Virtual chronic kidney disease (CKD) management solutions have no consistent impact on slowing disease progression or reducing healthcare costs, a new report from Peterson Health Technology Institute (PHTI) found.
CKD affects more than one in 10 adults—or 37 million people—in the U.S., data from the U.S. Centers for Disease Control and Prevention (CDC) show. However, 87% are unaware they have the condition, PHTI notes.
Researchers also note the disease places a “substantial economic burden” on the nation’s healthcare system, with traditional Medicare spending more than $141 billion annually on CKD beneficiaries and employers spending more than $107 billion—with $30 billion in absenteeism and lost productivity.
The report (PDF) analyzed the clinical effectiveness and economic impact of virtual CKD management solutions.
PHTI evaluated eight virtual CKD management solutions for the report: DaVita Integrated Kidney Care, Evergreen Nephrology, Healthmap Solutions, Interwell Health (part of Fresenius Medicare Care), Kidneylink (part of U.S. Renal Care), Monogram Health, Somatus and Strive Health. Each company assumes financial responsibility for the total cost of care for patients with CKD stages three to five and also contracts with Medicare Advantage plans—most also participate in Medicare’s Kidney Care Choices model.
PHTI researchers also reviewed more than 5,400 articles and other evidence—including information submitted by the eight companies.
Analysts found the virtual-based solutions show no consistent evidence of slowing disease progression, either by improving medication use or slowing the rate of kidney function decline, compared with usual care. And the limited clinical impacts do not result in meaningful reductions in healthcare spending, PHTI analysts wrote. For a million-member Medicare Advantage plan, the CKD companies are responsible for more than $5 billion in annual healthcare spending and reduce that spending by only 0.1%.
Virtual CKD can improve transitions to dialysis for a small number of patients, the analysis found. Evidence suggests that virtual CKD management solutions result in higher rates of patients beginning dialysis in a planned, outpatient setting rather than “crashing” into dialysis, which can lead to complications and increased spending. However, this benefit reaches just 1 in every 1,000 patients with CKD, PHTI said in the report.
Alongside their findings, PHTI researchers put forth a series of recommendations, including:
- Tying population-based performance payments to real cost reductions
- Prioritizing early patient identification and guideline-recommended medications
- Advancing evidence generation
- Shifting future care models to upstream care
“CKD is a common and under-treated condition affecting millions of Americans. The good news is that we know how to manage this disease effectively through early diagnosis and medications,” said Caroline Pearson, PHTI executive director, in a statement. “But instead of investing in what works, population-level CKD payment models have created mismatched incentives that drive a focus on cost control for patients with diagnosed, later-stage CKD.”
Pearson said contracts for virtual CKD management “should pay for the outcomes that actually slow disease progression” at individual patient levels, including earlier diagnosis and better medication management.
Kidney care companies challenge PHTI's analysis
Kidney care companies cited in the report pushed back on PHTI's findings when contacted by Fierce Healthcare, arguing it overlooks broader clinical outcomes and value-based care results.
Many companies also disputed PHTI's classification of their products and services as "virtual solutions."
“We appreciate PHTI's attention to the critical need for improving care and outcomes for people living with chronic kidney disease. Evergreen is actively advancing the priorities it identifies: earlier identification, PCP partnerships, stronger medication management, and more peer-reviewed evidence," Evergreen Nephrology CEO Heather Trafton said in a statement.
Trafton said the report evaluates the market through the narrow lens of “virtual solutions,” which does not fully reflect Evergreen’s model or the depth of care required for the complex patient population.
Evergreen partners with nephrology practices, enabling accountability for the total cost and quality of their patients’ care through clinical programs, care teams, data and operational infrastructure, she said. "Beyond standard services focused on slowing disease progression, our work includes quality improvement and accurate documentation, behavioral health, social determinants of health, ESKD management, and helping patients access hospice care when it aligns with their needs and goals," Trafton said.
