This piece originally appeared on Health Evolution. You can read it here.
The story of how Monogram Kidney Clinic came to be is one of the surest signs of health care’s paradigm shift towards a value-based future, coming out of the pandemic.
The clinic is the brainchild of Monogram Health, a company that offers an AI-based, biometric care management tech solution for kidney care management and Humana, a national insurer looking to advance engagement to lower the cost of care among its kidney disease population.
Monogram was created in 2019 by Sen. Bill Frist, MD, Monogram Health’s board chairman, CEO Mike Uchrin and Raymond Hakim, MD, the company’s CMO. It is a managed care company that uses predictive analytics on behalf of health plans to determine who might need dialysis and how to prevent that from happening. They then use at-home care management for patients with chronic kidney disease (CKD) or End Stage Renal Disease (ESRD) by leveraging in-home and telephonic visits conducted by nurses and working directly with the patient’s primary care physician and nephrologist.
As Monogram was ensuring its nurses were still conducting in-home visits during the early stages of COVID-19, Humana was recognizing it needed a better way to reach these kidney populations to deliver the preventive care necessary to avoid costly and debilitating dialysis treatment. Through their partnership, Humana and Monogram recognized the need for a clinic that could work directly with those patients. That clinic was launched in December and has already begun engaging kidney care management patients at nine times the rate Humana has seen with other partners.
“There is a staggering statistic out there: 50 percent of patients with stage 3 CKD don’t know they have it and have never seen a nephrologist,” says Kyle Cooksey, Monogram Care Clinic’s Senior Vice President, Renal Physician Services. “Kidney disease is a silent disease. It doesn’t present symptoms until one could be classified as near ready for dialysis and in the upper end of disease staging. Let’s move the needle back and start engaging with members when they are early onset kidney disease and can be managed through medication therapies, diet, exercise.”
Partnerships like the one between Monogram and Humana are becoming increasingly common as payer and provider organizations shift towards value-based care, spurred in part by a tenuous fee-for-service environment that’s been damaged by the loss of in-person care during the pandemic.
“There’s been a perfect alignment between value-based care priorities and the priorities we need to take as a health care organization to manage COVID,” says Kevin Coloton, CEO of Curation Health, a company which offers a decision platform that helps providers and payers navigate the transition to value-based care.
“I think COVID is likely the most consequential war games scenarios we’ve ever hard for risk management models. It’s hard to reflect on something that would be more high risk than COVID in a population of patients. It’s about managing risk at a very acute level with urgency and I think the end result is going to be a catalyzed event to drive value-based care across the industry,” Coloton adds.
Emphasis on kidney care
Kidney care, in particular, has gotten attention through payers and providers alike because of the lowered quality-of-life and heightened costs of dialysis care. According to one study of Medicare beneficiaries, less than 1 percent have ESRD, yet the condition accounts for more than 7 percent of overall Medicare spending. Moreover, the disparities in care impacting vulnerable populations during COVID have made a mark in kidney care too.
According to new research, nearly half of patients with kidney failure are Hispanic, Black, or Native American/Pacific Islander, and patients in those groups are more heavily impacted with COVID-19 compared with non-Hispanic Whites. Another research effort found that the prevalence of kidney disease is 1.5 times higher in Hispanic populations, and African Americans represent the highest affected group with 3.7 times the national average.
In September, CMS announced the ESRD Treatment Choices (ETC) Model, which aims to improve the quality of care and reduce Medicare expenditures for patients with chronic kidney disease. Not looking to get left behind private insurers are starting their own initiatives to tackle this costly patient population. In January, BCBS North Carolina announced an initiative with Fresenius Medical Care North America and Strive Health.
Cooksey says Monogram has partnerships with Centene for its commercial lives, WellCare for Medicare Advantage patients and other insurers across the country. Humana, for its part, has kidney care partnerships with Fresenius, Healthmap Solutions, REACH Kidney Care, Somatus and Strive Health as well.
“Health plans have brilliant economists and analytics teams associated to their organizations. When it comes to providing care, that’s when they find the need to partner with organizations like us,” says Cooksey. “Our goal is not only to acquire patients and begin care, but it’s to educate and inform. That’s what we provide to health plan members. We also provide access. Depending on where you live, nephrologists may be a limited group. The disease is not biased towards geographic location.”
For Monogram, Cooksey is willing to take on downside risk in a value-based care arrangement because he thinks the model they’ve created will thrive in that environment. He doesn’t see that being the case for all the kidney care management organizations because of an old-school mentality by doctors. “Without being too jaded, many nephrologists are motivated to have their patients on dialysis. It’s not the case everywhere, but we see it more and more,” he says.
