ESRD Clinical Summary

How the Program Works | Facts You Need to Know | Patient Self-Management Strategy | Compliance Management | Outcomes Reporting and Measurement

How the Program Works

Matria’s ESRD Management Program provides certified case managers who coordinate dialysis treatments and evaluate treatment progress. They serve as liaisons between patients, their primary care physicians (PCPs), nephrologists and other necessary specialists, insurance companies and employers to ensure the delivery of high-quality care within realistic cost-containment strategies.

Components of the program include:

• Evaluation of dialysis treatments to ensure appropriate frequency and duration and early diagnosis of an illness or infection
• Patient self-management education and empowerment
• Evidence-based practice guidelines
• Evaluation and measurement of clinical, humanistic and financial outcomes with regular reports to patients, physicians and ancillary providers
• Research of alternatives to care when necessary
• Transplant identification
• Family assistance, guidance and support
• Identification of community resources
• Negotiation of fees on behalf of patient and employer

Facts You Need to Know

Patients with irreversible kidney failure, otherwise known as end stage renal disease (ESRD), will die without costly dialysis treatments or a kidney transplant. A dialysis patient costs an average of $75,000 annually. Currently, 1.1 million people worldwide require dialysis at an estimated cost of $72 billion annually.

An obesity epidemic coupled with a growing population of aging baby boomers is leading to more cases of irreversible kidney failure, or ESRD. Chronic kidney disease is the number one cause of diabetes. With the ESRD population growing steadily at 8 percent a year, projections estimate that more than 2 million people will have ESRD in 2010, at a cost of $1.1 trillion.

Statistics indicate that out of 10 million patients who now have chronic kidney disease, 300,000 will develop ESRD. And to make matters worse, ESRD patients typically suffer from other chronic diseases, including diabetes (35 percent) and hypertension (25 percent).

As the number of ESRD cases has increased over the years, so has the period of time primary payers must cover this catastrophic illness before Medicare takes over. While in the past, Medicare kicked in after 18 months, now payers must wait 33 months, or nearly three years, before the government provides relief.

Patient Self-Management Strategy

Patients on dialysis often develop preventable catheter-related infections that result in costly hospitalizations and emergency room visits. Kidney failure, despite dialysis treatments, also leads to other serious illnesses that could be prevented with the right care and monitoring.

Our primary goal in the ESRD program is to help patients avoid infections and medical complications by slowing the progression of their disease. We accomplish this by working with patients to help them improve self-care skills, which could include any or all of the following:

• Increasing their knowledge about the disease and importance of adhering to the treatment plan
• Compliance with dialysis treatments, regular screenings for other illnesses caused by kidney failure, medications and diet plans
• Management of side effects to prevent noncompliance
• Identification of early symptoms of an infection or medical problem
• Strict adherence to an individualized diet plan, which is considered part of the plan of care for patients with kidney disease
• Make better healthcare decisions by understanding their benefits and becoming more educated about their treatment options and costs

Compliance Management

Our program is designed to help patients comply with their doctor’s plan of care, which involves several key clinical performance indicators based on recommended guidelines from the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative and the American Diabetes Associations Standards of Care for Patients with Diabetes Mellitus.

While working with patients, we track their adherence to these standards and report back measurable results to show program impact on patient compliance. For patients with ESRD, the following are just a few of the CPIs that we monitor:

• Use of graft vs. catheter in dialysis to prevent likelihood of infection
• Immunizations before dialysis begins
• Monitoring of blood pressure to prevent or monitor heart disease
• Use of blood pressure medications in cases of hypertension
• Loss of red blood cells to prevent or monitor anemia
• Iron supplementation if anemia is present
• Loss of calcium to prevent bone disease
• Monitoring of blood-glucose levels for patients with diabetes
• Assessment and support of malnutrition

Outcomes Reporting and Measurement

Matria provides written and verbal information for patients regarding dialysis, nutrition, anemia and other related conditions such as hypertension, diabetes and cardiac disease. Reports are compiled and sent the patient and physician regularly. They include the following:

• Monthly progress reports
• Annual and quarterly savings reports
• Patient satisfaction reports

The patient’s care regimen is continually assessed for cost-effectiveness opportunities to reduce unnecessary utilization of healthcare services while improving quality of care.