Evergreen Nephrology Introduces "CKD 3-Plus" Category in Landmark Study Published in The American Journal of Managed Care

News provided by

Jun 25, 2024, 09:21 ET

NASHVILLE, Tenn., June 25, 2024 /PRNewswire/ -- Evergreen Nephrology is proud to announce the publication of a pivotal study in The American Journal of Managed Care (AJMC), introducing a new category for chronic kidney disease (CKD) management called "CKD 3-Plus." This groundbreaking research highlights the importance of earlier nephrology intervention and expands access to value-based-care (VBC) models for individuals living with kidney disease.

Significance of the Research

CKD affects approximately 15% of adults in the United States, and its prevalence is expected to rise as the population ages and risk factors like diabetes continue to expand. Nephrology intervention often begins at CKD stage 4, if not later. However, this research identifies a subset of CKD stage 3 patients, termed "CKD 3-Plus," who exhibit disease progression and healthcare costs similar to those in later stages of CKD.

Representing approximately 35% of Original Medicare beneficiaries with CKD stage 3, the CKD 3-Plus category represents a significant expansion of the population who would benefit from nephrology intervention. As a value-based-care provider, Evergreen knows engaging people earlier in their disease progression provides the best opportunity to slow disease progression and improve health outcomes.

Key Findings:

Identification of High-Risk Patients: The study identified that Medicare beneficiaries with CKD stage 3 and at least one of seven selected comorbidities (CKD 3-plus) represented 35.4% of all CKD stage 3 patients. This cohort had cost and utilization patterns more akin to CKD stages 4 and 5, with significantly higher medical costs and rates of disease progression, suggesting they may benefit from the services commonly available only to people with more advanced stages of kidney disease.
Cost and Utilization Patterns: CKD 3-plus patients incurred medical costs averaging $3,877 per member per month (PMPM), compared to $1,145 PMPM for other CKD stage 3 patients. They also had five times the amount of acute inpatient medical costs and admissions compared to their counterparts without the selected comorbidities, presenting an opportunity to reduce costs for both patients and the healthcare system broadly.
Disease Progression: The CKD 3-plus cohort had a higher likelihood of progressing to end-stage kidney disease (ESKD) or death, with 40.4% experiencing such progression during the study period, compared to only 9.1% of other CKD stage 3 patients, demonstrating the need for kidney-focused interventions to provide them the best opportunity to receive a transplant or begin dialysis outside of a hospital, ideally with home dialysis.

Expanding Access to Value-Based-Care Models

The findings underscore the necessity of including CKD 3-plus patients in VBC models, such as the Comprehensive Kidney Care Contracting (CKCC) model from the Center for Medicare and Medicaid Innovation, in addition to Medicare Advantage plans.

By identifying and managing high-risk patients earlier, value-based enablers like Evergreen and their associated nephrologists can improve outcomes, drive more home dialysis, and increase the number of transplants, ultimately reducing healthcare expenditures.

Ultimately value-based models improve the lives of Evergreen patients like John. "For the first time in 50 years I was able to really share my experience with CKD and have someone listen," John explained. "I have a sense of hope for the first time in a long time that there's someone who cares."

Collaboration with AJMC

The authors extend their gratitude to The American Journal of Managed Care and its expert reviewers for their collaboration in bringing this crucial research to publication.

About Evergreen Nephrology

Evergreen Nephrology takes a patient-centric approach to kidney care. In collaboration with our nephrologist partners, along with Medicare and health insurance companies in value-based arrangements, Evergreen fosters a holistic-care experience for individuals living with kidney disease by empowering them through shared decision-making to take an active role in their own health. With over 750 provider partners serving patients across 24 states, Evergreen is making personalized, physician-led care the national standard for kidney care. Learn more about our efforts to advance value-based care and personalized treatment for kidney disease at EvergreenNephrology.com

The American Journal of Managed Care

The American Journal of Managed Care (AJMC) is a peer-reviewed, multidisciplinary journal dedicated to advancing healthcare delivery and outcomes through comprehensive coverage of the latest research and trends in managed care. Since its inception in 1995, AJMC has been a leading source of cutting-edge information for healthcare professionals, policymakers, and researchers. The journal publishes original research, reviews, and commentary on topics including healthcare policy, clinical care, and economic outcomes, with a strong emphasis on value-based care and patient-centered management. AJMC is committed to fostering the exchange of knowledge and best practices to improve the quality and efficiency of healthcare delivery.

SOURCE Evergreen Nephrology