Humana Partners With Fresenius To Offer New MA ESRD Care Model

Reprinted from SPECIALTY PHARMACY NEWS, a monthly newsletter designed to help health plans, specialty pharmacies, pharma companies, providers and employers contain costs and improve outcomes related to high-cost specialty products. 

By Angela Maas, Managing Editor

March 2017 Volume 14 Issue 3

In the second time in as many months, a partnership between a national health insurer and Fresenius Medical Care North America (FMCNA) that’s focused on end-stage renal disease (ESRD) has been announced. Humana Inc. is partnering with FMCNA to improve the care of its Medicare Advantage (MA) members with the condition, which can be very complex to manage.

Through its Fresenius Health Partners unit, FMCNA will put in place its care coordination model to help Humana members receive appropriate care. Each patient will have a team consisting of local nephrologists and clinicians who are working with FMCNA’s care navigation unit, which consists of specialized nurses and service coordinators who can provide care 24/7. Using this approach, the care navigation unit hopes to proactively identify issues before they occur, as well as help patients and their caregivers respond to any problems.

FMCNA and Humana “have had a long-standing relationship to treat Humana’s patients with” ESRD, explains William McKinney, president, Integrated Care Group at Fresenius Medical Care. “Our newly announced collaboration is a natural extension of both Humana’s desire to continue to improve and innovate around the care it provides its members, and FMCNA’s move into value-based care through this and similar arrangements, as well as our ESRD seamless care organizations (ESCOs) [see story, p. 6] and our Medicare Advantage ESRD Chronic Condition Special Needs Plans (C-SNPs).”

“Fresenius has provided quality care for Humana members with ESRD for many years,” says Mark Steffen, M.D., Humana medical director with the office of the chief medical officer. “This new arrangement developed out of a desire to leverage our joint capability to positively impact the health of Humana members that need it the most.” Incorporating the care navigation unit “help[s] to focus the care our members receive,” he adds.

Just last month, Fresenius unveiled a partnership with Cigna Corp. focused on people with ESRD (SPN 2/17, p. 7). McKinney notes that deal was for a commercially insured population, while the Humana arrangement is for an MA population.

“While the difference in patient demographics and underlying insurance structure drives some of the contractual differences in the programs, the way we manage patient care and the interventions we use to improve quality and clinical outcomes are largely the same,” he tells AIS Health.

Fresenius also struck a similar deal in 2014 with Aetna Inc., “and that arrangement remains in place today,” states McKinney. “We are currently in several additional ongoing conversations, and we are certainly open to discussing value-based arrangements for any health plans wishing to move towards value.”

ESRD Population Is ‘Complex and Expensive’

Such a care coordination model is critical to people with ESRD, say the companies. “FMCNA manages the health care of a complex and expensive population, and just about every risk-bearing entity out there — traditional insurers, ACOs, state governments — needs help managing the overall care of their members and patients with renal disease. It’s such a small, specialized group that many of the traditional care management programs just aren’t set up to address their needs. We’re in a great position to understand and impact the clinical outcomes of these patients and also to remove existing burdens and barriers to improve their quality of life,” says McKinney.

Steffen tells AIS Health that “many of our Humana members with ESRD have other chronic diseases. This often makes it difficult for them to manage both their kidney disease and the other illnesses.” In addition to “their regular doctor visits for their kidney disease and other health conditions, most people with ESRD get dialysis at least three times a week in a dialysis facility.…Anything we can do to help coordinate their care and make it more seamless can take some of the burden off the member and allow them to focus on other important areas of their life and health.”

McKinney agrees. “ESRD is commonly accompanied by a multitude of other serious health concerns, making care for these patients much more complex than just their dialysis treatment plan. As a result, ESRD patients experience more hospitalizations than the typical Medicare beneficiary. According to the United States Renal Data System, the average ESRD patient is hospitalized twice per year, and one-third of those patients are readmitted to the hospital within a month of their initial discharge. All of this factors in to a significantly higher cost of care for this group, with ESRD patients accounting for more than $32.8 billion in spending within the Medicare fee-for-service system.”

Program Has Multiple Goals

When asked about the measures Humana will use to evaluate whether the program is a success, Steffen responds that “along with coordinating their care, one of the main goals is to ensure our members do not have any barriers to getting their weekly dialysis treatment. This is something Fresenius’ care navigation unit will assist with. Receiving the required dialysis treatment ensures the member feels well and stays healthy. Other goals include reducing complications from their kidney disease, as well as reducing hospitalizations and ER visits.”

Through Humana’s Bold Goal initiative, the insurer is trying “to improve the health of the communities we serve by 20 percent by 2020,” Steffen says. “Humana members with ESRD are part of this overall vision, so anything we can do to improve their health gets us closer to our goal while at the same time improving each member’s overall health and well-being.”

Asked if the Humana arrangement is for a set period of time, McKinney says that “as long as the program is improving the quality, outcomes and cost of caring for Humana’s members with ESRD, everyone benefits from the arrangement. From FMCNA’s point of view, this type of partnership with other health care organizations represents the treatment model of the future for patients with ESRD, and negotiating per-treatment rates will be the exception, not the norm.”

The importance of appropriate care for people with ESRD cannot be overstated. Says McKinney, “Obviously, this population already has an extremely high mortality rate, and not getting the care they need when they need it can truly be a life-and-death issue.”

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