Achieving clinical and financial goals
with value-based care
The right care at the right time
Through our distinct value-based care programs, we combine predictive modeling, real-time treatment monitoring and high-touch intervention protocols to deliver the right care and patient support, both within and outside of the four walls of our dialysis centers, at the right time and place for your members. Fresenius Health Partners’ care coordination services, combined with Fresenius Kidney Care’s clinic-based competencies, improve the quality of care provided for this group of medically complex members. Through this collaboration, we have been able to reduce hospital admissions for our end-stage renal disease (ESRD) program participants by 15 percent or more, resulting in reductions in the total cost of care of Medicare Fee-for-Service (FFS) and Medicare Advantage (MA) patients by 5 percent or more. These outcomes have been accompanied by clinical metrics that confirm that that our client’s clinical goals are also being achieved.
Improving patient health and the bottom line
A Medicare ESRD patient’s annual cost of care is seven times that of their non-ESRD Medicare counterpart. On average, ESRD patients are admitted to the hospital nearly twice a year and about 30 percent are readmitted within the 30 days following discharge. This accounts for approximately 40 percent of Medicare expenditures for dialysis patients.
Having a single provider orchestrating care can decrease costly hospitalizations and eliminate costs incurred when multiple providers are treating a patient. These achievements on key quality indicators are measured against a baseline. Improvements in overall quality of care are used to determine provider payments.
Value-based Care Financial Model Options
FHP offers health plans with two value-based care financial models to select from:
Upside-only shared savings model
The first option is a one-sided shared savings model in which the health plan and FHP share program savings (against a Total Cost of Care Benchmark) on a 50/50 basis, such that FHP is at risk for the costs of delivering the ESRD care coordination program if its share of the savings are not sufficient to fully defray such costs, but FHP has no additional downside risk.
Two-sided risk with guaranteed savings model
The second option is a two-sided shared savings model in which FHP incorporates a guaranteed rate of savings for the health plan into the medical cost trend adjusted Total Cost of Care Benchmark, and FHP retains any program savings above such Benchmark as well as assumes liability for any deficit if the actual total cost of care is higher than the Benchmark. Depending on applicable state regulations, FHP’s share of savings/deficits may be subject to a cap/floor.
You’ve got a care manager who calls you. If you have missed appointments, they call to get you rescheduled. They are very hands-on. They give you no excuses.
— Ronald H., Patient