Aetna and Fresenius Medical Care North America are extending their value-based arrangement to better treat patients with end-stage renal disease (ESRD), who are now eligible to enroll in Medicare Advantage (MA).
Through the partnership, the companies will align reimbursement with quality benchmarks and cost reductions for MA members, and they're working together to develop metrics tied to Centers for Medicare & Medicaid Services measures to manage ESRD care.
Members will have access to both Fresenius' 2,600 dialysis centers as well as home dialysis options, Aetna said. The arrangement was effective as of Jan. 1, according to the announcement.
"This is a really important opportunity for us, as we know kidney disease impacts millions of people and requires very personalized treatment," Angie Meoli, senior vice president of network strategy and provider experience at Aetna, told Fierce Healthcare.
Patients with ESRD were eligible to enroll in Medicare Advantage plans beginning this year. ESRD is a costly condition to treat, and patients are at high risk for hospitalization and ambulance costs, an Avalere analysis shows.
As MA offers a more coordinated care experience compared to traditional Medicare, insurers have an opportunity to better manage their conditions, experts say.
Aetna said in the announcement that more than 785,000 Americans are living with kidney failure, with more than 554,000 of them relying on dialysis.
Meoli said one of the key goals of the enhanced partnership with Fresenius is putting patients in a position to manage their own care and have a greater awareness of their own health, including potential risk factors for worsening disease.
The arrangement is data-enabled, she said, to ensure smooth care coordination for the patient and to flag issues and risks.
She added that it was critical to provide MA members with options instead of offering only clinical dialysis. For instance, if a patient lacks transportation to a dialysis center, they may skip an appointment, which can have a snowball effect on their condition.
For that member, having the option for home dialysis may make it easier for them to access this needed care, Meoli said.
"We are ensuring that we’re thinking about the patient and the best ways to meet their needs," she said.