Healthmap Solutions Urges Medicare Advantage Plans to Act Now In Advance of 21st Century Cures Act Implementation

As COVID-19 Impacts Kidney Health, Enrollment Opens for 426,000+ Highly Complex, High Cost End-Stage Renal Disease Members to Choose a Medicare Advantage Plan Starting November 1st

Healthmap Solutions, a rapidly growing specialty Population Health Management (PHM) company with a flagship Kidney Health Management (KHM) program, urges Medicare Advantage (MA) plans to prepare now for the 21st Century Cures Act and a key provision which allows previously ineligible End-Stage Renal Disease (ESRD) patients to select a MA plan during open enrollment for the 2021 calendar year. According to the U.S. Renal Data System 2019 Annual Report, there are 746,557 people in the United States living with ESRD, a population that has grown by 2.6% since 2016.i Of this number, approximately 426,000 ESRDii patients are eligible to enroll in a MA plan for the very first time starting with open enrollment this fall. The cost to Medicare of caring for a patient living with ESRD ranges between $80,000 to $100,000 per patient per plan year.iii

Adding to the risk is the growing number of COVID-19 survivors who develop Acute Kidney Injury (AKI) while hospitalized. According to the National Kidney Foundation, 15% of patients hospitalized for COVID-19 develop AKI and many may now need dialysis. The statistics for COVID-19 patients who were admitted to the ICU are more staggering: 20% to 40%iv developed AKI, required renal replacement therapy while hospitalized, and may remain on dialysis following discharge. According to the U.S. Renal Data System, 31% of people who develop AKI are diagnosed with kidney disease within a year of being discharged from the hospital.v

“In just a few months, MA plans can expect a surge in the number of new end-stage renal disease members who require long-term, coordinated, multidisciplinary, complex care management,” said Joe Vattamattam, Chief Executive Officer of Healthmap

Solutions. “Add to this the number of COVID-19 AKI survivors on dialysis now or ultimately in need of dialysis, and the care and cost imperative of acting now to prepare for the Cures Act is clear.”

The growing number of ESRD patients and the cost of caring for them, which reached $36 billion in costs to Medicare in 2017,vi is just the tip of the iceberg. Right now, there are 37 million Americansvii living with Chronic Kidney Disease (CKD), the precursor to ESRD, at a cost to Medicare in excess of $84 billion.viii Millions of other patients are receiving treatment for CKD gateway conditions, such as hypertension, diabetes and obesity. The vast majority live unaware they have CKD until it reaches its more serious stage, ESRD, when dialysis or a kidney transplant is essential for survival. In fact, the National Kidney Association has designated kidney disease “the under-recognized public health crisis” in our country.

Early detection represents the single most effective means of disrupting the ESRD pipeline, when clinically proven interventions and complex care management can slow disease progression. The U.S. Renal Data System 2019 Annual Data Report points to disease prevention and progression to later stages of kidney disease as potential sources of expenditure reduction.ix

“MA plans that act now will be prepared to effectively and efficiently manage both the care and the cost of these new and vulnerable ESRD members as they enroll,” said Vattamattam. “They will also have the ability to identify members with CKD early and introduce clinically proven interventions that improve care, outcomes, member experience and costs by delaying or preventing the onset of ESRD.”

About Healthmap Solutions

Healthmap Solutions is a specialty population health management company with a specific Kidney Health Management (KHM) solution for patients with kidney disease, serving health plans, accountable care organizations (ACOs) and provider groups seeking value-based solutions that improve the clinical care and financial performance of high-risk, high-cost kidney patient populations. The company has a rich history forged in data and analytics, having begun as a healthcare data clearinghouse and going on to add robust health analytics expertise. Today, Healthmap Solutions uses that experience to power a complex KHM program with its clinical experts. Healthmap Solutions also provides similar integrated programs across a full range of specialty population health management. For more information: healthmapsolutions.com

i United States Renal Data System. “2019 USRDS annual data report: Epidemiology of kidney disease in the United States.” National Institutes of Health, National Institutes of Diabetes and Digestive Kidney Diseases, Bethesda, adr.MS, 2019. https://www.usrds.org/ aspx

ii United States Renal Data System. “2019 USRDS annual data report: Epidemiology of kidney disease in the United States.” National Institutes of Health, National Institutes of Diabetes and Digestive Kidney Diseases, Bethesda, MS, 2019. https://www.usrds.org/adr.aspx [ADR Section D; Table D.21}

iii United States Renal Data System. “2019 USRDS annual data report: Epidemiology of kidney disease in the United States.” National Institutes of Health, National Institutes of Diabetes and Digestive Kidney Diseases, Bethesda, MS, 2019. https://www.usrds.org/adr.aspx

iv Abelson, Reed; Fink, Sheri; Kulish, Nicholas; Thomas, Katie. “An Overlooked, Possibly Fatal Coronavirus Crisis: A Dire Need for Kidney Dialysis.” New York Times. April 18, 2020. Page 1.

v US Renal Data System. https://www.usrds.org/adrhighlights.aspx

vi United States Renal Data System. “2019 USRDS annual data report: Epidemiology of kidney disease in the United States.” National Institutes of Health, National Institutes of Diabetes and Digestive Kidney Diseases, Bethesda, MS, 2019. https://www.usrds.org/adr.aspx. Executive Summary page 11.

vii Centers for Disease Control. https://www.cdc.gov/kidneydisease/pdf/2019_National-Chronic-Kidney-Disease-

Fact-Sheet.pdf

viii United States Renal Data System. “2019 USRDS annual data report: Epidemiology of kidney disease in the United States.” National Institutes of Health, National Institutes of Diabetes and Digestive Kidney Diseases, Bethesda, MS, 2019. https://www.usrds.org/adr.aspx. Executive Summary page 11.

ix Ibid.

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This post was written by Elevate, Inc.