Health insurer Humana has introduced a new care coordination program to improve the health of patients with chronic kidney disease.
The program focuses on identifying kidney disease early, slowing its progression and keeping the patient informed about different care options, which could include receiving dialysis at home, according to Humana. It will target Medicare Advantage and commercial members in Florida.
"It's a priority for us at Humana to offer a more integrated care model that looks at the individual holistically and takes into account the member's personal lifestyle and needs," Dr. Amal Agarwal, Humana's vice president of transformative home solutions, said in a statement. "We are committed to breaking down barriers to coordinated care for our members with chronic kidney disease and end-stage renal disease, which is especially critical during this global pandemic."
Health insurers have been stepping up investments in care management programs for kidney disease patients ahead of a change that allows people with end-stage renal disease to enroll in Medicare Advantage—the privatized version of the traditional of Medicare—for the first time in 2021. Humana is has roughly 4.4 million Medicare Advantage members.
CMS expects tens of thousands of patients with end-stage renal disease, which is the final stage of chronic kidney disease, to shift to Medicare Advantage next year. Health insurers will be challenged to manage the care and cost of these very sick, very costly patients, or risk a hit to their bottom lines.
Patients with chronic kidney disease aren't able to properly filter their blood of waste and fluid. At the final stage of the disease, patients must undergo dialysis or receive a kidney transplant. Dialysis patients have been especially vulnerable amid the COVID-19 pandemic as many of them have no choice but to seek treatment at a clinic multiple times per week.
Humana Chief Financial Officer Brian Kane told investment analysts in February that the insurer was modeling how many members with permanent kidney failure it may enroll and standing up clinical teams to care for them. He said also that Humana was considering ways to increase the use of dialysis at home or through other alternatives sites of care.
Humana is launching its Florida care coordination program in collaboration with population health vendor Healthmap Solutions, which deploys a team of nurses, dieticians, pharmacists, and social workers to coordinate the care of kidney disease patients.
Healthmap uses claims, administrative and clinical data to identify members with kidney disease and pinpoint gaps in their care. It will then work directly with the patient and physicians to close those clinical care gaps or address other needs, such as affordable access to medications.