In a statement to Fierce Healthcare, Kidneylink, the value-based kidney care business of U.S. Renal Care, said its approach is built on "deeply integrated partnerships with nephrologists, embedded interdisciplinary care teams, and coordinated patient support designed to improve outcomes for people living with kidney disease."
"Kidneylink is not a 'virtual CKD' solution as referenced in the PHTI report," the company said.
A spokesperson for Monogram Health said the company is a "multispecialty medical group, providing care in patient’s homes—not a virtual CKD management point solution."
"The PHTI report evaluated a category of primarily virtual, nephrology-focused population health vendors operating under Medicare's Kidney Care Choices (KCC) model. Monogram does not participate in the KCC model and does not operate as a virtual-first service. Monogram’s patients experience in-person clinical relationships. As a result, our patients’ health outcomes are far above national averages," the spokesperson said, noting the results outlined in the company's 2025-2026 Impact Report.
DaVita, in a statement, said the PHTI report "starts from a flawed premise."
"It assumes fundamentally different care models can be evaluated as though they are the same, and relies on a limited set of measures to assess a complex, long-term transformation effort. Improving outcomes for people with kidney disease depends on a broad range of clinical, behavioral, and social factors that unfold over time. By excluding these considerations, the analysis offers an incomplete picture of both performance and progress," DaVita said.
Many companies also pointed to results from the Centers for Medicare and Medicaid Services (CMS) Kidney Care Choices (KCC) Model, which began in 2022 and will run through 2027. The value-based healthcare payment program aims to shift kidney care financial incentives from volume to value, prioritizing early intervention to slow the progression of chronic kidney disease.
The second performance year (PY) of the KCC Model continued to show significant improvements in key quality goals of the model, such as increased rates of home dialysis and home dialysis training, increased optimal starts to dialysis and increased preemptive and living donor transplants. Despite these quality gains, however, the model resulted in a significant net loss of approximately $304 million to Medicare in PY2023, according to an evaluation (PDF).
Those financial results prompted CMS to redesign the program this year.
A Wakely analysis of the CKCC model found that if CMS' redesign changes were applied retrospectively, the program would have generated net savings in program years 2023 and 2024.
DaVita executives said many of the report's observations regarding savings are not new and are consistent with findings from earlier evaluations that assessed the model during its initial years. "Those same evaluations also documented meaningful improvements in patient outcomes and care experience, underscoring the challenge of judging long-term transformation efforts on a limited timeline," the company said.
Many of the kidney care companies evaluated in the report that also participate in CMS' KCC Model noted they have delivered strong clinical quality improvements and hundreds of millions in shared savings.
"As stakeholders continue to evaluate evidence from CKD management programs, varying interpretations of the available data underscore the need for further evaluation of outcomes and cost impact across the industry. Existing evidence, including results from the CMS kidney care model, has demonstrated progress in areas such as improving optimal starts and generating shared savings," Interwell Health said in a statement when contacted by Fierce Healthcare.
Interwell says it's one of the largest participants in the Comprehensive Kidney Care Contracting (CKCC) model and Interwell-supported organizations delivered $273 million in shared savings to CMS over the program's first three years while consistently achieving leading quality results.
"Additional research and analysis will help further our understanding of which approaches deliver the greatest value for patients and the healthcare system," Interwell Health executives said.
Evergreen Nephrology also noted that its strong performance under CMS’s CKCC benchmarks and growing, multi-year Medicare Advantage partnerships demonstrate the strength of the company's "broader, physician-led approach."
Sumair Akhtar, M.D., Strive Health's Chief Clinical Officer, said that while the report highlights limitations in the evidence available across the broader category, its findings also underscore the importance of looking at the evidence behind individual approaches. "We’re encouraged that the assessment found Strive Health produced the strongest company-specific evidence of improved clinical outcomes among the companies evaluated. Those outcomes include statistically significant reductions in hospital readmissions and slower rates of kidney function decline for select patient populations. We remain committed to continuing to improve outcomes for people living with kidney disease," Akhtar said.