Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are notoriously costly and complicated conditions to manage.
With common causes such as hypertension, diabetes, and obesity on the rise in the United States, CKD affects approximately 37 million people in the U.S. and is one of the top 10 leading causes of death among adults in the country. Healthmap Solutions (Healthmap), an industry-leading Kidney Population Health Management company, offers a value-based solution for health plans, health systems, accountable care organizations (ACOs), and provider groups seeking to lower costs and improve outcomes for this complex population. Healthmap has received NCQA Population Health Program Accreditation for its innovative Kidney Health Management (KHM) program and is currently contracted to manage over 160,000 lives across 30+ states, including Puerto Rico.
Thanks to its holistic, patient-centered approach, Healthmap’s KHM program has been shown to slow CKD progression, improve medication adherence, reduce inpatient utilization and Emergency Department visits, and lower total healthcare expenditures, while also improving the quality of life for kidney patients. Historically, solutions for kidney patients have been limited to ESRD management only due to the high costs associated with dialysis therapy. However, to truly impact and slow the progression of kidney disease, Healthmap has worked diligently to change this care management paradigm by identifying patients early and “moving upstream” to manage patients with an end-to-end solution to include CKD stages 3, 4, 5, and Unspecified, in addition to those with ESRD.
“Early identification and engagement are key pillars in the Healthmap model,” says Healthmap CEO Eric Reimer. “We know that many of the early-stage CKD patients are not seeing a nephrologist. We can engage with those patients and start developing a personalized plan of care together with their providers, which will then slow their disease progression, prevent adverse events, and improve their overall health.”
Using advanced technology, predictive analytics, and clinical expertise, Healthmap achieves six key value levers for program success:
- Early Patient Identification: identifying patients early in their CKD progression and establishing a treatment pathway based on their clinical risk and stage of disease.
- Patient and Provider Engagement: engaging directly with providers and their patients in each local market.
- Slowing Disease Progression: working with providers and patients to deliver proactive and coordinated care via actionable timely data and clinical insights.
- Reducing Crashes Into Dialysis: coordinating care with nephrologists and specialists to obtain early dialysis access to ensure an optimal start to dialysis in a controlled setting.
- Optimizing Renal Replacement Therapy: empowering patients with improved education for identifying dialysis modality options such as in-home therapy while also ensuring appropriate transplant candidates while collaborating with nephrologists.
- Reducing Unnecessary Emergency Department Admissions and Readmissions: working with patients and providers to avoid unnecessary admissions and ensure appropriate transitions in care to prevent readmissions.
In addition to an advanced proprietary analytical engine that risk-stratifies patients and identifies personalized intervention opportunities, Healthmap’s KHM program also includes a multidisciplinary care management team. These Registered Nurses, Registered Dietitians, Social Workers, and Pharmacists interface directly with providers and patients to ensure treatment adherence, facilitate care gap closure, and maintain seamless communication between all providers on a patient’s care team. “Healthmap collaborates with the full spectrum of our clients’ provider networks, including primary care providers, nephrologists, and other specialists. By broadening provider access, we are able to impact the maximum number of eligible members,” says Mr. Reimer.
This proven and predictable method has led to impressive improvements in care for kidney patients, and the program’s results speak for themselves. Healthmap clients can expect to see a total medical expense reduction of 10% to 15% for the eligible population in the KHM program. Healthmap has also achieved industry-leading member engagement rates of 70% and higher, a true market differentiator amongst their competition. Further, the KHM program has done wonders for patients requiring renal replacement therapy with home dialysis usage rates for Healthmap members ranging from 30% to 40%, surpassing the national average of 12%. By focusing on proactive and preventative measures, Healthmap has achieved a 50%+ reduction in dialysis crash rates and a 20% to 30% reduction in hospital admissions and 30-day readmissions.
The Healthmap Solutions team looks forward to exhibiting and speaking at the upcoming Becker’s Payer Issues Roundtable in April. To learn more about Healthmap, email KidneySolutions@HealthmapSolutions.com.