Renal care company Fresenius Medical Care North America (FMCNA) has broadened its collaboration with insurer Humana Inc. to improve the health of Humana members with chronic kidney disease (CKD) and end stage renal disease (ESRD) through more coordinated, holistic care.
The companies noted that the expanded partnership is in keeping with the goals outlined in the 21st Century Cures Act, which enables people with ESRD to enroll in Medicare Advantage Plans, and with federal initiatives that call for earlier diagnosis and treatment of kidney disease; a reduction in the number of Americans developing ESRD; and support for patient treatment options such as home dialysis or kidney transplant as applicable.
FMCNA currently provides specialized care coordination services for Humana members with CKD in three states: Iowa, Kentucky, and North Carolina. Starting in 2021, the agreement expands the availability of these services to eligible Humana members in an additional 39 states, with the goals of improving quality of life and health outcomes, increasing access to care and minimizing care gaps, slowing disease progression and lowering hospitalization rates, and reducing the cost of care.
FMCNA's care coordination services include early detection of CKD to slow disease progression; medication reviews and regimen adherence guidance; behavioral health screenings; nutritional counseling; strategies for managing multiple comorbidities; education about — and support for — home dialysis treatment when applicable and beneficial to the patient; transplant education; and palliative care.
FMCNA partners with InterWell Health, a physician-led population health management company working to improve clinical outcomes and lower medical costs through its network of over 1,100 nephrologists across the country.
The agreement is intended to locate what are called Transitional Care Units in select areas where Humana has significant Medicare Advantage membership. These units are designed to help people recently diagnosed with kidney failure learn about treatment options available to them — including transplant and home dialysis — and be more empowered in managing their own care. Transitional Care Units may be either a space within a dialysis center or a standalone facility.
This week, Humana announced results of a study that reveals that 2.41 million Humana individual Medicare Advantage beneficiaries who receive care from primary care physicians in value-based payment models experienced, on average, better health outcomes, lower costs and more preventive care, as opposed to fee-for-service models. An estimated $4 billion in plan-covered medical expenses would have been incurred by Humana Medicare Advantage members if they had they been under original Medicare’s fee-for-service model instead of in value-based agreements.
Humana also is seeking to expand its value-based contracts in renal care. The collaboration expands the parties’ existing clinic network contract, which provides eligible Humana Medicare Advantage and commercial members with ESRD access to dialysis at more than 2,600 centers of Fresenius Kidney Care, the dialysis services division of Fresenius Medical Care North America. By implementing a value-based payment model for in-center and home dialysis services and at Transitional Care Units, as well as for CKD care coordination services, compensation will be based on meeting agreed-upon quality improvement and patient outcome goals, and reducing overall costs to the system.
Value-based renal care is aligned with the objectives of CMS’s recently released End Stage Renal Disease Treatment Choices (ETC) Model, which encourages increased adoption of home dialysis and greater access to kidney transplants.
“This agreement represents an evolution of our work with Humana and leverages our over 10 years of industry leadership in value-based care,” said Bill Valle, Fresenius Medical Care North America’s CEO, in a statement. “Our scale, integrated nephrology network, and standardized clinical interventions and protocols uniquely position us to predictably and consistently improve health outcomes and reduce overall costs. We welcome this opportunity to offer more coordinated, holistic care to Humana’s members, with a keen focus on education, comorbidity management, early detection, and treatment options, including home dialysis. This approach also helps eliminate barriers to keep renal disease treatment uninterrupted for at-risk populations.”