This is intended for producers with business in Delaware, Pennsylvania and West Virgnia.
INTRODUCING THE KIDNEY CARE MANAGEMENT PROGRAM
CKD and its progression to ESRD is a perfect storm of high cost and high clinical complexity. According to the CDC, Chronic kidney disease affects 37 million US adults at a cost of $23,700 per person annually and approximately 90% of adults with CKD are unaware they have the disease. Highmark is launching a Kidney Care Management program with an NCQA accredited kidney population health management company. The goal of the program is to enhance the physician-to-member relationship and avoid adverse and costly health care events for members with kidney disease. The program provides a personalized approach to care between office visits and connects members to community services they may need to maintain access to quality health care. Ideally, the program will improve health outcomes and health care while helping the member have a longer, better quality of life.
The Kidney Care Management program identifies members with Chronic Kidney Disease (CKD) Stages 3 through 5 and End Stage Renal Disease (ESRD) and works with members and their providers to prevent or delay the transition to dialysis. The program includes, among other features:
- Delivery of critical clinical data and key member events to help support the provider’s practice
- Coordinates care between the member’s Primary Care Physician (PCP) and specialty practices
- Assists providers and members with medication management and adherence
- Provides members with nutrition and behavioral health resources
- Helps members address obstacles related to social determinants of health
When will the program be available?
For commercial fully-insured and Medicare Advantage clients: Beginning May 1, 2022, Kidney Care Management will be added to the services available to members.
For ASO clients: Beginning January 1, 2023, self-insured clients will have the ability, upon renewal, to implement the same Kidney Care Management program for $60 PEMPM (Per Eligible Member Per Month).
Why are we making these changes? CKD and its progression to ESRD is a perfect storm of high cost and high clinical complexity. According to the CDC, Chronic kidney disease affects 37 million US adults at a cost of $23,700 per person annually and approximately 90% of adults with CKD are unaware they have the disease.
In addition, the National Kidney Foundation states that undermanaged CKD has led to triple the prevalence of ESRD in the US since 1990. Thus, Highmark is deploying a national kidney care management solution, to better serve this high-risk population and deliver cost savings.
How will members be notified of this change? Practice relationship managers will conduct outreach to designated Providers via a variety of communication channels, which may include telephone, text, video, and or in-person engagement. Likewise, Care Navigators will also conduct outreach to eligible members to improve adherence and compliance with a healthy action plan developed by the member’s physician.
Questions? If you have questions, please contact your Highmark Sales Executive or Client Manager. |