DaVita® Medical Insights

Study: Improved Dialysis Outcomes and Cost Savings through a Payer-Provider Partnership

End stage renal disease (ESRD) patients experience a variety of complicated medical issues requiring significant and costly care. Initiating an intensive patient management program at the beginning of dialysis has been shown to improve outcomes and possibly reduce costs while also increasing adherence to complicated medical regimens. With that data in mind, a payer and a provider recently partnered to implement an integrated care, shared-savings incentive program for ESRD patients receiving dialysis at the provider’s Pennsylvania facilities. Combining the payer’s claims data with the provider’s analytic capabilities enabled the provider to target patients for specific interventions, including transitioning patients from central venous catheters (CVCs) to arteriovenous grafts (AVGs) or arteriovenous fistulas (AVFs), reducing hospitalizations and decreasing the frequency of readmissions. A retrospective, observational analysis of outcomes and costs resulting from the collaboration was published in the American Journal of Managed Care.

In the analysis, the payer-provider partnership led to improvements in increasing AVF and AVG utilization while decreasing CVC utilization. Vaccination rates for influenza and pneumococcus were above 95 percent in member patients, significantly higher than the general Medicare ESRD population. Hospitalization rates also improved: admissions, number of hospitalized days, emergency department visits and readmission rates all decreased. Inpatient and overall healthcare costs declined as well. These findings were consistent with other studies of care coordination for ESRD patients. The analysis also found that overall medication costs increased more during years one and two than during the baseline period. That increase could be attributed to better patient adherence to medical regimens or to some patients receiving extremely costly medications. The reasons, though, were not entirely clear, indicating that further investigation is needed to determine why medication costs rose.

The analysis was not designed to address cause-and-effect relationships and it was limited to patients in Pennsylvania. Further, the study population was determined by patients’ choice of payer and provider and their willingness to enroll in the program. For these reasons, the findings show “promising trends” in outcomes and cost reductions resulting from payer-provider collaborations offering intensive ESRD patient management.

For more information, read the full study here.

David A. Roer, MD, FACP, FASH, FASN

David A. Roer, MD, FACP, FASH, FASN

David A. Roer, MD, is vice president of medical affairs for integrated kidney care at VillageHealth and DaVita Kidney Care. He also serves as the chairman of the patient safety and quality committee of the Renal Physician Association and is involved in several clinical research projects locally and nationally. He currently serves on the board of directors at St. Mary’s Hospital and, previously, he served as chief of nephrology, chief of staff and chair of the medical executive committee, medical director of patient safety and clinical quality, chairman of the peer review oversight committee and chair of the ethics committee. Dr. Roer was a member of the National Kidney Foundation of Connecticut’s board of directors for 15 years and developed comprehensive prevention and service programs for more than 3,000 dialysis patients and facilitated legislative changes for kidney disease. In 2008, the foundation honored him with the Gift of Life Community Achievement Award. He and his wife, Mary Lizabeth Aquavia, MD, are founding members of the Ada DeBold Society, a group that ensures the philanthropic future of the National Kidney Foundation. Dr. Roer is an associate clinical professor at Yale School of Medicine, where he also completed his nephrology and hypertension training. He has been awarded Teacher of the Year on six occasions from the Yale Primary Care Residency Program. He holds a specialty certification in clinical hypertension from the American Society of Hypertension and has been the managing partner of Nephrology and Hypertension Associates in Waterbury, Connecticut, for 30 years.