Specialized, holistic management for each stage of kidney disease continuum
Chronic and costly, renal disease demands a comprehensive solution. Today, the national spend for end stage renal disease (ESRD) and related expenses of dialysis, transplantation, inpatient care, pharmacy and laboratory costs approach $50 billion.1 Affecting more than one out of 10 adults, chronic kidney disease (CKD) is on the rise, largely due to the increasing prevalence of obesity and diabetes.2,3,4 Members with poorly managed CKD have more complications and hospitalizations and progress more quickly to ESRD. Once the kidneys fail, survival depends upon dialysis or a kidney transplant, if appropriate. Both have profound and costly implications for health plans, employers and members.
Not all health plans have the capacity or clinical expertise to efficiently manage the care for members with CKD or in renal failure. They require clinically sophisticated renal care management that generalized disease management programs may not provide. The Optum Kidney Resource Services program uses a proactive approach to manage the different disease stages, and their unique challenges.
Traditional hemodialysis charges can cost a health plan more than $200,000 annually.5 Access to the Optum KRS network of more than 5,500 preferred dialysis facilities can cut a health plan's dialysis costs by an average of 55 percent, ranging from 35 to 60 percent.6
Progressive Renal Care Management
Our intensive, dedicated renal care management requires a team possessing advanced clinical knowledge and experience to proactively recognize and respond to the care complexities of individuals with renal disease. The licensed renal care specialists work one-on-one with the member with CKD, in nearly 500,000 engagements annually, from stages 3, 4 and 5 through ESRD.6 While the goal is to preserve as much kidney function as possible, the program also supports and educates the member, leading to informed decisions as the disease progresses. A critical component is care by a nephrologist for members in stages 4 and 5. Our program ensures these members are referred for nephrology care.
Costs spike at dialysis initiation and are significant once the patient begins dialysis.
1. United States Renal Data System (USRDS) Annual Data Report, http://www.usrds.org/2013/pdf/v2_ch11_13.pdf.[In 2011, $14.93 billion for non-Medicare patients and $34.3 billion for Medicare patients for total of $49.23
billion.] Accessed 8/10/2015.
2. National Institute of Diabetes and Digestive and Kidney Diseases, 2009 ESRD Statistic. https://www.niddk.nih.gov/health-information/health-statistics/Pages/kidney-disease-statistics-united-states.aspx#12.Accessed: 9/20/2016.
3. United States Renal Data System (USRDS) 2014, Vol. 2, intro, pg 80, Table i.1, http://www.usrds.org/2013/
pdf/excel/vol2_01_inc_prev_13_ web.zip Figure 1.10 Accessed 7/15/15.
4. James P. Boyle, PhD, Amanda A. Honeycutt, PhD, K.M. Venkat Narayan, MD, Thomas J. Hoerger, PhD, Linda S. Geiss, MA, Hong Chen, MS and Theodore J. Thompson, MS, Diabetes Care, American Diabetes Association, November 2001 vol. 24 no. 11 1936-1940. http://care.diabetesjournals.org/content/24/11/1936. Accessed 8/18/2015.
5. Optum Health Analysis 2015, based on 80,000 covered commercial lives, 2014 claims data, NortheastUnited States. Plosser. July 2015.
6. Optum data analysis 2016, based on review of national contracts. August, 2016.
7. LaCombe, P. medical expense figure based on Optum Healthcare Expense (HCE) analysis of large health plans, 2015 data.