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Blue Cross and Blue Shield of Minnesota has become the latest insurer seeking to better manage the risk of patients afflicted with permanent kidney failure, with such patients now eligible to enroll in Medicare Advantage plans for the first time.
The effort takes the form of a partnership with VillageHealth, an integrated kidney care program from DaVita, which addresses the holistic health needs of certain eligible members with chronic kidney disease (CKD) or end-stage kidney disease (ESKD).
The value-based agreement is designed to improve health outcomes and reduce the total cost of care for eligible Blue Cross members.
It will seek to do so in part by coordinating care for eligible members. VillageHealth and DaVita, in collaboration with nephrologists and primary care physicians, will coordinate all care via one integrated plan that can be managed on behalf of the patient, the companies said.
The program will also include an awareness campaign for primary care providers to help them improve kidney disease screening, proactively manage early-stage CKD patients and facilitate appropriately-timed referrals to nephrologists.
Also, in collaboration with the Nephrology Care Alliance, VillageHealth will help identify eligible high-risk members and inform providers about opportunities for individual health interventions, including home dialysis and transplantation. Predictive analytics from DaVita will facilitate this effort. Community-based virtual education will also be offered.
WHAT'S THE IMPACT?
According to the Centers for Disease Control and Prevention, one in seven U.S. adults is estimated to have chronic kidney disease. Because symptoms are often silent in the early stages, most are unaware of their condition. If left untreated, the condition can progress to end-stage kidney disease, when a transplant or dialysis is necessary to sustain life.
Many beneficiaries with ESKD suffer from poor health outcomes and face increased risk of complications with underlying diseases. For example, those with ESKD who contract COVID-19 have higher rates of hospitalization.
Similar programs have reduced hospital admissions for patients with kidney disease by nearly 30%, the companies said. Another key component for ESKD members is increasing the rates of transplantation and home dialysis treatment options, both of which can help improve patients' healthcare experience and quality of life.
THE LARGER TREND
In September 2020, Centers for Medicare and Medicaid Services finalized the End-Stage Renal Disease Treatment Choices Model, which is meant to improve or maintain quality of care and reduce Medicare expenditures for patients with chronic kidney disease. ESRD is another term for ESKD.
The ETC Model was a component of former President Trump's Advancing Kidney Health Executive Order, and encouraged increased use of home dialysis and of kidney transplants in helping improve the quality of life of Medicare beneficiaries with ESRD.
The ETC Model was expected to impact about 30% of kidney care providers, and was implemented on January 1 at an estimated savings of $23 million over five and a half years.
Roughly 20% of dollars in traditional Medicare – $114 billion a year – are spent on Americans with kidney disease, according to CMS. While more than 100,000 American begin dialysis to treat end-stage renal disease each year, one in five will die within a year.
CMS proposed changes to the ESRD Prospective Payment System in July 2020, which CMS said at the time encouraged the development of certain new and innovative home dialysis machines.