Even More Critical for Medicare Advantage Plans with Unaddressed Cures Act RisksBy Eric Reimer
Chief Executive Officer and Co-Chairman of the Board
Published December 15, 2020
The costly status quo for end-stage renal disease (ESRD) patients is to automatically send them to in-center dialysis treatment. However, in-home dialysis represents one of the greatest opportunities to improve care, outcomes, member experience, and better manage cost. Healthmap Solutions’ Kidney Health Management (KHM) program guides providers and patients to in-home dialysis treatment. We’re currently working with national, regional, and local health plan clients to increase in-home dialysis adoption among their ERSD patient populations.
Medicare Advantage Plans and the Cures Act Risks
Increased adoption of in-home dialysis has never been more important for Medicare Advantage (MA) plans. On January 1, 2021 the 21st Century Cures Act takes full effect, opening the door to thousands of previously ineligible ESRD patients to gain coverage under a MA plan. The Centers for Medicare and Medicaid Services (CMS) estimate that 63% of newly eligible ESRD patients will choose coverage under a MA plan by 2026. People living with ESRD are among the most complex and vulnerable populations, being high-risk for avoidable ER visits and unplanned hospitalizations. According to CMS, these patients have a 112% medical loss ratio.
Patient-Centric, Provider-Supporting KHM programs
Our proven KHM program uses big data, artificial intelligence (AI), machine learning and predictive analytics to leverage clinical expertise and complex care management for patients with CKD and ESRD. In doing so, our solution will proactively plan and facilitate life improving care for patients and lower cost for health plans by:
- Identifying people who are at-risk of renal failure before they need dialysis
Intervening early with clinically-proven care can slow or delay disease progression to ESRD. Should a patient need renal replacement therapy (RRT), we work with them and their healthcare provider in advance to plan for the most appropriate RRT option. Proper planning and patient education allow physicians and patients to make informed decisions and for patients to prepare emotionally and medically for their transition to the next level of care, avoiding the traumatic and costly “crashes” into dialysis.
- Identifying patients who are ideal candidates for in-home dialysis
Our KHM program proactively identifies people whose medical profiles match those of other ESRD patients who have successfully transitioned to in-home dialysis. This information is shared with the physician to determine the patient’s appropriateness for and the expected effectiveness of in-home dialysis. Any social determinants of health barriers that exist are addressed prior to the transition by connecting the patient to the appropriate community-based programs.
- Championing patients and caregivers to succeed
In-home dialysis is a life-altering alternative to in-center dialysis, helping people regain control of their lives. It also requires a high-level of engagement, confidence, and discipline on the part of the patient and their caregivers. Our Care Navigation team arranges for the training that patients and their caregivers need to administer and manage in-home dialysis treatment. The Care Navigation team remains in regular contact to ensure patients are adapting well to in-home treatment, continue to adhere to their treatment plan, medication regimen, and ensure they continue to attend their medical appointments. Telehealth candidates can be identified and assessed for readiness, a vital consideration for kidney care patients who are among the most vulnerable to COVID-19. Patients who feel supported report better member experiences.
- Keeping people dialyzing safely and confidently at home
Problems that occur at any time can discourage a patient and drive them back to in-center dialysis treatment, or worse, into an ER or hospital. The Healthmap multidisciplinary Care Navigation team troubleshoots issues as they arise. Patients and caregivers have 24/7 access to nurses who can answer questions, help address issues, and offer the encouragement and support a patient or caregiver may need in the moment.
- Empowering providers with actionable, timely patient-specific information
Our KHM program supports physicians by putting data and clinical insights in their hands and improving their understanding of their patients' day-to-day needs. This may include the social determinants of care that could preclude a patient from fully accessing their healthcare or adhering to care plans or medication regimens.
The Healthmap Solution
At Healthmap, our industry-leading KHM program is designed to improve the lives of people living with kidney disease and deliver results across the board on the value-based measures that matter most to providers and health plans. We are prepared to support our clients in providing a robust KHM program that addresses patients with ESRD and are able to scale and make an impact no later than QI 2021. If you are ready to put our expertise to work for your MA plan, please contact us .