Program promises to take a team approach to tackling severe kidney disease

Kidney disease often advances quietly and then falls on patients, providers and payers like an avalanche of complex medical conditions that cost a lot of money to control.

To address this, Providence Health Plan is teaming up with Interwell Health, a company that focuses on care for patients with severe kidney complications, to mitigate these challenges before they become costly, life-disrupting emergencies.

“Not everybody is going to avoid dialysis,” Robert Gluckman, M.D., chief medical officer for Providence Health Plan, told Fierce Healthcare. “But people can present in two ways. They can present where we know that it’s coming, and we’re planning for it. And that could be an orderly transition.”

Or, he said, they can present as emergency cases, or “what’s called crashing into dialysis.”

“Now you’ve got to deal with somebody that you’re not really prepared for," he said. "And for those patients, the disease has an impact on quality of life, and outcomes, and costs. One of the goals is to identify people while we try to forestall those complications, and they can have a timely and orderly transition into treatment.”

The program uses a team approach to manage patients with chronic kidney disease as well as end-stage kidney disease. Nephrologists in Providence’s network will lead teams that include social workers, dietitians, nurses, pharmacists and peer mentors. The program also aims to ensure that individuals who need a preemptive kidney transplant get it.

The companies said they will also help transition patients to dialysis, including when individuals receive care in their homes.

George Hart, M.D., Interwell’s chief medical officer, told Fierce Healthcare that “unfortunately, for the longest time, it’s a very silent disease. So, people will frequently only become aware of their disease process when they start to have symptoms. That doesn’t mean that they can’t have highly functional lives and continue to work full-time. That they can’t be husbands, wives, sons, daughters, co-workers."

"What we’re trying to do is minimize the impact of their renal disease, help them find strategies that work for their lives and, obviously, keep them out of the hospital," Hart said.

According to a study published in JAMA Network Open last November, dialysis for patients enrolled in commercial health plans costs $238,126 in the first year after initiation of that treatment. Patients on dialysis can qualify for Medicare coverage no matter what their age after a three-month waiting period. Patients in employer-sponsored health plans who begin dialysis can use Medicare for secondary coverage for 30 days but then can choose to make Medicare the primary coverage entity.

Interwell Health wants to embed renal care coordinators in local physician practices to help beneficiaries better manage their condition. Interwell will also monitor patients who may need to have a kidney transplant.

“The resources that are necessary frequently go beyond what the insurance payers or some of the healthcare networks have access to,” said Hart. “So, we come in with our specialized nurses, our trained pharmacists, social workers, dietitians, our nephrologist, partners to provide expert care and put our arms around these patients so that they can stay out of the hospital.”

The value-based program operates in a way that both Interwell and Providence, headquartered in Oregon, take on the financial risk, said Gluckman.

“When I look at a carve-out, there’s a shedding of the risk and of the financial implications of treatment,” says Gluckman. “This is more of a partnership. If there’s a big cost explosion over this condition, then they have some financial risk. And they share in some of the benefits.”

In a joint press release, Interwell said it’s cut hospital admissions by 34% for members in some of its other value-based programs.

The program leans a lot on the claims and clinical data Providence can provide to get a sense of which beneficiaries might need better monitoring, said Gluckman. In addition, Interwell’s recent acquisition of Cricket Health provides beneficiaries with a digital platform that seeks to keep patients on top of their kidney care.

“In other words, kidney care doesn’t always have to involve a face-to-face or voice contact with the human being,” Gluckman said. “People can engage in a way that’s more efficient and effective for them.”

Hart added that the program uses patient education, usually provided by nurses, to make the process work.

“We are dedicated to meeting patients wherever they need their care delivered,” he said. “That can be in the home. That can be in a physician's office. That can be in a dialysis unit. It can be by foot, by phone. It can be through technology. We have all those capabilities, which is kind of unique in this space right now.”