Economic and Clinical Outcomes Resulting From the Stage 4 Chronic Kidney Disease Case Management Quality Improvement Initiative

Abstract

Purpose of Study:Chronic kidney disease (CKD) is a costly and burdensome public health concern. The goal of this study was to evaluate the impact on outcomes and utilization of a pilot program to identify and engage beneficiaries with CKD at risk for progression from Stage 4 to Stage 5.Primary Practice Settings:A quality improvement initiative was conducted to assess the impact of case management on costs and outcomes among 7,720 Cigna commercial medical beneficiaries with Stage 4 CKD enrolled in the United States between January 2012 and October 2012.Methodology and Sample:Claims data were analyzed to compare 3,861 beneficiaries randomized to receive condition-focused case management with 3,859 controls, with follow-up through July 2013. After using an algorithm to identify beneficiaries at highest risk of progression, a case management team implemented, among those assigned to the intervention, an evidence-based assessment tool, provided education and follow-up, engaged nephrologists and other providers, and conducted weekly rounds. Primary outcome measures were hospital admissions, emergency department visits, nephrologist visits, dialysis, arteriovenous (AV) fistula creation, and total medical costs. Analysis of variance techniques were used to test group differences.Results:As compared with controls, intervention beneficiaries were 12% more likely to have fistula creation (p = .004). Intervention beneficiaries were observed to have savings of $199 per member per month (PMPM), F = 23.05, p = .04. This difference equated to 6% lower total medical costs in the intervention group. Savings observed were derived half from improved in-network utilization and half from reduced hospital costs.Implications for Case Management Practice:The observed 12% increased rate of creation of AV fistulas and $199 (6%) decrease in PMPM cost between the intervention and control groups corresponded to a savings of more than $18 million in 2015 U.S. dollars (USD).On the basis of observation of substantial improvements in outcomes and cost savings, health plan administrators could better serve those at highest risk of progression by implementing focused case management.Our findings support the value of care coordination between nephrologists, providers, and health plan case managers in improving outcomes and reducing total medical costs among beneficiaries at risk for CKD progression from Stage 4 to Stage 5.

A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure Using a Large Administrative Claims Database

“…Our model uses demographics, comorbidities, and drug utilization data that are obtained routinely in patients with CKD in the enrollment, medical, and pharmacy claims databases, and the variables can be automatically generated and easily integrated into a clinical decision-making system. Similar to the systematic review studies discussed, 20–23 , 33 , 34 we found that younger age, male sex, advanced stage CKD, hypertension, DM, congestive heart failure, peripheral vascular disease, iron deficiency anemia, and higher prospective ERG risk score predict a higher risk of CKD progression to kidney failure. In addition, we found two new predictors; the presence of HK and poor RAASi adherence are significantly associated with progression of CKD.…”

The cost of arteriovenous fistula placement in patients with chronic end-stage renal disease in Ouagadougou (Burkina Faso) 2020

“…According to the National Kidney Foundation, in the United States, Medicare spends an average of 90,000 USD per patient per year on hemodialysis treatment for CKD [10]. Another study proved that performing AVF saved beneficiaries $199 per limb per month [11]. Yang.S et al in 2017 had reported in their study an average first-year cost per patient of USD 11,240 less for AVF than for SAVF [12].…”

Gestión de casos: adaptación para pacientes pluripatológicos y cuidadores en Colombia

“…Con respecto a la evidencia científica sobre los efectos de la GC se destacan: mejoras de la calidad de vida; aumento de la capacidad funcional; reducción de caídas, en personas mayores que viven en su domicilio; mejora en los resultados clínicos; disminución de complicaciones; aumento de satisfacción en pacientes y cuidadores; disminución de costos financieros en salud derivados de reducción de polifarmacia, de ingreso a instituciones de cuidado a largo plazo y hospitalizaciones; y, días de estancia y consultas de salud, en diferentes poblaciones (16)(17)(18).…”