Fresenius Medical Care Sees U.S. Plans for Kidney Disease as Positive
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RONALD H., DIALYSIS PATIENT
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 thirty 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.
Fresenius Health Partners (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.
Our Care Navigation Unit (CNU) provides patients with solution-driven interventions when they need it most. Using real-time clinical data, they work to anticipate issues before they arise and help your members, our patients, their families, and the providers respond quickly when they happen. These stories show our commitment to improving the quality of life of every patient, every day, in any situation.
ASSISTANCE DURING A NATURAL DISASTER
When Hurricane Harvey made landfall in August 2017, it was impossible for this patient to attend treatment. The CNU coordinator reached out to identify the nearest open center to schedule treatment. However, the patient ended up in the emergency room after rapidly rising waters kept him from getting to this clinic. The CNU coordinator continued to monitor his care and helped him navigate flooded roads to a different clinic. The patient was so grateful for the CNU's kindness and compassion during a chaotic time.
MEDICATION SUPPORT FOR PAYOR PROGRAM PATIENT
During a routine review of patient data, the CNU came across a new-to-clinic patient. At the patient's previous clinic, she was receiving Mircera twice a week. She had already undergone two HGB draws since starting at the clinic, but the Mircera algorithm had not been initiated and a dose was due. The CNU contacted the clinic RN, who alerted the anemia manager to administer a dose and initiate the algorithm to prevent a decrease in the patient's HGB levels.
PATIENT STRUGGLES WITH ADHERENCE DUE TO CHRONIC PAIN
The CNU received a case referral for a dialysis patient with a history of narcotic use. Due to his chronic pain, he was only completing two hours of his prescribed treatment. The CNU met with the patient and then collaborated with the clinic team to prioritize care needs. They identified palliative care as a solution and within four days had the patient enrolled in the program resolving DME, transportation, and care needs. The patient now completes most of his four-hour treatments.