Payer Launches Value-Based Kidney Care Agreement for CKD, ESKD

Blue Cross and Blue Shield of Minnesota (Blue Cross) announced a value-based kidney care agreement with a DaVita Integrated Kidney Care program for members who have chronic kidney disease or end stage kidney disease.

“By collaborating with VillageHealth, we are committed to enhancing the quality of life for thousands of members, while simultaneously reducing the cost of care by improving outcomes related to kidney disease,” said Dr. Mark Steffen, chief medical officer of Blue Cross and Blue Shield of Minnesota.

The value-based agreement encompassed four primary elements. The goal will be to reduce healthcare spending and boost patient outcomes for members with chronic kidney disease or end stage kidney disease.

First, the partners will target coordinated care between the program’s staff, nephrologists, and primary care providers.

The program’s second aim will be to improve awareness about chronic kidney disease in order to catch the disease and start key chronic disease management strategies earlier. The partners plan to bolster awareness about chronic kidney disease by providing primary care providers with more information.

By educating primary care providers about the disease, these providers—who are often closest to members—can improve chronic kidney disease screenings and support chronic disease management in newly-diagnosed members. When appropriate, well-informed primary care providers can also connect members with a nephrologist.

Early stage interventions will emphasize comorbidity management through medication and healthy food intake. For members with more advanced chronic kidney disease or end stage kidney disease, preemptive kidney transplants and home-based or center-based dialysis will be available as well as measures to prevent hospitalization.

Apart from relying on primary care providers, the partnership will utilize data analytics as another method of identifying at-risk members. Leveraging both proprietary data and a collaboration with the Nephrology Care Alliance, the partners will help providers know which patients are at-risk and what treatments might be most useful at their stage.

Finally, while educating primary care providers and arming them with data, the partners will also turn to the patients to provide them with a better understanding of chronic kidney disease.

Members will receive education about chronic kidney disease via community-based efforts through both in-person and virtual channels.

“We have a significant opportunity to help delay the progression of kidney disease and better meet the complex health needs of those with kidney failure,” Steffen said.

According to the Centers for Disease Control and Prevention (CDC), more than one in seven American adults—or around 37 million people—have chronic kidney disease, a condition that results in fluid and waste build-up inside of the body which can lead to heart disease or stroke. In fact, kidney diseases are in the top ten most prevalent causes of death in the US.

Unfortunately, four in ten individuals who have severe chronic kidney disease do not even know that they have it, which is why healthcare professionals are pushing to improve awareness.

Chronic kidney disease cost $81.8 billion in 2018 for the Medicare population alone. It accounted for around seven percent of paid Medicare claims.

Other payers have likewise tried to control healthcare costs through value-based agreements.

For example, at the beginning of 2021, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) launched an initiative as part of its value-based care program, Blue Premier.

“Through transformative, value-based kidney care, Strive Health addresses patient care in a way that will help Blue Cross NC improve members’ lives while controlling long-term health care costs,” Chris Riopelle, chief executive officer of Blue Cross NC’s partner Strive Health, said at the time.

The ability to provide a home healthcare dialysis option has also become crucial for members. Not only does home healthcare provide members with flexibility, but it also protects their damaged immune systems during the coronavirus pandemic.

These were the reasons that Humana provided when it announced its chronic kidney disease home healthcare partnership for Medicare Advantage members.

“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,” Amal Agarwal, MD, Humana’s vice president of transformative home solutions, explained in the press release.