Virtual solutions for chronic kidney disease (CKD) management don’t slow disease progression, nor do they reduce total healthcare spending, according to a new analysis by the Peterson Health Technology Institute (PHTI).
PHTI is an independent evaluator of digital health solutions. For the analysis, PHTI reviewed more than 5,400 articles and other evidence. The solutions evaluated in the report include DaVita IKC, Evergreen Nephrology, Healthmap Solutions, Interwell Health, Kidneylink, Monogram Health, Somatus and Strive Health. These companies take on financial responsibility for the total cost of care for patients with stage 3–5 CKD, and typically work with Medicare Advantage plans and Medicare’s Kidney Care Choices model.
The assessment focuses on managing chronic kidney disease before patients progress to end-stage kidney disease, including the need for dialysis or a kidney transplant.
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The analysis found that virtual CKD management programs don’t have consistent evidence of slowing disease progression compared with usual care, either by increasing use of recommended medications or reducing the decline in kidney function.
In addition, the solutions don’t meaningfully reduce healthcare spending: for a Medicare Advantage plan with 1 million members, these CKD companies oversee more than $5 billion in annual healthcare spending while reducing costs by just 0.1%.
However, virtual CKD solutions improve transitions to dialysis for a small number of patients. Virtual CKD management programs may increase the likelihood that patients start dialysis in a planned outpatient setting rather than requiring an emergency “crash” start, which can result in complications and higher costs. But the benefit applies to only about 1 in 1,000 patients with CKD.
The report finds that the biggest opportunities to improve CKD outcomes come early in the disease. Current solutions, however, tend to focus on patients with more advanced CKD. PHTI recommends that purchasers change contracts and incentive programs to reward milestones that are more likely to slow disease progression, like earlier diagnosis.
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In addition, the organization recommends prioritizing engagement with primary care providers and generating more evidence on which approaches work when it comes to CKD.
“CKD is a common and undertreated condition affecting millions of Americans. The good news is that we know how to manage this disease effectively through early diagnosis and medications,” said Caroline Pearson, executive director of PHTI. “But instead of investing in what works, population-level CKD payment models have created mismatched incentives that drive a focus on cost control for patients with diagnosed, later-stage CKD. Contracts for virtual CKD solutions should pay for the outcomes that actually slow disease progression—earlier diagnosis and better medication management—at an individual patient level.”
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