A group of more than 650 nephrologists has joined with Fresenius Medical Care North America (FMCNA), to raise $20 million in initial funding and announce the formation of InterWell Health, a population health management company focused on supporting the renal patient population across the full continuum of care.
With their experience in value-based arrangements, including the End Stage Renal Disease Seamless Care Organization (ESCO) program, these investors in InterWell will facilitate and support renal providers across the country to create value in managing the chronic kidney disease and end stage renal disease patient population by improving patient outcomes and lowering overall costs to the system.
InterWell Health will foster collaboration among clinicians across the country to support their value-based operations. The combined clinical and analytical expertise of the nephrology practices and FMCNA will be leveraged to provide shared know-how, state-of-the-art models of care, and other resources for value-based arrangements in local and national markets, according to the new company.
"This is the next step in value-based care and will provide the blueprint for all renal providers to engage in these types of arrangements," said Ravindra Bollu, MD, managing partner of Kidney Care Specialists LLC in Bethlehem, Pa., in a statement. "We believe with strong physician leadership, InterWell Health is well positioned to advance a rapid transformation of renal care models."
Early study results of value-based care models focused on kidney care have shown promise. A recent analysis following the second payment year of the Comprehensive End-Stage Renal Disease Care (CEC) Model found that it led to a decrease in hospitalizations and an increase in outpatient dialysis sessions.
The CEC Model tests whether the creation of ESRD Seamless Care Organizations (ESCOs) can reduce Medicare expenditures while maintaining or improving quality of care. Each ESCO, which is made up of dialysis facilities, nephrologists and other providers, is a specialty-oriented accountable care organization (ACO) that assumes responsibility for the quality of care and Medicare Part A and Part B spending of their aligned beneficiaries. These ESCOs represent a variety of geographic regions, ownership structures and sizes.
Data analyzed by the Lewin Group showed there was a 4 percent decrease in the number of hospitalizations and nearly a 1 percent increase in the number of outpatient dialysis sessions for CEC beneficiaries relative to non-CEC beneficiaries. These results may be due to ESCOs targeting patients at a high risk of hospitalization, increasing access to urgent dialysis care at facilities, and coordinating care to reduce avoidable hospital admissions, the report said.
CEC beneficiaries experienced 6 percent fewer hospitalizations from ESRD complications and were 8 percent less likely to use a catheter compared to non-CEC beneficiaries. Overall, there was no evidence that the relative reductions in cost and utilization compromised quality.
The Lewin Group report also found that the CEC Model reduced Medicare spending by $68 million or 1.8 percent during the combined payment years. These results were primarily driven by Wave 1 ESCOs. However, Medicare experienced aggregate net losses of $46 million after accounting for shared savings payments made to ESCOs.
