Humana, Fresenius Medical Care Expand Partnership to Improve Care Coordination for Medicare Advantage Members

Humana Inc. and leading renal care company Fresenius Medical Care North America (FMCNA) announced an agreement to broaden their collaboration toward improving the health of eligible Humana Medicare Advantage and commercial members with chronic kidney disease (CKD) and end-stage renal disease (ESRD) through more coordinated, holistic care.

The expanded partnership is in keeping with the goals outlined in the 21st Century Cures Act, which enables people with ESRD to enroll in Medicare Advantage Plans, and with federal initiatives that call for earlier diagnosis and treatment of kidney disease; a reduction in the number of Americans developing ESRD; and support for patient treatment options such as home dialysis or kidney transplant as applicable.

The agreement between Humana and Fresenius Medical Care North America goes into effect Jan. 1, 2021, and encompasses the following:

Expanded Availability of Care Coordination Services: FMCNA currently provides specialized care coordination services for Humana members with CKD in three states: Iowa, Kentucky, and North Carolina. The agreement expands the availability of these services to eligible Humana members in an additional 39 states, with the goals of improving quality of life and health outcomes, increasing access to care and minimizing care gaps, slowing disease progression and lowering hospitalization rates, and reducing the cost of care.

FMCNA’s care coordination services include early detection of CKD to slow disease progression; medication reviews and regimen adherence guidance; behavioral health screenings; nutritional counseling; strategies for managing multiple comorbidities; education about – and support for – home dialysis treatment when applicable and beneficial to the patient; transplant education; and palliative care.

FMCNA partners with InterWell Health, a physician-led population health management company working to improve clinical outcomes and lower medical costs through its network of over 1,100 nephrologists across the country.

Transitional Care Units: These units are designed to help people recently diagnosed with kidney failure learn about treatment options available to them – including transplant and home dialysis – and be more empowered in managing their own care. Transitional Care Units may be either a space within a dialysis center or a standalone facility, offering comprehensive, hands-on education from dedicated staff that is individualized for each patient. This includes the importance of renal nutrition, medication adherence, and vascular access care; assisting patients transitioning between modalities (e.g., from in-center dialysis to home dialysis); and supporting individuals returning to dialysis from transplant. The agreement is intended to locate Transitional Care Units in select areas where Humana has significant Medicare Advantage membership.

Value-Based Agreement: The expanded collaboration also improves upon the parties’ existing clinic network contract, which provides eligible Humana Medicare Advantage and commercial members with ESRD access to dialysis at more than 2,600 centers of Fresenius Kidney Care, the dialysis services division of Fresenius Medical Care North America. By implementing a value-based payment model for in-center and home dialysis services and at Transitional Care Units, as well as for CKD care coordination services, compensation will be based on meeting agreed-upon quality improvement and patient outcome goals, and reducing overall costs to the system.

Why It Matters

Value-based renal care is aligned with the objectives of CMS’s recently-released End Stage Renal Disease Treatment Choices (ETC) Model, which encourages increased adoption of home dialysis and greater access to kidney transplants.

Individuals with CKD have kidneys that do not filter blood properly, which causes waste and fluid levels that can be dangerously high. CKD and ESRD affect a wide spectrum of the population but the degree of impact is not uniform. For example, kidney failure rates among Black Americans are about three times that of white Americans. In total, approximately 15% of American adults, or about 37 million people, have CKD, but many are unaware of their condition. CKD management is complex, and failure to appropriately manage the condition may cause considerable symptoms and worsening health outcomes, including ESRD.

This agreement represents an evolution of our work with Humana and leverages our over 10 years of industry leadership in value-based care,” said Bill Valle, Fresenius Medical Care North America’s Chief Executive Officer. “Our scale, integrated nephrology network, and standardized clinical interventions and protocols uniquely position us to predictably and consistently improve health outcomes and reduce overall costs. We welcome this opportunity to offer more coordinated, holistic care to Humana’s members, with a keen focus on education, comorbidity management, early detection, and treatment options, including home dialysis. This approach also helps eliminate barriers to keep renal disease treatment uninterrupted for at-risk populations.”

Source: hitconsultant