Senior smiles at phone, reviewing SMS reminder received by care coordination team

Effective Care Management for Chronic Kidney Disease

Tanya Flores-OlneyArticles, Care Coordination, Chronic Care Management, Remote Patient Monitoring, Reports, Virtual Care Management

Chronic kidney disease (CKD) is a life-threatening condition affecting millions of people. Similar to many chronic conditions, CKD is another disease that is frequently diagnosed among Medicare recipients. Approximately 15% of Medicare recipients aged 65 years and older are diagnosed with CKD.

There are resources that can lead to more effective management of kidney disease and a higher standard of care. Healthcare providers must have access to up-to-date information about patients and their treatments. That’s where Chronic Care Management (CCM) comes in.

CCM involves the coordination of services and resources for the long-term care of chronic conditions. This program and overall approach to care fosters better communication between patients and caregivers, as well as provides more timely access to resources and treatment when needed.

Early identification of kidney disease is important for taking immediate preventive action. If gone untreated, the presence of CKD runs the risk of worsening other conditions the patient might also have, such as heart disease.

Unique Challenges and Unique Solutions to Treating Chronic Kidney Disease

CKD is a complex condition that often requires coordinated care from a team of specialists. While there is no cure for CKD, early detection and treatment can help slow the progression of the disease and improve quality of life.

Historically, there are observable challenges to the conventional means of Chronic Kidney Disease Care. Up until 2020, the reimbursement model in the U.S. favored fee-for-service over quality of care. This means there is little incentive for providers to coordinate care or adopt best practices. In a 2020 press release, the Centers for Medicare & Medicaid Services (CMS) announced meaningful reform to this compensation policy.

“The [model] will test shifting Medicare payments from traditional fee-for-service payments to payments where providers are incentivized for encouraging receipt of home dialysis and kidney transplants.”

This change reimburses practices that implement remote resources to provide care and monitoring from the comfort of a patient’s home. Providers are also encouraged to speak with their patients as soon as possible about treatment options. There are many other positive changes to the Medicare and Medicaid reimbursement policies. This shift to a value-based methodology for delivering CKD care is critical in motivating providers to go that extra step for a higher quality of care, outside of traditional, in-person appointments.

The cost of treating patients with kidney disease can be significant. It is estimated to be approximately $50 billion each year. As the disease progresses, it can lead to a costly increase in hospital readmissions. Additionally, CKD often leads to other complications such as anemia, diabetes, or hypertension, which can also add to the cost of care.

Improving Outcomes Through Chronic Care Management

Chronic care management is an evidence-based approach to care. Incorporating virtual care tools and Remote Patient Monitoring, this method for CKD care relies on strong coordination between primary care providers and specialists, consistent monitoring of patient progress, and providing education and support to patients and their families.

Chronic kidney disease is characterized by numerous episodes or emergencies that may require frequent hospitalization. This is one of the primary reasons for the high medical costs associated with CKD for all parties — patient, provider, and payer. This is also the central reason that Chronic Care Management, utilizing virtual care and remote monitoring, is so pivotal to the effective treatment of this disease.

Without the ability to remotely monitor a patient’s status and vital signs, it can be very difficult to know the severity of symptoms and develop an appropriate plan for preventive care. This is another reason that virtual care can be so impactful in treating kidney disease.

A 2019 report of clinical research findings — “The Primary-Secondary Care Partnership to Improve Outcomes in Chronic Kidney Disease” — measured the effectiveness of management programs for CKD patients. The conclusion highlights a significant improvement in care processes, improved cost effectiveness, and a reduced risk in the development of cardiovascular disease among CKD patients.

TimeDoc Health’s Tools for Chronic Care Management

Our CCM platform and services support an extensive and comprehensive coordination of care, extending beyond disease management. The TimeDoc Health CCM program streamlines holistic care, from medication reconciliation and appointment scheduling to durable medical equipment (DME) assistance.

There are a broad range of tools, resources, and specialists available to medical organizations. Here’s what TimeDoc Health can do for you and your CKD patients:

  • Drive Clinical Outcomes: Use actionable data to proactively improve your patients’ health while reducing unnecessary hospitalizations and emergency room visits.
  • Monitor Multiple Conditions: Choose from blood glucose meters, scales for weight management, and self-monitoring blood pressure devices that are all cellular enabled to support monitoring of various chronic conditions.
  • Integrate with your EHR: We support the use of your current systems by pushing patient data directly from our platform onto the patient chart in your EHR.
  • Deliver Easy-to-Use Devices: Cellular-enabled devices that are preconfigured for any patient to use right out of the box without the need for smartphones, Bluetooth pairing, Wi-Fi, or monthly data plans.
  • Automate Data Collection: Devices automatically push readings into the patient dashboard on our powerful, web-based platform that displays biometric data in real time.

Get in Touch

Find out more about how TimeDoc Health helps medical organizations increase efficiencies, reduce unnecessary costs and improve CKD outcomes.

Request a demo today to speak with one of our team members and learn how we can support your patients, your staff, and your business.