Payer Boosts MA Chronic Kidney Management Access, Patient Outcomes

To increase access to chronic disease management and improve patient outcomes, Cigna has announced that an in-home kidney care program will be available to Medicare Advantage members in 11 additional states.

Utilizing a care model from Monogram Health, the evidence-based program consists of regular home visits from care managers to help people living with chronic kidney disease (CKD) and end stage renal disease (ESRD) manage their health and stay out of the hospital.

The staff of nurse case managers and social workers collaborate with primary care physicians, nurses, and nephrologists to develop personalized care plans that include medication therapy management and co-morbidity management with a particular focus on addressing patients' social determinants of health.

"Cigna is taking a personal, individualized approach to raising the quality of care for our customers with CKD and ESRD," said Gina Conflitti, MD, Cigna Medicare Advantage's chief medical officer. "Cigna wants our customers with kidney disease to know all of their care options. We will work to help them receive evidence-based treatment that maximizes their health and quality of life."

Based on data from the Department of Health and Human Services (HHS), 20 percent of traditional Medicare spending ($114 billion) goes toward providing care to a growing population of 30 million Americans with kidney disease.

Additionally, 746,557 Americans live with ESRD and this number grows annually by 20,000, according to the US Renal Data Systems.

Addressing these rates of kidney disease and improving patient outcomes through access to care and increased use of home therapies has become a priority for HHS and other federal healthcare programs. For instance, the 21st Century Cures Act increased access to chronic care management by allowing previously ineligible Medicare beneficiaries with ESRD to enroll in a Medicare Advantage plan.

Originally, the program was available for Cigna’s individual MA beneficiaries in Arkansas, Tennessee, Mississippi, Arizona, Alabama/North Florida, and Georgia.

Now, Cigna MA members can access the kidney care program in most parts of Florida as well as Colorado, Texas, Pennsylvania, Illinois, North Carolina, South Carolina, New Jersey, Delaware, Maryland, Missouri, Kansas, and the District of Columbia.

Humana has also committed to improving CKD and ESRD patient outcomes through home healthcare. Last year, the payer announced a partnership with a chronic kidney disease management and awareness organization, REACH Kidney Care, a nonprofit affiliate of Dialysis Clinic, Inc.

Through this new partnership, Humana offers home healthcare options, including home dialysis, for members living with CKD and ESRD. Like Cigna’s kidney care program, Humana’s chronic disease management program focuses on providing coordinated care through collaboration with the member’s primary care provider and nephrologist in the development of a care strategy.

“This partnership is part of Humana’s dedication to innovation, especially in meeting care challenges presented by the coronavirus,” Amal Agarwal, MD, Humana’s vice president of transformative home solutions, said in a press release at the time of the announcement. “We’re committed to offering our members with kidney disease a modern, personalized strategy that provides synchronized care options.”

Humana’s kidney care services are available to MA enrollees in Alabama, North Carolina, South Carolina, and Tennessee.

“This whole-person approach to treating chronic kidney and end-stage renal disease provides our members greater choice and flexibility in their care, including for some the option for in-home treatment,” Agarwal said.