Care Coordination Program Improved Outcomes and Reduced Costs

Orlando—Chronic kidney disease (CKD) exacts a burden on healthcare resources and is a serious public health concern. Beverly Everett, MD, and colleagues at Cigna Health and Life Insurance Company recently designed a study to assess the impact on outcomes of utilization of a pilot program designed to identify and engage CKD patients who are at risk for progression from CKD stage 4 to CKD stage 5.

The researchers conducted a quality improvement initiative to define the impact of case management on costs and outcomes. Results of the initiative were reported during a poster session at the NKF 2017 Spring Clinical Meetings in a poster titled Economic and Clinical Outcomes Resulting from the Stage IV Chronic Kidney Disease Quality Improvement Initiative.

Cigna commercial medical beneficiaries at highest risk of progression of CKD from stage 4 to stage 5 were identified using an algorithm. Those randomized to the intervention group received an evidence-based assessment tool, education, and follow-up. Nephrologists and other providers were engaged and weekly rounds were conducted. The primary outcome measures were hospital admissions, visits to the emergency department (ED), dialysis, fistula placement, and total medical costs. Follow-up continued through July 2013.

Eleven million beneficiaries were screened for eligibility; of those, 7720 with stage 4 CKD were randomized between January 2012 and October 2012. There were 3861 beneficiaries randomized to the intervention group; of those, 1065 received the case management intervention. A control group (n=3859) received standard care. At baseline, there were no differences in demographic and clinical characteristics between the two groups.

Outcomes examined included number of hospital admissions, number of ED visits, number of nephrologist visits, number of dialysis visits, fistula placement, total claim cost, and per member per month cost. There were no statistically significant pre-period differences between the intervention and control groups.

Compared with the control group, the intervention group had slightly fewer hospital admissions and slightly more visits to nephrologists and EDs; the differences were not statistically significant. Those in the intervention group were 12% more likely to have an arteriovenous fistula placement (P=.004) than those in the control group.

Beneficiaries in the intervention group had savings of $199 per member per month compared with those in the control group. This difference equated to 6% lower total medical costs in the intervention group (P=.041).

“Our findings support the value of care coordination between nephrologists, providers, and payer case managers in improving outcomes and reducing total medical costs among beneficiaries at risk for CKD progression from stage 4 to 5,” the researchers said.

Source: Everett B, Castel L, McGinnis M, Beresky A, Cane RC, Cooper T, et al. Economic and clinical outcomes resulting from the stage IV chronic kidney disease quality improvement initiative. Poster presented at the National Kidney Foundation 2017 Spring Clinical Meetings, April 19-22, 2017, Orlando, Florida. Cigna Health and life Insurance Company supported this study.