Specialized Disease Management Program Reduced Costs and Inpatient Admissions

Orlando—Optum’s Disease Management (DM) program utilizes communication via telephone and hard copy between renal specialty nurses and patients and healthcare providers to enhance patients’ knowledge of chronic kidney disease (CKD) and ways to maximize their healthcare. Employers purchase the DM program to enable patient-access. In 2016, a meta-analysis of the efficacy of DM programs focused on CKD demonstrated improved quality of life among CKD patients.

Kael Haig, MS, and colleagues recently conducted a study to measure the relationship between access to a nurse-based specialty DM program and outcomes in patients with stage 4 or 5 CKD. Results of the study were reported during a poster session at the 2017 NKF Spring Clinical Meetings in a poster titled Impact of a Specialized Disease Management Program on Medical Cost and Time to ESRD Transition among Patients with Stage 4-5 CKD.

The researchers compared two patient populations: a group with access to the DM program (n=7469) and a group without access to the program (n=21,617). The outcomes of interest were medical costs and time to initiation of chronic dialysis from the onset of CKD stage 4-5.

The study population included all commercially insured members who were identified as having stage 4-5 CKD between January 1, 2013, and December 31, 2015. Members new to insurance during the measurement period were excluded.

Reviews of medical claims up to 36 months following initial identification of stage 4 or 5 CKD were conducted to determine all-cause medical spend, inpatient admission, and transition to end-stage renal disease (ESRD). CKD stage 4-5 was defined as at least one claim with a diagnosis code for CKD 4 or 5 and at least two laboratory claims with an estimated glomerular filtration rate of less than 30 mL/min/1.73 m2. ESRD was defined as requiring ≥3 consecutive months of dialysis.

During the study period, monthly all-cause healthcare costs for patients with access to the DM program were $2430 compared with $2917 for those in the no-access group, for a difference of $487 (P<.001). The annualized all-cause healthcare spend for patients in the DM group were $29,160 compared with $35,002 for those in the no-access group (annualized difference, $5842). Patients in the access group also saved 0.14 inpatient admissions compared with the no-access group. Following adjustment for patient risk and characteristics, those in the group with access to the DM program had a 9% reduced risk of dialysis initiation.

“The findings suggest that access to a specialized DM program may be associated with reduced spend and utilization as well as delayed progression to chronic dialysis initiation among individuals with stage 4 or 5 CKD,” the researchers said.

Source: Haig K, Chien A, Gray H, Bannister W, Stankovic A. Impact of a specialized disease management program on medical cost and time to ESRD transition among patients with stage 4-5 CKD. Poster presented at the National Kidney Foundation 2017 Spring Clinical Meetings, April 19-22, 2017, Orlando, Florida. The study was sponsored by Optum® Inc.