Virtual CKD Management Solutions Do Not Slow Chronic Kidney Disease or Reduce Healthcare Spending

NEW YORK—The Peterson Health Technology Institute (PHTI) today released an evaluation of virtual solutions for chronic kidney disease (CKD) management. The available evidence shows no consistent impact on slowing disease progression and no reduction in total healthcare spending for patients managed by these solutions. The solutions do appear to increase rates of planned dialysis starts, but because so few patients initiate dialysis annually, these improvements do not translate into population-level benefits.

CKD affects one in seven U.S. adults—37 million people—yet 87% are unaware they have the condition. As the disease advances, patients face increasing risk of cardiovascular complications and premature death, and once kidneys fail, patients need dialysis or a transplant to survive. Traditional Medicare alone spends $141 billion annually on patients with CKD, and employers spend approximately $107 billion, plus an additional $30 billion in indirect costs due to absenteeism and lost productivity.

The PHTI assessment addresses CKD population health management prior to when patients transition to end-stage kidney disease (ESKD), including dialysis and transplant care. PHTI evaluated eight virtual CKD management solutions: DaVita Integrated Kidney Care, Evergreen Nephrology, Healthmap Solutions, Interwell Health, Kidneylink, Monogram Health, Somatus, and Strive Health.

These companies assume financial responsibility for the total cost of care of patients with diagnosed CKD stages 3–5, typically including every eligible patient in a geography or affiliated with a participating nephrology practice, regardless of whether the company has any direct interaction with the patient. They all contract with Medicare Advantage plans and most participate in Medicare’s Kidney Care Choices model.

For this report, PHTI reviewed more than 5,400 articles and other evidence, including information submitted by companies with solutions included in the report, as well as performance and financial data from Medicare’s Kidney Care Choices model. However, the companies have produced very little clinical evidence, which is noteworthy given the high level of capital investment in this technology area.

PHTI’s review of the evidence found that virtual CKD management solutions:

The report concludes that the greatest opportunities to improve CKD outcomes occur early in the disease progression, whereas current solutions are designed to reach patients who already have more advanced disease.

PHTI’s report recommends public and private purchasers evolve contracts and incentive programs to reward patient-level milestones that are more likely to slow disease progression, such as earlier diagnosis and adoption of guideline-recommended medications. PHTI also recommends that companies prioritize engagement with primary care providers, who are best positioned to diagnose CKD earlier and slow its progression. Companies should also generate more evidence on which approaches work to impact disease progression and sustain engagement with early-stage patients.

“CKD is a common and undertreated condition affecting millions of Americans. The good news is that we know how to manage this disease effectively through early diagnosis and medications,” said Caroline Pearson, executive director of PHTI. “But instead of investing in what works, population-level CKD payment models have created mismatched incentives that drive a focus on cost control for patients with diagnosed, later-stage CKD. Contracts for virtual CKD solutions should pay for the outcomes that actually slow disease progression—earlier diagnosis and better medication management—at an individual patient level.”

This report is based on PHTI’s independent assessment framework, which evaluates the clinical and economic impact of digital health solutions. The report was developed in collaboration with clinical advisors and experts in nephrology, health economics, and health technology assessment. PHTI also interviewed patients with CKD who had experience with the assessed solutions and health plans that contract with these solutions.