Healthmap Solutions Alerts Medicare Advantage Plans to Prepare Now for 21st Century CURES Act Implementation
JANUARY 29, 2020—TAMPA, FL — Healthmap Solutions, a rapidly growing national Population Health Management (PHM) company with a flagship Kidney Health Management (KHM) program, is urging Medicare Advantage (MA) plans to prepare now for the 21st Century CURES Act and a key provision which allows previously ineligible End-Stage Renal Disease (ESRD) patients to select an MA plan during open enrollment for the 2021 calendar year. ESRD is an irreversible condition that requires dialysis or a kidney transplant to survive. Currently, 726,000 Americans are living with ESRD, a number that grows 5% each year. The cost to treat patients with ESRD ranges between $80,000 to $100,000 per member per plan year.
According to CMS, there are approximately 120,000 ESRD beneficiaries enrolled in MA plans currently. They represent about 0.65% of enrollees, and about 5% of total MA plan spend. Should every eligible beneficiary with ESRD enroll in an MA plan during open enrollment in 2020, that number would increase to approximately 2.7% of enrollment, and it is estimated that claims attributable to ESRD would increase to 20% of total claims.
“In 2020, MA plans can expect and must immediately prepare for a large influx of new ESRD members who require long-term, coordinated, multidisciplinary care customized to the individual patient,” said Joe Vattamattam, Chief Executive Officer of Healthmap Solutions. “But addressing the ESRD population goes only so far. Early identification, intervention, and effective care plans for members at risk of developing, or have CKD, is the most effective means of slowing the progression of kidney disease and disrupting the growth of ESRD patients. By using big data and predictive analytics, it is possible to initiate clinically appropriate steps to intervene early, improve clinical outcomes, and reduce costs."
While the prevalence and cost of care for ESRD patients is significant, it represents just the tip of the iceberg. There are 37 million Americans living with Chronic Kidney Disease (CKD), the precursor to ESRD, and millions of others receiving treatment for conditions such as hypertension, heart disease, diabetes, and obesity, which are all gateway conditions to CKD. Non-ESRD kidney care costs Medicare $23,558 per person, almost double the cost of the average, non-CKD Medicare beneficiary.
“For MA plans looking to get out ahead of the implementation of the CURES Act, we recommend identifying and engaging a KHM partner who offers both the data and technology to predict patient risk coupled with the clinically proven multidisciplinary programs to treat CKD and ESRD," said Vattamattam. "This powerful combination of high-tech and high-touch care is key to achieving the desired financial and clinical results when caring for and covering the complex kidney health population."
Healthmap Solutions offers the following CURES Act Readiness timeline for MA plans:
Fall 2019 to Early Spring 2020: Evaluate solutions to manage complex ESRD
Spring/Early Summer 2020: Contract with and onboard a solution provider
Late Summer/Fall 2020: General pre-open enrollment marketing; prepare for ESRD questions from current and potential new members
Fall 2020 Open Enrollment: Medicare patients make decisions to enroll in a new plan or add benefits to an existing one
January 1, 2021: ESRD patients are covered by their chosen MA plans
Healthmap Solutions is a population health management company with a specific solution for kidney patients, serving health plans, including Medicare Advantage and employer-sponsored plans, as well as accountable care organizations (ACOs) and provider groups seeking value-based solutions that improve the clinical care and financial performance for high-risk, high-cost kidney patient populations. The company has a rich history forged in data and analytics, having begun as a healthcare data clearinghouse, adding robust healthcare analytics expertise, and today Healthmap Solutions uses that experience to power complex Kidney Health Management programs with its clinical experts. The company also provides similar integrated programs across a full range of specialty population health management. For more information: healthmapsolutions.com
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 2019 projection from CMS April 2, 2019, Final Announcement