Chronic Kidney Disease Care

Fellowship Class 2011-2012

Background

People suffering from chronic kidney disease (CKD) have higher rates of hospitalization and cardiovascular events, experience more disability, and often die prematurely. One percent of CKD patients have severe, non-reversible kidney damage (end-stage renal disease or ESRD). Americans with CKD incur roughly $315 billion in annual health spending and account for almost a quarter of Medicare spending — over $121 billion annually. Patients who progress to ESRD incur health spending in excess of $87,000 per person per year.

Safely reducing per capita CKD spending    

CERC’s CKD care redesign team found three addressable failure points in current care. Team members address these failure points via a new care model with three core elements: (1) more proactive identification and treatment of patients with early-stage CKD to slow disease progression and its high costs; (2) cost-efficient coordination of care for patients approaching ESRD to prevent costly, unnecessary hospitalization and emergency room visits, and to establish the least hazardous form of vascular access for those patients who prefer hemodialysis to treat end-stage disease; and (3) assurances that patients have an opportunity to select a treatment for ESRD that best fits their personal preferences. This includes the opportunity to select home-based treatment options such as peritoneal dialysis, which are much less costly and exhausting than care in dialysis centers.

Estimated savings     

A conservative estimate of net savings from national implementation of the CERC CKD model is $63 billion dollars in direct health care spending per year — 20% of the estimated $315 billion spent each year on CKD by public and private payers.

Authors

Graham Abra, MD, Manali Patel, MD, David Moore, PhD, Terry Platchek, MD, Donna Zulman, MD, MS, Arnold Milstein, MD, MPH, 2012