It is Time to Bring Kidney Care into the 21st Century

by Richard Popiel, M.D., M.B.A. 
Chief Medical Officer at Healthmap Solutions
Published March 11, 2021

Kidney disease is life-altering for patients and families, complex for providers to treat, and costly for health plans to cover. It doesn’t have to be this way.

According to the Centers for Disease Control, 37 million people in the U.S. have chronic kidney disease (CKD), and 90% live unaware of their condition. Most first learn of their condition when their kidneys fail and they “crash” into dialysis in a hospital emergency room. In 2018, more than 131,000 people were newly diagnosed with end-stage renal disease (ESRD). Overwhelmed by their diagnosis and uninformed of their options, the vast majority start thrice-weekly dialysis treatment in a dialysis center, having to schedule their lives around the availability of a dialysis chair.

By the end of 2018, 785,883 people were living with ESRD, an increase of 2.3% from 2017. Of that number, 485,052 were receiving dialysis in a dialysis center. To put this in perspective: only 68,986, or 12.5%, were being treated at home even though in-home dialysis is as clinically safe and effective as in-center dialysis, and can reduce cost by up to 15.5% per patient versus in-center treatment. More than twice as many people were receiving in-center dialysis treatment than living with a kidney transplant (229,887), even though a transplant is the only known cure for the disease.

We can do better!

Rising Costs Stress an Already Overburdened Healthcare System

In 2018 the cost of kidney care to Medicare was over $131 billion. The average cost to Medicare to treat a patient with ESRD ranges from $80,000 to $100,000 per year. Specialized care, in-center dialysis, extensive medication regimens, and unplanned visits to emergency departments and hospitalizations, which account for 40% of the cost to Medicare, take a significant toll on a patient’s physical and emotional well-being, which can further stress an already overburdened healthcare system.

We can help improve clinical quality, kidney management outcomes, member experience, and total medical expense by making early detection a priority, untethering patients from dialysis centers, and proactively working with the patient and their providers to keep them engaged and supported with their healthcare.

The Disruptive Power of Advanced Technology, Clinical Expertise, and Personalized Care

Robust and broad data resources, integrated advanced technology, clinical expertise, and complex care management can be a powerful combination to:

• Predict patients who are most at risk for kidney disease and recommend clinically proven interventions that can delay kidney disease onset and slow the progression of the disease.
• Use predictive analytics to uncover patients whose medical and socioeconomic profiles put them at risk of adverse medical events, months in advance, by matching them against similar patients and intervening to prevent the event from happening.
• Identify appropriate candidates for in-home dialysis and effectively implement a plan of treatment for the start of in-home dialysis therapy. In-home dialysis frees patients from a treatment schedule tied to the availability of an in-center dialysis chair. Because in-home dialysis can be administered more frequently and with flexibility, patients tend to be more compliant and satisfied with their therapy. Quality of life improves for patients, their caregivers, and their families.
• Identify candidates for preemptive kidney transplants and proactively refer them for a transplant evaluation well before their kidneys fail and dialysis is needed. Early identification gives patients time to learn more about the transplant process, how to get on the waiting list, and the post-transplant practices. It may also give the patient time to find a donor, whether directly from a family member, friend, or through a paired donation.
• Support providers with timely and actionable patient-specific data and offer the clinical insights to help them deliver proactive care and improve the clinical management of their patients. This includes detecting the social determinants of health barriers, such as transportation, food insecurity, and social/emotional challenges that may keep patients from fully accessing their provider's plan of care and healthcare services.
• Empower patients with information to make informed decisions as an advocate for their care. Help patients gain a clear understanding of all of the care options, which may include in-home dialysis, a kidney transplant, or conservative care. Patients can be assessed for telehealth readiness, an essential consideration for kidney care patients, who are among the most vulnerable to COVID-19. Patients who feel supported report better member experiences.

We can improve the lives of people living with kidney disease and the costs associated with caring for them. To do so requires us to reverse long-held assumptions about kidney care and leverage big data, advanced technology, clinical expertise, and care management capabilities available today. Contact us to learn more about the Healthmap Solutions Kidney Health Management program.