Population Health for Kidney Disease Patients Concordium 2016 - PowerPoint PPT Presentation

Population Health for Kidney Disease Patients Concordium 2016 Arlington, Virginia 10:30 a.m. – 11:45 a.m., September 13, 2016

Panelists • Bruce Gordon, MD, The Rogosin Institute, New York, NY • Steven Fishbane, MD, Northwell Health, Manhasset, NY • Doug Johnson, MD, DCI, Nashville, TN • Moderator: Craig Schneider, Ph.D, Mathematica Policy Research, Cambridge, MA 2

Background on ESRD • 600,000 Americans w/ ESRD • 1.1% of Medicare population but 5.6% of Medicare costs (2012 data from CMS) • 17.5% uninsured prior to Medicare (pre-ACA data) • Medicare enrollment quadrupled in past 30 years (110,000 in ‘85, 462,000 in ‘13) • More than half (53%) under 65 • Disparities: – 48% non-white – Transplant rates 81% higher for whites than African- Americans) (29% vs. 16%) 3

Background on Panel Session • Two Mathematica projects for CMMI: 1. Health Care Innovation Awards Round 2 – Northwell Health is 1 of 39 awardee sites 2. Learning Systems for Accountable Care Organizations, Phases 1 and 2 – Medicare ACO models include one focused on kidney disease care • Presentation with Dr. Johnson at HIMSS on the DCI ACOs (“ESCOs”) – thought it would be informative to hold a panel at Concordium with another ESCO (Rogosin) and Northwell to discuss ways to improve care for advanced kidney disease patients before they reach end-stage and become eligible for Medicare 4

Benefits of Early Intervention • eGFR is measure of kidney function – 90+ is healthy, <30 is AKD, <16 may result in dialysis • Several “modalities” for dialysis – Transplant – Home dialysis (peritoneal or hemodialysis) – Conservative (palliative) care – Hemodialysis in a facility, with fistula or graph – Hemodialysis in a facility, with catheter • Need to intervene early enough so patient can receive AVF and avoid catheter - more patient-centered, higher quality, lower cost • Problem: Traditional Medicare only covers patients once they go on dialysis 5

Comprehensive ESRD Care (CEC) Model • Currently 12 LDOs (>200 dialysis facilities) and 1 non-LDO • Must include nephrologists and dialysis clinics • Accountable for clinical quality, financial outcomes • Additional ESCOs expected to join the program in January 2017 • “This new ACO model represents a paradigm shift in care for beneficiaries with ESRD; it promotes a patient- centered approach to their dialysis and non-dialysis care needs that will accomplish our delivery system reform goals of better care, smarter spending, and healthier people.” – Patrick Conway, MD, Acting Deputy Administrator, Chief Medical Officer, CMS 6

Dialysis ESCO Name Location Organizations DCI Liberty Kidney Care Alliance, LLC Newark, NJ DCI Palmetto Kidney Care Alliance LLC Spartanburg, SC DCI Music City Kidney Care Alliance, LLC Nashville, TN DaVita Phoenix-Tucson Integrated Kidney Care Phoenix, AZ DaVita South Florida Integrated Kidney Care Miami, FL DaVita Philadelphia- Camden Integrated Kidney Care Philadelphia, PA Fresenius Fresenius Seamless Care of San Diego, LLC San Diego, CA Fresenius Fresenius Seamless Care of Chicago, LLC Chicago, IL Fresenius Fresenius Seamless Care of Charlotte, LLC Charlotte, NC Fresenius Fresenius Seamless Care of Philadelphia, LLC Philadelphia, PA Fresenius Fresenius Seamless Care of Columbia, LLC Columbia, SC Fresenius Fresenius Seamless Care of Dallas, LLC Dallas, TX Smaller dialysis organization: Dialysis Organization ESCO Name Location Rogosin Institute Rogosin Kidney Care Alliance New York, NY 7