As the leader in chronic kidney disease (“CKD”) case management for self-funded employers, we are thrilled by the new Executive Order directing Medicare to develop payment models encouraging providers to identify and treat Medicare beneficiaries who have late-stage CKD, to prevent them from progressing to end-stage renal disease (“ESRD”) and dialysis.
We recognized many years ago that good CKD case management is the best way to avoid the severe health problems and heavy financial costs that come with dialysis. Since we began our CKD case management program in 2014, no member we have served has progressed to ESRD. We know how much can be saved this way, and hope that Medicare, and its beneficiaries, see the kind of benefits our clients and their members have seen.
Medicare is at a very early stage in developing its program, of course. It is most likely Medicare will mostly leave the details of how CKD case management is done up to health care providers and case managers, under payment incentives for those who succeed in preventing progression to ESRD. The provider financial incentive to provide dialysis at this point is much greater than the incentive to prevent ESRD, since they can charge so much more for dialysis than for case management. So it will be interesting to see how Medicare shifts these incentives, and how the providers respond.
Of course, one side effect of this initiative is very likely to be increased pressure on self-insured plans as a source of dialysis provider revenues. If Medicare can succeed in reducing the number of its beneficiaries who need dialysis, that will be good for Medicare – but not so much for dialysis providers. Going forward it will be even more important for self-insured plans to protect themselves with good preventive measures through CKD case management, and if that fails with sound dialysis cost containment.
The next few years will no doubt be very interesting in this area. We will continue to update you as these and other issues develop.