In talking with brokers and TPAs about chronic kidney disease and dialysis and the massive claims costs, we agree that something must be done to protect health plan assets against the escalating risk and prevalence. Often, the only remaining question is how to pick the plans that could benefit most from dialysis cost containment. I’m going to cover that here. But first, let me share a couple of quick facts about how urgent cost containment is becoming for health plans.
- Today, 1 in 7 US adults have chronic kidney disease (CKD) and most don’t know it. In 2020, chronic kidney disease (CKD) cost US health plans more than $100 billion.
- Every day about 380 US adults start dialysis. Dialysis Claims cost for one member on dialysis is typically between $1.2 and $1.4 million annually.
So, which plans will benefit most from cost savings and cost avoidance? Nothing replaces our ability to identify and take action to manage hidden risk associated with CKD and dialysis. However, here are some key indicators to look for in your plans that will help you identify populations that may include greater risk.
1. PLANS WITH 2500 OR MORE MEMBERS
Based on US ESRD incidence rates, in general, an average plan with 2,500 covered lives is statistically likely to have at least one catastrophic dialysis claim each year.
2. AGE AND ESRD
Age is a leading factor in ESRD incidence. If your plans’ covered lives include an older population, the risk is higher. ESRD Cases per million people increase with age.
3. RACE AND ESRD
ESRD incidence is 32.2% higher among Hispanic people than non-Hispanic people. Race also can be an indicator of risk. ESRD Cases Per Million as reported by USRDS.org:
According to the CDC, members who work in specific industries can have 4X-6X increased risk of developing CKD.
5. CKD MOST COMMON COMORBIDITIES
Per the CDC, the most common comorbidities of CKD are diabetes, hypertension, heart disease, obesity, family history of CKD, inherited Kidney disorders, and older age.
6. HEALTH PLANS WITH INCREASED RISK
Health plans that still use a multiple of Medicare to reprice dialysis claims are at higher risk. Our usual and reasonable dialysis repricing methodology was validated as a safe harbor for these plans.
Dialysis is not inevitable. We stratify each plan’s highest-risk cohorts and create tailored care plans that improve members’ health while providing cost savings and catastrophic cost avoidance.
Our clients save an average of 78% net off those massive charges. Plus, the best case of cost containment is when you can eliminate dialysis all together. KDAP is our clinically proven case management program that helps slow, stop, and even reverse members’ progression toward dialysis. Fewer than 1% of participating KDAP members have progressed to dialysis.
We help brokers and TPAs protect plan assets everyday. Want to learn more? Contact us today.