) claims. The company contracts with insurance brokers, third-party administrators (TPAs), stop loss carriers, captives, employers, and PPO networks to reduce specialty healthcare expenses through capitated case rates, negotiated provider networks, and dedicated clinical case management for high-cost renal and oncology claims.
Product overview
Specialty Care Management (SCM) offers a unified portfolio of healthcare cost containment and care management solutions focused primarily on dialysis and chronic kidney disease (CKD). The core offerings include Outpatient Dialysis Cost Containment and CKD Management, supported by additional service programs such as Dialysis Plus, Dialysis Prime, Kidney Care Complete, Cancer Management, Prevention Programs (diabetes, weight, hypertension management), Air Ambulance, Negotiation Services, Transplant, and Underwriting Support Services. SCM operates with a model featuring free renal-related data analytics, no set-up fees, fixed capitated case rates, and dedicated RN-credentialed Nurse Coaches. The company serves self-funded health plans including brokers, TPAs, stop loss carriers, captives, employers, and PPO networks through its network, TPA, and provider agnostic approach.
Differentiator
Problem solved
Functional benefit
Products and services
- Outpatient Dialysis Cost Containment A dialysis cost containment program that delivers capitated case rates for outpatient dialysis treatments, designed for payers seeking predictable, fixed pricing for high-cost renal claims.
- CKD Management A chronic kidney disease management program focused on slowing disease progression and reducing the likelihood of costly dialysis or transplant claims, offered to employer health plans, TPAs, and stop loss carriers.
- Kidney Care Complete A comprehensive bundled kidney care program that integrates CKD management, dialysis cost containment, transplant support, and prevention services for payers seeking an end-to-end renal solution.
- Cancer Management A specialty oncology cost containment program that negotiates and manages high-cost cancer treatment claims for payers, leveraging capitated arrangements and clinical oversight.
- Prevention Programs Preventive renal health programs designed to identify at-risk members early and reduce future incidence of kidney disease and related high-cost claims.
- Air Ambulance
Quantifiable outcome
- 32% off billed charges in oncology case study
- +1 more outcomes
Companies that use Specialty Care Management
Customer profileNamed customers5 records
Segments6 records
Ideal customer profiles4 records
Specialty Care Management technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature3 records
Specialty Care Management partnerships and signals
Strategic signalScale indicators4 records
Recent moves5 records
Expansion highlights4 records
Specialty Care Management competitors and assessment
Company assessmentBroad incumbents
- Optum (UnitedHealth Group): Largest healthcare cost, PBM and care management franchise in the U.S., with renal and chronic condition programs that compete with SCM and can disintermediate niche vendors through payer integration.
- CVS Health (Caremark / Evernorth): Diversified payer-PBM-services incumbent with care management and specialty drug capabilities that overlaps with SCM's chronic condition and high-cost claim management scope.
Direct peers
- MultiPlan: One of the largest independent cost-containment providers in the U.S., delivering repricing, negotiation, and specialty network services including renal/dialysis claim management directly comparable to SCM's core offering.
- Zelis: Healthcare cost management platform offering claims cost reduction, network solutions and care management; competes with SCM for self-funded health plan and TPA wallets across similar capitated and contingency-style engagements.
- Imagine Health: Healthcare cost management company focused on bundled, value-based contracting for self-funded employers; competes for the same plan-sponsor budget pool around high-cost specialty care.
- Valenz: Cost containment platform purpose-built for self-funded health plans, combining repricing, negotiation, and care management services that overlap directly with SCM's dialysis and chronic condition programs.
- ELAP Services: Specialized cost-containment vendor serving self-funded employer health plans with repricing, negotiation, and high-dollar claim management analogous to SCM's dialysis and cancer case services.
Emerging players
- DaVita: Largest U.S. dialysis provider; while primarily a provider rather than a cost-containment vendor, it is a direct counterparty in dialysis claim economics and a frequent target of SCM-style negotiation and repricing services.
- Fresenius Medical Care: Second-largest U.S. dialysis provider and integrated kidney care services operator; relevant counterparty and emerging adjacent competitor given its push into value-based kidney care contracting.
Regional players
- Sunstone Management Consultants: Smaller U.S. cost containment and population health firm providing repricing and care management services to TPAs and self-funded plans — comparable in scope and customer base, smaller in scale.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
Specialty Care Management social profiles
Digital presenceSpecialty Care Management financial estimates
Financial estimateRevenue estimate
Valuation estimate
Specialty Care Management leadership team
Management profileNumber of profiles
Profiles3 records
Specialty Care Management funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Specialty Care Management M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Specialty Care Management
What does Specialty Care Management do?
Specialty Care Management (SCM) provides healthcare cost containment services focused on dialysis and chronic kidney disease (CKD) claims. The company contracts with insurance brokers, third-party administrators (TPAs), stop loss carriers, captives, employers, and PPO networks to reduce specialty healthcare expenses through capitated case rates, negotiated provider networks, and dedicated clinical case management for high-cost renal and oncology claims.
Is Specialty Care Management a public or private company?
Specialty Care Management is a private company. It is classified as family owned and is currently operating.
When was Specialty Care Management founded?
Specialty Care Management was founded in 2002. It employs 11 to 50 people.
Where is Specialty Care Management based?
Specialty Care Management is headquartered in Lahaska, United States, in the North America region.
How does Specialty Care Management make money?
One revenue line is on record: dialysis Cost Containment Services.
Who are Specialty Care Management's main competitors?
Broad incumbents on record are Optum (UnitedHealth Group) and CVS Health (Caremark / Evernorth). Direct peers are MultiPlan, Zelis, Imagine Health, Valenz and ELAP Services. Emerging players are DaVita and Fresenius Medical Care. Sunstone Management Consultants is listed as a regional player.
Does Specialty Care Management have an API?
No public API is recorded for Specialty Care Management.
What industry is Specialty Care Management in?
Specialty Care Management's product category is Healthcare Cost Containment. Its primary akta.pro industry code is HLAKAHAB, Chronic Kidney Disease (CKD) Management Clinics, with a secondary code of HLAKAHAM, Onconephrology (Kidney Care in Cancer Patients). Its NAICS code is 524292 and its SIC code is 6324.