End Stage Renal Disease Management Program

Why Renal Disease Management?

For many reasons, end stage renal disease (ESRD) is an excellent disease to target for a disease management program.

• Prevalence is low, so enrollment in the program can easily be tracked.
• Cost per patient is extremely high (often up to $100,000 per patient, per year) and a significant portion is related to hospitalizations that are potentially avoidable.
• ESRD patients interact with many different types of providers (primary care physicians, nephrologists, dialysis units, hospitals, etc.) and can benefit from care coordination.

Program Basics
Preferred Care utilizes the Renaissance Renal Disease Management Program to provide disease management services for Preferred Care members with renal disease. The Renaissance Program improves patient outcomes by collaborating with the existing system of care. Renaissance provides a multi-disciplinary case management team led by board-certified nephrologists.

The disease management approach incorporates clinical criteria/algorithms developed in conjunction with nephrologists and based upon nationally recognized evidence-based literature. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) guideline recommendations provide evidence-based clinical practice guidelines for all stages of chronic kidney disease and related complications including dialysis adequacy, anemia management, nutrition, and vascular access. The K/DOQI guidelines can be viewed and/or ordered from the National Kidney Foundation at www.kidney.org or
1-800-622-9010 .

Certified Nephrology Nurses as Case Managers
Renaissance utilizes a core group of experienced registered nurses as patient case managers. The case managers are certified nephrology nurses (CNN) with experience in acute care, peritoneal dialysis, hemodialysis, and transplants.

The design of this patient-focused disease management program recognizes the need for a more intensive care management approach. The cornerstone of the program is comprised of individualized patient evaluation and risk assessment which assures appropriate stratification of risk and customization of care plan development. Patients are stratified on a scale from low to high risk, and intervention includes direct patient contact (face-to-face) in conjunction with telephone-based counseling. Home visits by case managers, who are registered nurses, are conducted in select cases. Patients are most frequently visited at dialysis centers during dialysis treatment.

Through this focused approach of risk assessment and individualized care management, the Renaissance nursing staff dedicates 80% of time and resources to the 20% of patients in greatest need. The Renaissance system of patient follow-up through lab data, patient notification, and close ties with the dialysis facility assure that appropriate change in status is tracked and managed.

Improved Patient Outcomes
The Renaissance managed care program has improved patient outcomes:

• Albumin (Nutrition) goal is 3.5 or greater for 80% of the population
  2006 Aggregate Renaissance Clinical Performance: 79%
• Kt/V or URR (Adequacy of Dialysis) goal is 1.2 or greater, or URR is 65% or greater for 85% of the population
  2006 Aggregate Renaissance Clinical Performance: 96%
• Ca*PO4 (Bone Disease) goal is 70 or less for 90% of the population
  2006 Aggregate Renaissance Clinical Performance: 98%
• Hemoglobin (Anemia) goal is 10 or greater for 90% of the population
  2006 Aggregate Renaissance Clinical Performance: 98%

In addition to excellent clinical performance, both hospital admissions and emergency room utilization have decreased since implementation of this care management program.


How to Get Your Patient Involved
If you would like additional information on the Renaissance Renal Disease Management program or would like to refer a member for enrollment, please call the Preferred Care Renaissance Plan Liaison at 1-800-933-3920, ext. 5744.

Last updated: August 30, 2007