In-Patient Admissions Reduced with Participation in a CKD Management Program

Rahul Dhawan, MD, and colleagues at Optum®, part of United Healthcare, Eden Prairie, Minnesota, conducted a study to assess the association between access to and participation in a program for management of kidney disease and patient outcomes, including utilization of the emergency department, in-patient hospital admission, and costs of care. Results of the study were reported online in an abstract from the NKF 2020 Spring Clinical Meetings.

The program is part of an established product of Optum; the current study was designed to illustrate quality improvement in CKD patients as a result of patient engagement.

The study population included fully insured commercial patients identified as having chronic kidney disease (CKD) stage 4 or 5 from July 2017 to July 2018. The researchers sought to examine the reduction in utilization of in-patient care as well as the total cost of care. The study compared data from program participants with data from nonprogram participants. The study included a subanalysis of patients who transitioned to end-stage renal disease (ESRD) during the study period. Outcomes measured included all-cause medical allowed amount per participant and all-cause in-patient admissions per participant.

The treatment group included 805 unique members; the control group included 2714 unique members. Eligible patients had at least one claim with a diagnosis code for CKD 4 or 5 in the previous 24 months, or at least two laboratory claims at least 7 days apart with an estimated glomerular filtration rate result ≤30 mL/min/1.73 m2 in the previous 24 months.

Utilization for each member was measured starting from the date of CKD identification or at the beginning of the study period, whichever was later. Program participant was defined as a patient engaged in three or more outreach calls from a case manager. Nonparticipants were defined as patients with CKD but who were not contacted.

Among patients who did not transition to ESRD during the study period, there was an 11% cost reduction between the control and treatment groups during the study period. There was also a 52% reduction in in-patient admissions between the control and treatment groups, which equated to $2.6 million annual savings.

Among patients who did transition to ESRD, there was a 6% reduction in costs for those who participated in the program. In addition, there was a 36% reduction in in-patient admissions. Program participants were seen more often by a nephrologist compared with nonparticipants.

“This study highlights the benefits of patient participation in a kidney disease specific management program. Participation increases patient engagement in the disease process, reduces hospitalizations, and therefore improves quality of life,” the researchers said.

Source: Dhawan R, Friedman J, Bannister W, et al. Impact of a kidney disease management program on ER utilization in patient utilization and total cost of care. Abstract of a presentation at the National Kidney Foundation 2020 Spring Clinical Meetings; abstract #288.