Tackling end-stage renal disease (ESRD) through healthcare innovation

People living with End Stage Renal Disease (ESRD are chronically ill, often underserved, and costly to care for compared to the larger population as a whole. In fact, there are currently 468,000 ESRD patients on dialysis that account for $31 billion dollars in healthcare expenditures each year — a staggering amount especially when you think about these costs on a per patient basis.

Despite the potential to improve patient lives and control costs, innovations in the treatment of ESRD have been slow to take shape and have not been adopted at scale across the industry.  There is still some hope on the horizon — here are a few of the innovations that are taking shape to improve the lives of those who have ESRD.

Comprehensive ESRD Care Model: Modeled and designed after Pioneer ACO models and MSSP, Medicare created the Comprehensive ESRD Care (CEC) Model to evaluate new ways to improve care for Medicare beneficiaries with ESRD.  Across the United States there are currently 37 Seamless Care Organizations (ESCOs) where nephrologists and other providers collaborate to more efficiently coordinate care for Medicare beneficiaries. Prior to the establishment of ESCOs, dialysis clinics operated under a traditional fee-for-service model, where patients would receive dialysis four hours a day, three days a week. The ESCO model was designed to encourage clinicians to think more deeply about supporting a patient’s health needs both in and outside of a dialysis clinic. These clinics take on risk, with the goal of reducing healthcare dollars spent treating ESRD and delivering better outcomes for patients.  A few ESCOs have already proven that the model works -- Fresenius Medical Care realized more than $43 million in gross savings and reduced healthcare expenditures by 5.47%.  

The Innovators Solution: Harvard educated Dr. Ikenna Okezie is the Co-Founder & CEO of Somatus, a risk-based dialysis clinic based in Virginia whose admission is to delay or prevent ESRD before it gets started in the first place..  They identify Chronic Kidney Disease patients and provide 24/7 kidney care in the home. Patients have access to nurses, physicians, and other healthcare professionals to address their medical needs..  Dr. Okezie and team are the first movers to take risk on preventing ESRD rather than simply treating it. If their model proves to be successful — and we have no doubt that it will — it's safe to assume more companies will enter the market with similar business strategies.

Patient Transportation:  For a transportation-disadvantaged ESRD patient, getting to dialysis appointments three times a week can be a daunting task.  On average the missed treatment rate among dialysis patients is 7.1 treatments per patient per year and the reschedule rate is only 9.8%. This results in increased morbidity rates for patients, increased risk for ESCOs, and lost revenue for dialysis facilities.  In fact,  a 2014 study  of kidney patients indicated transportation was the third leading cause of missed appointments and a major contributor to unexpected hospitalizations, which further increased the amount spent combating this disease.  The study estimated that efforts to improve transportation to dialysis could decrease these unexpected hospitalizations by 0.8 days per patient per year.  Here at Circulation, we currently service 2,500 healthcare facilities (many of which are ESCOs) with HIPAA compliant, non-emergency patient transportation. Our transportation exchange partners with Lyft and other specialized transportation providers — including wheelchair vans, stretchers and client-owned fleets — to ensure that all patients have a way of getting to and from their medical appointments. For ESCOs, we’ve found that investments in a transportation platform like Circulation pays off by way of reduced hospital admissions, improvements to the overall patient experience, and reduced no-shows. To see a demo of our ride-ordering platform and to learn how Circulation helps improve financial results and patient outcomes for ESCOs, schedule a meeting with me!

Michael is an Account Executive at Circulation