Humana finds value-based care leads to fewer hospital admissions for kidney patients

Value-based care arrangements significantly reduce costs and improve outcomes for people with chronic kidney disease and end-stage renal disease, according to a report from Humana.

The report (PDF) pointed to Humana’s commitment in the space, backed by studies showing the importance of preventive care for patients needing kidney treatment.

Patients in value-based arrangements experience 5% fewer unnecessary hospital admissions than their fee-for-service counterparts, Humana discovered among its 2023 Medicare Advantage members. Since VBC engagement has increased since 2019 among members with chronic kidney disease, the company’s medical expense ratio for this group has dropped more than 12%

Additionally, value-based arrangements help lower costs and improve care coordination, helping patients manage care “proactively,” Humana said in a news release.

“Kidney disease is a challenging diagnosis for patients to face. The prognosis is tough, and treatment is costly and burdensome for patients,” said Kate Goodrich, M.D., chief medical officer at Humana, in a statement. “Value-based care’s emphasis on primary care physicians, specialists, care teams and patients working together to delay the most difficult outcomes through preventive and preemptive steps gives patients and their providers hope and a plan forward during that difficult time.”

Chronic kidney disease currently impacts 37 million people in the U.S. and can often lead to end-stage kidney disease. This leaves many patients waiting for a transplant, which often are not readily available.

Another study found that “ACO-aligned patients had $572 per year lower spending than non-ACO patients.”

“We’re seeing VBC providers successfully track dialysis starts and permanent access points, conduct behavioral health screening and monitor how the patients manage glucose and blood pressure,” said Brandon Spicer, a Humana director working to advance VBC strategy in the kidney care specialty. “It has all been made simpler using state-of-the-art information and data-sharing systems. Transforming how providers are rewarded on these measures helps patients avoid complications and stay healthier.”

CMS has two VBC models for kidney disease: The End Stage Renal Disease Treatment Choices Model and the Kidney Care Choices Model. They allow clinicians to receive capitation payments for care services.

Humana partners with Evergreen Nephrology, Monogram Health, Interwell, Strive Health, DaVita and Fresenius. In total, they manage care for more than 77,000 kidney patients.

In a total cost of care contract they develop, Humana and the companies agree to certain financial metrics. Sometimes providers earn additional rewards if metrics are met, including medication adherence, blood pressure regulation, dialysis delay or successful kidney transplants, the report said.

“Many of my nephrologist colleagues still practice fee-for-service for predictable revenue, highly dependent on partnerships with large dialysis organizations to drive most of their income,” said Shaminder Gupta, M.D., a nephrologist with Monogram Health, in the report. “This is compounded by their poor understanding of the variability of their care and its impact on quality. I want readers to understand that VBC kidney programs eliminate these issues.”