Taking advantage of recent changes to federal law, a Medicare Advantage plan is partnering with a healthcare provider to rein in kidney care costs.
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Regence announced Tuesday that it is partnering with Strive Health to deliver comprehensive kidney care to 16,000 Regence Advantage and commercially insured plan members in Oregon, Washington, Idaho and Utah.
Until 2021, Medicare beneficiaries with advanced kidney disease couldn’t access Medicare Advantage plans, except in limited circumstances. The 21st Century Cures Act changed that. Now all beneficiaries with end-stage kidney disease are allowed to enroll in such plans.
MA plans are required to cap out-of-pocket costs, where original Medicare doesn’t. That’s a boon for members with complex chronic disease, since medical costs can quickly get out of hand. But managing that care and holding the line on the associated cost is a challenge, and MA plans have been scrambling to find ways to do both.
The partnership between Portland, Oregon-based Regence and Strive Health provides members with everything from home-based care to virtual clinical services and access to the regional Strive Health Kidney Care Center in Medford, Oregon, which supports on site and in-home dialysis.
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Managing chronic diseases such kidney ailments also requires going beyond regular maintenance treatments. For instance, Strive Health incorporates predictive analytics that rely on artificial intelligence to anticipate possible complications, while taking a team-based approach to prevention and halting disease progression.
“People living with kidney disease require a more person-focused and holistic treatment approach,” Marion Crouch, chief medical officer and senior vice president of healthcare solutions at Regence, said in a news release about the partnership. “Strive Health’s comprehensive and proactive care approach will help us deliver on our goal to make healthcare better, simpler and more affordable to our members and customers.”
Strive Health aims to take both a technologically advanced and hands-on approach to improve outcomes and keep costs down. That includes minding the fundamentals, like ensuring that care between a patient’s primary doctor, kidney care specialist, or nephrologist, and other specialists is well coordinated.
The Denver-based company is not the only kidney care provider that is teaming up with health plans to provide value-based care models for handling chronic kidney disease. Others include Somatus, Cricket Health.
The Cures Act-related policy change that allowed people with end-stage kidney disease to access Medicare Advantage is expected to increase enrollment by 83,000 in that group over six years. That will only put more cost pressure on private insurers offering MA plans.
Most patients with end-stage kidney disease have to undergo dialysis multiple times a week, and they’re more likely to suffer from other chronic conditions, ranging from diabetes to heart disease. A study authored by USC researchers, published last year in JAMA Internal Medicine, finds that for patients with end-stage kidney disease, their average total monthly spending on all healthcare services is 33 times that of patients who don’t have kidney disease ($14,399 versus $435).
That heavy cost burden and the involved medical needs of kidney disease patients require Advantage plan sponsors and health providers to keep innovating to ensure members get the care they need at a price that’s manageable.
“Kidney disease requires a fresh and comprehensive approach centered around the patient,” Chris Riopelle, CEO of Strive Health, said in announcing its partnership with Regence. “Regence and Strive Health will offer transformative care to address the clinical and social determinants impacting kidney disease in a way that also controls long-term healthcare costs.”
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