Humana is launching a pair of programs aimed at improving care coordination for Medicare Advantage and commercial members with kidney disease.
The insurer unveiled the pilots Wednesday in partnership with Monogram Health and Somatus in four states.
Reported first in FierceHealthcare, members in Louisiana and Mississippi will have access to Monogram Health’s services while members in Georgia and Virginia can use Somatus’ services. Both programs provide a coordinated, data-driven approach to better identifying and managing the needs of members with kidney disease.
Each harnesses a multidisciplinary clinical team including nephrologists, nurses, dieticians and social workers who work alongside a patient’s physicians to educate them about treatment options and provide in-home assessments.
William Shrank, M.D., Humana’s chief medical officer, told FierceHealthcare that with the amount of interest in the industry broadly in innovating kidney care, work like Humana’s can offer lessons for other insurers and serve as a “rising tide to lift all other ships in the marketplace."
“We believe there’s so much to really learn here about how to help these patients,” he said.
Members in Louisiana and Mississippi will have immediate access to Monogram Health, while members in Georgia and Virginia can tap into Somatus beginning Jan. 1, Humana said.
Amal Agarwal, vice president of Medicare trend and innovation at Humana, said he took on that role just over a year ago and has made the kidney space a priority in his work during that time.
Internal research, he said, found that Humana had a notable number of members who were on dialysis. About 37 million Americans in total are estimated to have chronic kidney disease (CKD), according to a recent report from the National Kidney Foundation. In addition, about 90% of people with CKD are unaware they have it, according to the report.
Overhauling the existing paradigm for kidney care has also been of great interest to regulators; the Centers for Medicare & Medicaid Services earlier this year unveiled a set of five new payment models with the goal of reducing reliance on clinic dialysis over home dialysis or transplantation.
The Trump administration has also formed KidneyX, an accelerator aimed at backing innovative approaches to kidney care.
Shrank said this “political milieu” did not go unnoticed at Humana. Agarwal said the buzz wasn’t unnoticed by potential startups they could partner with on new kidney care programs, either.
“One thing that’s kind of unique is that a lot of these companies started a few years ago, and the timing was just right because there’s a lot of attention being given to the kidney space,” Agarwal said.
Humana will be tracking both programs through a slate of metrics with the goal of scaling them up should the results be strong, Agarwal said.
Shrank said the insurer intends to be “very transparent” with progress in the kidney programs and will be bringing all its data analytics capabilities to these partnerships. Moving toward kidney care that is “more convenient, more coordinated, more integrated and takes a more holistic view” of a patient’s needs is “very much in keeping with our business strategy.”
“We think that offers a great opportunity to better coordinate care and manage health for the patients that choose us,” Shrank said.