<body><div><img src="https://img.particlenews.com/image.php?type=thumbnail_580x000&amp;url=46Ttuo_0vhd12IX00" alt="https://img.particlenews.com/image.php?url=46Ttuo_0vhd12IX00" width="480" height="270" >In addition to being one of the top 10 causes of death in the United States, chronic kidney disease is a significant driver of cost for commercial insurance and Medicare. These significant costs can be avoided with earlier detection, better quality care, and aligned physician incentives. Health plans, physicians, and patients often feel powerless to delay the progression of chronic kidney disease (CKD) and its corresponding costs, but most plans and CKD care management programs don’t follow the most cost-effective solutions for delaying disease progression.Deadly and expensiveCKD is a silent killer because the symptoms are subtle, and the kidneys’ ability to compensate for lost function can mask the disease until it is far along. As a result, many patients are unaware they have CKD until it has progressed to later stages. About 37 million U.S. adults are estimated to have CKD, and most are undiagnosed. Ninety percent of people with the disease are not aware they have it.Consequently, nine of 10 patients are diagnosed at Stage 3 or later. Health plans, even those with kidney disease programs, frequently underestimate the prevalence of members with CKD. CKD can progress to end-stage renal disease (ESRD), which is fatal without artificial filtering (dialysis) or a kidney transplant. Treatment and lifestyle changes can slow CKD progression but not reverse it.Treating CKD is expensive. According to the U.S. Renal Data System 2022 Data Report, Medicare spending for CKD patients ages 66 or older exceeded $75 billion in 2020, representing 25.2% of Medicare spending in this age group. (CKD, in its final stages, makes individuals eligible for Medicare regardless of age). Medicare-related expenditures for those with ESRD totaled $50.8 billion in 2020—the more advanced the disease, the more expensive the treatment.Commercial plans are also expensive. A 2017 study found that for commercial carriers, the average per-patient annual cost accelerates from $7,357 for those without CKD to $121,948 for those with ESRD without dialysis.Fortunately, there is a way that plans can address costs and improve care for their members with CKD.Use lab valuesEarlier diagnosis and disease management are critical in CKD. Many health plans have programs to identify patients but rely solely on analyzing claims data. However, that method is inadequate because of coding issues, the lag between patient care, and the time claims are submitted and available for analysis. Therefore, early identification is limited as claims data does not represent the complete picture.However, lab test values can be analyzed to identify high-risk, undiagnosed, and non-staged members across all CKD stages. This approach uses insurers’ claims data and lab results from multiple tests, such as creatinine, estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (uACR), and hemoglobin A1c.In a recent case study with a regional commercial health plan, lab value analysis revealed that 11,000 members were undiagnosed or unstaged. The health plan informed those members and their physicians, and they can now receive the indicated treatment for not only CKD but also heart disease, diabetes, and early death. The program projects a savings of $979 per Stage 4 member in just the first year of the program.Improve control of diabetes and hypertensionMost CKD care management programs aren’t focused on the key contributors to disease progression: uncontrolled diabetes and hypertension. Controlling these comorbidities not only helps patients, but controlled patients are less likely to be hospitalized and less likely to require dialysis.Analysis of lab values from members of another regional commercial plan demonstrates that patients with uncontrolled diabetes are 15% more likely to progress to the next stage of CKD over 27 months. Controlling diabetes means savings for plans: uncontrolled diabetics cost $4,473 per year more on average than controlled diabetics.Align nephrologist incentivesMany failed value-based care programs focus on support services that are out of the control of nephrologists. However, a program that uses patients’ lab values to analyze the performance of their providers can identify high and low performers using a care management score. Analysis of high-performing physician groups reveals that the bottom quartile of physician performers cost $534 (32%) more per CKD member per month.A lab values-based program can also provide clinical decision support through a monthly “chase list” of patients who may need guideline-recommended staging, testing, office visits, or medications. Providers who act on the list will see better results for their patients.ConclusionThe three tactics outlined above can save health plans substantial costs while improving members’ health and quality of life. One commercial plan that recently implemented a quality improvement program built around these initiatives saw the following results:<ul><li>Reduced average PMPM from $9,683 to $8,702</li><li>10% reduction in total costs after 24 months</li><li>Savings driven by cost reductions of stages 3 and 5 patients</li></ul>Health plans no longer need to feel powerless about CKD. Plans can contain costs and help members live longer, healthier lives by taking a more aggressive approach to identifying and managing the disease.</div></body>

Mountain View, CA

NewsBreak

Controlling Care Costs for Chronic Kidney Disease

In addition to being one of the top 10 causes of death in the United States, chronic kidney disease is a significant driver of cost for commercial insurance and Medicare. These significant costs can be avoided with earlier detection, better quality care, and aligned physician incentives. Health plans, physicians, and patients often feel powerless to delay the progression of chronic kidney disease (CKD) and its corresponding costs, but most plans and CKD care management programs don’t follow the most cost-effective solutions for delaying disease progression.