“Dialysis patients receive treatment in a facility for an average of four hours per treatment, three times a week,” according to Dr. Stephen McMurray, VP of Clinical Integrated Care Management at DaVita.
“This complex population faces unique challenges,” said Nathan Lohmeyer, VP of DaVita’s VillageHealth. “Dialysis patients typically have three or more chronic conditions in addition to kidney disease, are hospitalized more than 11 days per year, and take an average of 21 pills every day.”
“We have an amazing opportunity to turn our dialysis facilities into medical ‘homes’ for our patients, improving overall clinical outcomes and quality of life,” Lohmeyer added.
Accordingly, DaVita has developed an innovative platform for care delivery in the 2,200 dialysis centers it operates, with the goal of changing its focus from being a dialysis service provider, to managing and improving a patient’s overall health.
(Image credit: DaVita)
“We started with looking at all the data to identify causes of avoidable hospital admissions and readmissions,” McMurray explained. “For example, 60% of our patients had diabetes with associated complications such as leg ulcers from poor foot care that could lead to hospitalization. So we developed the StepAhead program, which focuses on basic health education and checks relevant to diabetics, such as making sure patients have glucometers that work and are getting regular eye, foot and health exams.”
An 18-month study of the StepAhead program showed a more than 93 percent improvement in physician-driven diabetes management, eye exams, glucometer possession and overall diabetes education. The program also helped reduce amputation rates for patients.
“We used the ongoing access to patients in our facilities to move away from the old paradigm of only providing dialysis treatment to more comprehensive care,” McMurray said.
Next, DaVita took a big step toward taking on financial accountability for all patient costs, including those outside the dialysis care it provides. DaVita’s End Stage Renal Disease (ESRD) Seamless Care Organizations (ESCOs) are an example of the company’s full risk partnerships with other healthcare providers and Medicare to manage total patient care and cost.
“We know we can improve health outcomes, patient satisfaction and overall cost,” according to Lohmeyer. “By partnering with Medicare on ESCOs, we have a unique ability to manage and measure the overall quality improvement and cost savings for the patients in the program.”
“For our sickest and most high risk patients, our team looks at health, nutritional, behavioral and psychological tools to engage with them,” said McMurray. “Each patient gets a customized and local hands-on team approach to their health needs.”
This approach has meant fundamentally changing operations, technology and partnerships with nephrologists/hospital leaders in the three markets in which the ESCO model is being tested. Its StepAhead program for integrated kidney care is already being rolled out to the company’s centers nationwide.
“This could be transformational to patient care delivery and could be a role model for American health care, particularly for the growing number of complex, chronically ill patients,” McMurray said.
