A Peterson Health Technology Institute report finds virtual chronic kidney disease management programs fail to slow disease progression or reduce healthcare costs. The study evaluated eight companies offering these services, finding no consistent evidence of clinical or economic benefits. Launched in 2023, PHTI operates as a nonprofit dedicated to independent evaluations of healthcare technologies, aiming to improve health outcomes and reduce costs through rigorous, evidence-based assessments. This report aligns with its mission by scrutinizing digital health solutions’ clinical and economic impacts, including their effects on health equity, privacy, and security.
Virtual CKD Management Falls Short
The report, from the Peterson Health Technology Institute (PHTI), analyzed virtual chronic kidney disease (CKD) management solutions from DaVita Integrated Kidney Care, Evergreen Nephrology, Healthmap Solutions, Interwell Health, Kidneylink, Monogram Health, Somatus, and Strive Health. These companies operate under Medicare Advantage and Kidney Care Choices (KCC) models, assuming financial responsibility for patients with CKD stages 3-5. Despite this, the report found no significant impact on slowing disease progression or reducing overall healthcare spending. The evaluation was based on a systematic literature review, company-submitted data, website analyses, and CMS KCC model data, ensuring a full assessment of these programs’ effectiveness.
These companies, operating under Medicare Advantage and Kidney Care Choices (KCC) models, assume financial responsibility for patients with CKD stages 3-5. Despite this, the report found no significant impact on slowing disease progression or reducing overall healthcare spending. Notably, the KCC model, launched in 2022, has shown no reductions in healthcare spending for CKD patients compared to non-participants, with incentive payments to nephrology practices increasing Medicare costs.
Limited Clinical Effectiveness
PHTI’s evaluation revealed that these virtual solutions showed no consistent evidence of slowing CKD progression. While they demonstrated some benefit in planned dialysis starts, this did not translate to meaningful reductions in hospitalizations or other healthcare utilization. The report shows that these programs fail to improve medication use or slow kidney function decline compared to usual care. The limited clinical impact is further compounded by the low rate of dialysis starts, with only 1% of attributed patients beginning dialysis annually, making population-level savings negligible.
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The report highlights a key issue: only 1 in 100 attributed patients begin dialysis annually, and only 1 in 1,000 would experience an improved start. This limits the potential impact of these solutions on a population level.
Economic Impact: Minimal Savings
PHTI’s budget impact model found small reductions in healthcare spending due to improved dialysis transitions. However, these savings were deemed “immaterial” when spread across the entire CKD population. The report suggests that health plans may still find value in these solutions due to potential improvements in risk coding and budget predictability, even without significant cost reductions.
Focus on Early Detection Needed
Caroline Peterson, PHTI’s executive director, emphasizes the need for a shift in focus. She argues that current payment models prioritize late-stage CKD interventions, neglecting the key role of early screening and diagnosis. Peterson highlights that many proven, generic medications for CKD are under-prescribed, and earlier intervention could prevent progression to end-stage kidney disease. By refocusing on primary care and medication management, the healthcare system could achieve significant cost savings and improve patient outcomes.
Peterson advocates for contracting and payment models that incentivize early detection and medication management. She stresses that the clinical tools exist, but the current system lacks incentives for early detection. With the right models, the gap between guideline-recommended care and actual patient care could be closed, transforming CKD management.
